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WALGREEN CO.
STD336093 West Central Gastroenterology dba Gastro Florida
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Covered Entity Details
Entity Name
West Central Gastroenterology dba Gastro Florida
Subdivision Name
Gastro Florida Division 14
Type
Sexually Transmitted Diseases
340B ID
STD336093
Entity Address
2919 W Swann Ave
Ste 106
Tampa, FL 33609
Grant Number
H25PS005131
Participating Start Date
1/1/2022
Last Recertification Date
5/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13631
30280 US HWY 19 NORTH
CLEARWATER, FL 33761
Pharmacy Comments
Contract Details
Approval Date
12/3/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/6/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Seena Salyani, CEO
(727) 347-0536
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2021
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