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WALGREEN CO.
CH04550G 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
CH04550G
Entity Address
37944 Pasco Avenue
Dade City, FL 33525
Grant Number
H80CS00101
Participating Start Date
7/1/2015
Last Recertification Date
2/10/2020
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 12318
2480 US HIGHWAY 19
HOLIDAY, FL 34691
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
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
10/12/2017
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