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WALGREEN CO.
RWII34982D Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII34982D
Entity Address
1434 Kennedy Drive
Key West, FL 33040
Grant Number
X07HA00057
Participating Start Date
4/1/2020
Last Recertification Date
2/20/2023
Entity Termination Date
4/1/2024
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
4/16/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
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
4/16/2023
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