Contract Pharmacy Details

WALGREEN CO.
RWI32204D AIDS Healthcare Foundation

Covered Entity Details

Entity Name

AIDS Healthcare Foundation

Subdivision Name

AHF Healthcare Center - Orlando

Type

Ryan White Part A

340B ID

RWI32204D

Entity Address

1701 N. Mills Ave.
Orlando, FL 32803

Grant Number

H89HA00030

Participating Start Date

1/1/2018

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03811
4502 S ORANGE BLOSSOM TRAIL
ORLANDO, FL 32839-1704

Pharmacy Comments

Contract Details

Approval Date

1/16/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/16/2023

340B Drug Pricing Program Database