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WALGREEN CO.
STD337102 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 3
Type
Sexually Transmitted Diseases
340B ID
STD337102
Entity Address
7017 Central Ave.
Saint Petersburg, FL 33710
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 # 04380
1903 STATE ROAD 60 E
LAKE WALES, FL 33853
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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