Contract Pharmacy Details

WALGREEN CO.
CH0423770 NORTHEAST FLORIDA HEALTH SERVICES, INC.

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 # 02378
2400 S WOODLAND BLVD
DELAND, FL 32720

Pharmacy Comments

Contract Details

Approval Date

7/19/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/18/2018
Business decision by covered entity and/or pharmacy

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

7/19/2016

340B Drug Pricing Program Database