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WALGREEN CO
STD342661 J AGUSTIN LACSON MD INC
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Covered Entity Details
Entity Name
J AGUSTIN LACSON MD INC
Subdivision Name
ARCADIA
Type
Sexually Transmitted Diseases
340B ID
STD342661
Entity Address
1709 EAST OAK STREET
ARCADIA, FL 34266
Grant Number
NH25PS005131
Participating Start Date
11/17/2021
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10668
2575 NE HWY 70
ARCADIA, FL 34266
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
5/9/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
agustin juan lacson, president
(863) 835-0060
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2022
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