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Walgreens #21395
CH0413190 TREASURE COAST COMMUNITY HEALTH INC
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Covered Entity Details
Entity Name
TREASURE COAST COMMUNITY HEALTH INC
Subdivision Name
TREASURE COAST COMMUNITY HEALTH, INC. South County
Type
HRSA-Funded Health Center
340B ID
CH0413190
Entity Address
1545 9th St. SW
Vero Beach, FL 32962-4312
Grant Number
H80CS00187
Participating Start Date
7/1/2000
Last Recertification Date
2/12/2025
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
7/10/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VICKI L. SOULE, CEO
(772) 571-1986
Contract Pharmacy Representative
Treasure Coast Community Health
Rashonda Williams, Pharmacy Director
(772) 257-8224
Signed By Date
7/10/2023
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