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WALGREEN CO.
RW423036 CHILDREN'S DIAGNOSTIC & TREATMENT CENTER
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Covered Entity Details
Entity Name
CHILDREN'S DIAGNOSTIC & TREATMENT CENTER
Subdivision Name
Type
Ryan White Part D
340B ID
RW423036
Entity Address
1401 SOUTH FEDERAL HWY
FT LAUDERDALE, FL 33316
Grant Number
H12HA24787
Participating Start Date
7/1/2009
Last Recertification Date
2/6/2024
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12725
2401 W ATLANTIC BLVD
POMPANO BEACH, FL 33069
Pharmacy Comments
Contract Details
Approval Date
1/10/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/29/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
SUSAN M. WIDMAYER, ADMINISTRATOR
(954) 728-1055
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2013
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