Contract Pharmacy Details

WALGREEN CO.
CHC11395-00 DEPARTMENT OF HEALTH FLORIDA

Covered Entity Details

Entity Name

DEPARTMENT OF HEALTH FLORIDA

Subdivision Name

George A. Dame Community Health Center - Lecanto Main Campus

Type

HRSA-Funded Health Center

340B ID

CHC11395-00

Entity Address

3700 Sovereign Path
Lecanto, FL 34461-8071

Grant Number

H80CS12860

Participating Start Date

10/1/2009

Last Recertification Date

3/10/2016

Entity Termination Date

4/1/2016

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05578
11283 N WILLIAMS ST
DUNNELLON, FL 34432

Pharmacy Comments

Contract Details

Approval Date

5/1/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2016

Contacts

Covered Entity Signing Official

Robin Wright, Administrator
(352) 540-6800 Ext: 82111

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

5/1/2013

340B Drug Pricing Program Database