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WALGREEN CO.
RWII32114 Outreach Community Care Network
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Covered Entity Details
Entity Name
Outreach Community Care Network
Subdivision Name
Type
Ryan White Part B
340B ID
RWII32114
Entity Address
240 N Frederick Avenue
Daytona Beach, FL 32114
Grant Number
XO7HA00057
Participating Start Date
4/1/2013
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04261
1420 BEVILLE ROAD
DAYTONA BEACH, FL 32114-5622
Pharmacy Comments
Contract Details
Approval Date
4/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Latreace Flynt, Clinical Director
(386) 235-1911 Ext: 216
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/4/2023
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