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WALGREEN CO
HV013122 GATEWAY COMMUNITY SERIVES, INC
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Covered Entity Details
Entity Name
GATEWAY COMMUNITY SERIVES, INC
Subdivision Name
Type
Ryan White Part C
340B ID
HV013122
Entity Address
555 Stockton Street
Jacksonville, FL 32204
Grant Number
H76HA01312
Participating Start Date
7/1/2019
Last Recertification Date
2/7/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #11580
1215 DUNN AVENUE, SUITE #2
JACKSONVILLE, FL 32218
Pharmacy Comments
Contract Details
Approval Date
11/3/2020
Contract Begin Date
11/10/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Tina M. Bottini, Senior Asst. Dean, Research
(904) 244-9478
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
11/3/2020
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