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WALGREEN CO.
CH0423770 NORTHEAST FLORIDA HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Subdivision Name
PIERSON Family Health Source
Type
HRSA-Funded Health Center
340B ID
CH0423770
Entity Address
216 N. FREDERICK ST.
PIERSON, FL 32180
Grant Number
H80CS02520
Participating Start Date
10/1/2004
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07241
1700 N. NORMANDY BLVD
DELTONA, FL 32725-4536
Pharmacy Comments
Contract Details
Approval Date
4/16/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Debbie Hall, Director of Operations
(386) 202-6025 Ext: 2705
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2015
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