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Walgreens #21395
STD3280612 Sunshine Specialty Health Outreach Foundation
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Covered Entity Details
Entity Name
Sunshine Specialty Health Outreach Foundation
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD3280612
Entity Address
220 E. Gore St
Orlando, FL 32806
Grant Number
5nu62ps924532-02
Participating Start Date
10/12/2022
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
Walgreens #21395
Pharmacy Address
Walgreens Central Fill #21395
5710 Young Pine Rd
Orlando, FL 32829
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
10/12/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jillian Hall, President
(407) 325-1299
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
9/28/2022
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