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WALGREEN CO.
PED103304-00 NEMOURS CHILDRENS HOSPITAL
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Covered Entity Details
Entity Name
NEMOURS CHILDRENS HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED103304-00
Entity Address
6535 NEMOURS PARKWAY
ORLANDO, FL 32827
Medicare Provider Number
103304
Participating Start Date
4/1/2017
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #13072
8333 N DAVIS HWY STE 50
PENSACOLA, FL 32514
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hal Williams, Operational Vice President Central Florida Finance
(407) 650-7456
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2023
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