Contract Pharmacy Details

WALGREEN CO.
STD336262 West Central Gastroenterology dba Gastro Florida

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 # 09031
3851 4TH ST NORTH
ST PETERSBURG, FL 33703

Pharmacy Comments

Contract Details

Approval Date

1/10/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/14/2022
Agreement registered in error

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

340B Drug Pricing Program Database