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Walgreens #21395
CH049070 COMMUNITY HEALTH CENTERS OF PINELLAS, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF PINELLAS, INC.
Subdivision Name
Evara Health - Johnnie Ruth Clarke
Type
HRSA-Funded Health Center
340B ID
CH049070
Entity Address
1344 22nd St S
Saint Petersburg, FL 33712-2744
Grant Number
H80CS00463
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
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
10/5/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elodie Leigh Dorso, CEO
(727) 824-8100
Contract Pharmacy Representative
Walgreen Co.
Omama Osman, 340b Client Relationship
(847) 964-6484
Signed By Date
10/5/2022
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