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Walgreens #21395
STD331621 Positive Assistance, Inc.
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Covered Entity Details
Entity Name
Positive Assistance, Inc.
Subdivision Name
Prima Health Center
Type
Sexually Transmitted Diseases
340B ID
STD331621
Entity Address
125 NE 167th Street
North Miami Beach, FL 33162
Grant Number
5NU62PS924532-02
Participating Start Date
1/1/2022
Last Recertification Date
5/29/2024
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
10/1/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andre J Antenor, President
(863) 242-3322
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/1/2022
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