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WALGREEN CO.
RWIID32304 FLORIDA DEPARTMENT OF HEALTH
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Covered Entity Details
Entity Name
FLORIDA DEPARTMENT OF HEALTH
Subdivision Name
AIDS Drug Assistance Program (ADAP)
Type
Ryan White Part B ADAP Direct Purchase
340B ID
RWIID32304
Entity Address
4052 BALD CYPRESS WAY
BIN A-09
TALLAHASSEE, FL 32399
Grant Number
X07HA00057
Participating Start Date
1/1/2009
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15208
1250 GREENVIEW SHORES BLVD
WELLINGTON, FL 33414
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JIMMY ROGER LLAQUE, ADAP STATE PROGRAM DIRECTOR
(850) 545-6836
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2023
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