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Walgreens #21395
STD327634 Home Of Grace INC
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Covered Entity Details
Entity Name
Home Of Grace INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD327634
Entity Address
955 Town Center Drive
Suite 100
Orange City, FL 32763
Grant Number
H25PS005131
Participating Start Date
1/4/2023
Last Recertification Date
5/22/2024
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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