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WALGREEN CO.
RWII327921F Hope and Help Center of Central Florida, Inc.
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Covered Entity Details
Entity Name
Hope and Help Center of Central Florida, Inc.
Subdivision Name
Diversity Health Center of Tampa Bay
Type
Ryan White Part B
340B ID
RWII327921F
Entity Address
4302 N. Habana Ave.
Suite 200
Tampa, FL 33607-6368
Grant Number
X07HA00057
Participating Start Date
4/1/2018
Last Recertification Date
Entity Termination Date
7/1/2018
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #12578
2117 S BYRON BUTLER PKWY
PERRY, FL 32348
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lisa Barr, Executive Director
(407) 645-2577 Ext: 121
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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