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Walgreens #21395
STD331396 PREVENTION 305, Inc.
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Covered Entity Details
Entity Name
PREVENTION 305, Inc.
Subdivision Name
PREVENTION 727
Type
Sexually Transmitted Diseases
340B ID
STD331396
Entity Address
3000 1st Avenue North
Saint Petersburg, FL 33713
Grant Number
NH25PS005131
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
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
4/15/2024
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