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WALGREEN CO.
CH042400 CAMILLUS HEALTH CONCERN INC
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Covered Entity Details
Entity Name
CAMILLUS HEALTH CONCERN INC
Subdivision Name
CAMILLUS HEALTH CONCERN, INC.
Type
HRSA-Funded Health Center
340B ID
CH042400
Entity Address
336 NW 5th St
Miami, FL 33128-1616
Grant Number
H80CS00026
Participating Start Date
7/1/1995
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04917
690 NW 183RD ST
MIAMI GARDENS, FL 33169
Pharmacy Comments
Contract Details
Approval Date
1/8/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shed Boren, CEO
(305) 577-4840 Ext: 202
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2015
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