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Walgreens #21395
STD330302 Mani Medical Center
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Covered Entity Details
Entity Name
Mani Medical Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD330302
Entity Address
151 NW 11th Street
W303
Homestead, FL 33030
Grant Number
NH25PS005131
Participating Start Date
12/7/2021
Last Recertification Date
5/9/2024
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
7/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Taylor, CEO/Present
(954) 854-7475
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/9/2024
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