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WALGREEN CO.
STD336143 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 13
Type
Sexually Transmitted Diseases
340B ID
STD336143
Entity Address
4600 N Habana Ave
Ste 29
Tampa, FL 33614
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 #13631
30280 US HWY 19 NORTH
CLEARWATER, FL 33761
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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