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Walgreens #21395
STD331272 Pridelines Youth Services, Inc.
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Covered Entity Details
Entity Name
Pridelines Youth Services, Inc.
Subdivision Name
Pridelines
Type
Sexually Transmitted Diseases
340B ID
STD331272
Entity Address
5525 NW 7th Ave
Miami, FL 33127
Grant Number
NU62PS924532
Participating Start Date
7/1/2024
Last Recertification Date
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
5/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Edward Summers, Executive Director
(347) 468-6621
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2024
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