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WALGREEN CO.
STD321141 Outreach Community Care Network
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Covered Entity Details
Entity Name
Outreach Community Care Network
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD321141
Entity Address
240 N. Frederick Avenue
Daytona Beach, FL 32114
Grant Number
1H25PS75095001550
Participating Start Date
1/1/2020
Last Recertification Date
5/9/2024
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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