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WALGREEN CO.
STD33558 West Central Gastroenterology dba Gastro Florida
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Covered Entity Details
Entity Name
West Central Gastroenterology dba Gastro Florida
Subdivision Name
Gastro Florida Division 15b
Type
Sexually Transmitted Diseases
340B ID
STD33558
Entity Address
4695 Van Dyke Rd
Lutz, FL 33558
Grant Number
H25PS005131
Participating Start Date
1/1/2021
Last Recertification Date
5/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09031
3851 4TH ST NORTH
ST PETERSBURG, FL 33703
Pharmacy Comments
Contract Details
Approval Date
11/30/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Seena Salyani, CEO
(727) 347-0536
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2020
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