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Walgreens #21395
CH0418990 PRIMARY CARE MEDICAL SERVICES OF POINCIANA, INC.
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Covered Entity Details
Entity Name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA, INC.
Subdivision Name
PRIMARY CARE MEDICAL SERVICES OF POINCIA
Type
HRSA-Funded Health Center
340B ID
CH0418990
Entity Address
1877 Fortune Rd
Kissimmee, FL 34744-4428
Grant Number
H80CS30749
Participating Start Date
1/1/2009
Last Recertification Date
1/29/2024
Entity Termination Date
1/1/2025
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
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Belinda Johnson-Cornett, CEO
(407) 414-9760
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2022
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