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WALGREEN CO.
RWII34982C Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII34982C
Entity Address
5701 Overseas Highway
Ste # 10
Marathon, FL 33050
Grant Number
X07HA00057
Participating Start Date
4/1/2020
Last Recertification Date
2/8/2021
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREEN #04391
2501 VIRGINIA AVENUE
FORT PIERCE, FL 34981
Pharmacy Comments
Contract Details
Approval Date
4/9/2021
Contract Begin Date
4/9/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/9/2021
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