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Walgreens #21395
STD337101 Advanced Bay Area Medical Associates
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Covered Entity Details
Entity Name
Advanced Bay Area Medical Associates
Subdivision Name
St Pete Office
Type
Sexually Transmitted Diseases
340B ID
STD337101
Entity Address
1700 66th Street North
Sute 510
St Petersburg, FL 33710
Grant Number
NH25PS005131
Participating Start Date
8/27/2020
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
Walgreens #21395
Pharmacy Address
Walgreens Central Fill #21395
5710 Young Pine Rd
Orlando, FL 32829
Pharmacy Comments
Contract Details
Approval Date
5/16/2023
Contract Begin Date
5/16/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey R Levenson, President
(727) 384-2479
Contract Pharmacy Representative
Walgreen Co
Trevor Perkins, Sr Analyst 340B Implementation
(847) 282-2701
Signed By Date
5/16/2023
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