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WALGREEN CO.
CH040330 Jessie Trice Community Health System, Inc,
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Covered Entity Details
Entity Name
Jessie Trice Community Health System, Inc,
Subdivision Name
JTCHS - Fatima Zafar MD Health & Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH040330
Entity Address
5361 NW 22nd Ave
Miami, FL 33142-8035
Grant Number
H80CS00732
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 12724
1251 SOUTH STATE ROAD 7
DAVIE, FL 33317
Pharmacy Comments
Contract Details
Approval Date
3/8/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/4/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Annie Neasman, CEO
(305) 805-1700 Ext: 23151
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2013
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