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WALGREEN CO.
CHC11395-00 DEPARTMENT OF HEALTH FLORIDA
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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 # 05980
795 W NORVELL BRYANT HWY
HERNANDO, FL 34442
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
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