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WALGREEN CO.
STD336262 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 9c
Type
Sexually Transmitted Diseases
340B ID
STD336262
Entity Address
12780 Race Track Rd.
Ste 405
Tampa, FL 33626
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 #11190
24170 HWY 27
LAKE WALES, FL 33859
Pharmacy Comments
Contract Details
Approval Date
1/10/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Seena Salyani, CEO
(727) 347-0536
Contract Pharmacy Representative
Walgreens
Chris Sutter, Account Manager, Health Systems
(847) 612-0296
Signed By Date
1/10/2022
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