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WALGREEN CO.
STD32174 Midway Specialty Care Center
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Covered Entity Details
Entity Name
Midway Specialty Care Center
Subdivision Name
Sexually Transmitted Diseases
Type
Sexually Transmitted Diseases
340B ID
STD32174
Entity Address
570 Memorial Circle
Ste 140
Ormond Beach, FL 32174
Grant Number
NH25PS005131
Participating Start Date
7/1/2023
Last Recertification Date
5/8/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06383
2901 SW PORT ST LUCIE BLVD
PORT ST LUCIE, FL 34953
Pharmacy Comments
Contract Details
Approval Date
5/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2023
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