Contract Pharmacy Details

WALGREEN CO.
STD336113 PREVENTION 305, Inc.

Covered Entity Details

Entity Name

PREVENTION 305, Inc.

Subdivision Name

PREVENTION 813

Type

Sexually Transmitted Diseases

340B ID

STD336113

Entity Address

3317 West Gandy Blvd
Tampa, FL 33611

Grant Number

NH25PS005131

Participating Start Date

4/1/2024

Last Recertification Date

5/14/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #21155
5966 S DIXIE HWY STE 103B
SOUTH MIAMI, FL 33143

Pharmacy Comments

Contract Details

Approval Date

4/12/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Patrick Whiteside, Chief Executive Officer
(866) 773-7305 Ext: 100

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/12/2024

340B Drug Pricing Program Database