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WALGREEN CO.
STD322023 FIRST COAST COMMUNITY DEVELOPMENT, INC
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Covered Entity Details
Entity Name
FIRST COAST COMMUNITY DEVELOPMENT, INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD322023
Entity Address
525 N. Newnan Street
Jacksonville, FL 32202
Grant Number
6NU62PS924532-05-01
Participating Start Date
5/25/2022
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #11137
1801 N DAVIS ST
JACKSONVILLE, FL 32209
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
7/14/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/21/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Charlie Bernard Griffin, Executive Director
(904) 866-7483
Contract Pharmacy Representative
Walgreens
Chris Sutter, Account Manager, Health Systems
(847) 612-0296
Signed By Date
7/12/2022
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