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Walgreens #21395
STD3280613 Sunshine Specialty Health Outreach Foundation
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Covered Entity Details
Entity Name
Sunshine Specialty Health Outreach Foundation
Subdivision Name
Delta Internal Medicine Center
Type
Sexually Transmitted Diseases
340B ID
STD3280613
Entity Address
220 E. Gore Street
Suite 202
Orlando, FL 32806
Grant Number
5NU62PS9224532-02
Participating Start Date
4/1/2024
Last Recertification Date
5/7/2024
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
2/7/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jillian Hall, CEO
(407) 888-5980
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2024
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