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Walgreens #21395
STD32724 Home Of Grace INC
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Covered Entity Details
Entity Name
Home Of Grace INC
Subdivision Name
Home Of Grace INC
Type
Sexually Transmitted Diseases
340B ID
STD32724
Entity Address
230 E New York Ave
Deland, FL 32724
Grant Number
H25PS005131
Participating Start Date
7/20/2022
Last Recertification Date
5/13/2024
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
7/3/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adaobi Oguchi, President
(407) 402-6324
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/3/2023
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