Contract Pharmacy Details

WALGREEN CO.
CH04023M Agape Community Health Center, Inc.

Covered Entity Details

Entity Name

Agape Community Health Center, Inc.

Subdivision Name

Agape Dunn Avenue

Type

HRSA-Funded Health Center

340B ID

CH04023M

Entity Address

1680 Dunn Ave Unit 35-37
Jacksonville, FL 32218-4782

Grant Number

H80CS29456

Participating Start Date

10/1/2020

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16527
1801 N MAIN ST
JACKSONVILLE, FL 32206

Pharmacy Comments

Contract Details

Approval Date

7/15/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tabatha Ball, COO
(904) 760-4904

Contract Pharmacy Representative

Walgreens
Karl Mechan, Vice President Health Systems Programs
(847) 315-2663

Signed By Date

7/15/2021

340B Drug Pricing Program Database