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Walgreens #21395
CH04550N PREMIER COMMUNITY HEALTHCARE GROUP, INC.
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Covered Entity Details
Entity Name
PREMIER COMMUNITY HEALTHCARE GROUP, INC.
Subdivision Name
Cox Elementary School-Based Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH04550N
Entity Address
37615 MARTIN LUTHER KING BLVD
DADE CITY, FL 33523-3099
Grant Number
H80CS00101
Participating Start Date
1/1/2021
Last Recertification Date
2/14/2025
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
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Resnick, CEO
(352) 518-2000 Ext: 9000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2023
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