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WALGREEN CO.
STD41101 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
STD41101
Entity Address
336 29th Street
Suite 203
Ashland, KY 41101
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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