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WALGREEN CO.
STD328066 Two Spirit Health Services
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Covered Entity Details
Entity Name
Two Spirit Health Services
Subdivision Name
Orlando Infectious Disease Clinic
Type
Sexually Transmitted Diseases
340B ID
STD328066
Entity Address
2884 S. Osceola Avenue
Orlando, FL 32806
Grant Number
1H25PS00432-02
Participating Start Date
7/1/2018
Last Recertification Date
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 06504
2814 CURRY FORD ROAD
ORLANDO, FL 32806
Pharmacy Comments
Contract Details
Approval Date
5/21/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/8/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Baker-Hargrove, President/Co-CEO
(321) 800-2922
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/11/2018
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