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Walgreens #21395
STD33055 Benevolence Medical Services,Inc
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Covered Entity Details
Entity Name
Benevolence Medical Services,Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33055
Entity Address
19533 NW 57th ave
miami gardens, FL 33055
Grant Number
5nu62ps924532
Participating Start Date
10/1/2023
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
1/5/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arshad Ali Mohammed, DIRECTOR
(786) 863-5539
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/5/2024
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