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WALGREEN CO.
CH045500 PREMIER COMMUNITY HEALTHCARE GROUP, INC.
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Covered Entity Details
Entity Name
PREMIER COMMUNITY HEALTHCARE GROUP, INC.
Subdivision Name
Dade City Dental Center
Type
HRSA-Funded Health Center
340B ID
CH045500
Entity Address
37944 Pasco Ave
Dade City, FL 33525-4207
Grant Number
H80CS00101
Participating Start Date
4/1/1998
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREEN #03629
12028 MAJESTIC BLVD.
HUDSON, FL 34667
Pharmacy Comments
Contract Details
Approval Date
10/4/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Resnick, CEO
(352) 518-2000 Ext: 9000
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/4/2016
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