Contract Pharmacy Details

WALGREEN CO.
RWII327921G Hope and Help Center of Central Florida, Inc.

Covered Entity Details

Entity Name

Hope and Help Center of Central Florida, Inc.

Subdivision Name

HIV & STD Prevention & Care Services

Type

Ryan White Part B

340B ID

RWII327921G

Entity Address

2123 W. Doctor MLK Jr. Blvd.
Suite 202
Tampa, FL 33607

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 # 09578
2580 CRAWFORDVILLE HWY
CRAWFORDVILLE, FL 32327-2174

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

340B Drug Pricing Program Database