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Walgreens #21395
CH041899B PRIMARY CARE MEDICAL SERVICES OF POINCIANA, INC.
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Covered Entity Details
Entity Name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA, INC.
Subdivision Name
Osceola Community Health Services at Stadium Place
Type
HRSA-Funded Health Center
340B ID
CH041899B
Entity Address
1501-1507 Bill Beck Blvd
Kissimmee, FL 34744
Grant Number
H80CS30749
Participating Start Date
7/1/2013
Last Recertification Date
2/11/2025
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
11/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Belinda Johnson-Cornett, CEO
(407) 414-9760
Contract Pharmacy Representative
Walgreen Co.
Christine Precht, 340B Client Relationship Analysit
(847) 964-6560
Signed By Date
11/8/2024
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