Contract Pharmacy Details

WALGREEN CO.
STD33150 I&B Medical Associates PLLC

Covered Entity Details

Entity Name

I&B Medical Associates PLLC

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD33150

Entity Address

9400 NW 12 Ave.
Ste. 1
Miami, FL 33150

Grant Number

NH25PS005131

Participating Start Date

7/1/2018

Last Recertification Date

5/8/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04484
8790 W. MCNAB ROAD
TAMARAC, FL 33321

Pharmacy Comments

Contract Details

Approval Date

4/1/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Etzer Dolce, Director of Operations
(305) 835-9264

Contract Pharmacy Representative

Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116

Signed By Date

4/1/2025

340B Drug Pricing Program Database