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WALGREEN CO.
STD34684 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 9a
Type
Sexually Transmitted Diseases
340B ID
STD34684
Entity Address
33920 US 19 N
Ste 124
Palm Harbor, FL 34684
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
12/1/2020
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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