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WALGREEN CO.
STD41143 Fresh Start Health PSC
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Covered Entity Details
Entity Name
Fresh Start Health PSC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD41143
Entity Address
207 N Carol Malone Blvd
Ste. 3
Grayson, KY 41143
Grant Number
6NH25PS005135-01-01
Participating Start Date
4/1/2023
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21170
393 WALLER AVE STE 5
LEXINGTON, KY 40504
Pharmacy Comments
Contract Details
Approval Date
2/2/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerrel Boyer, Medical Director
(606) 923-1124 Ext: 6062258298
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2023
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