Contract Pharmacy Details

WALGREEN CO.
RWI32204 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF JACKSONVILLE

Type

Ryan White Part A

340B ID

RWI32204

Entity Address

2 SHIRCLIFF WAY
Suite 900
JACKSONVILLE, FL 32204

Grant Number

H89HA00039

Participating Start Date

7/1/2007

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 02928
18910 US HWY 441
MT DORA, FL 32757

Pharmacy Comments

Contract Details

Approval Date

10/12/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Philip Ho, Senior Director of Pharmacy and 340B Compliance
(323) 860-5323

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/12/2020

340B Drug Pricing Program Database