Covered Entity Details

STD349721 Midway Specialty Care Center Inc (Terminated) - information as of 4/25/2025 6:33:52 PM

Main Details

Name

Midway Specialty Care Center Inc

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD349721

Grant Number

NH25PS005131

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.

Additional Details

Current Program Status

Terminated

Registration Date

7/10/2018

Participating Start Date

10/1/2018

Participating Approval Date

8/20/2018

Last Recertification Date

5/12/2020

Notice of Funding Opportunity (NOFO) Number

Termination Date
Termination Reason

1/1/2021
Business decision by the Covered Entity

Contacts

Authorizing Official

Midway Specialty Care Center Inc
Kathryn E Hayden, CFO
(772) 742-9276

Primary Contact

Midway Specialty Care Center
Anand Sukhram, CEO
(772) 464-9746

Addresses

Street Address

113 NE 19TH DRIVE
OKEECHOBEE, FL 34972

Billing Address

Midway Specialty Care Center Inc
356 E Midway Road
Ft Pierce, FL 34982

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	AVITA PHARMACY 1047	AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR	801 N MAGNOLIA AVE STE 406	ORLANDO	FL	32803-3843	04/13/2019	07/01/2019	01/01/2021	01/01/2021
Contract Detail	AZOF ENTERPRISES	PORT ST LUCIE DISCOUNT PHARMACY	1936 SE PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34952	08/20/2018	10/01/2018	01/31/2020	05/19/2020
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/15/2019	10/01/2019	01/01/2021	01/01/2021
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/15/2019	10/01/2019	01/01/2021	01/01/2021
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/15/2019	10/01/2019	01/01/2021	01/01/2021
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/15/2019	10/01/2019	01/01/2021	01/01/2021
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/15/2019	10/01/2019	01/01/2021	01/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/15/2019	10/01/2019	01/01/2021	01/01/2021
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05174	1150 NE 26TH ST	WILTON MANORS	FL	33305	07/15/2020	10/01/2020	01/01/2021	01/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04491	9306 NARCOOSSEE RD.	ORLANDO	FL	32827	07/15/2020	10/01/2020	01/01/2021	01/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00580	4800 BISCAYNE BLVD	MIAMI	FL	33137	07/15/2020	10/01/2020	01/01/2021	01/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03779	530 TRUMAN AVE	KEY WEST	FL	33040	07/15/2020	10/01/2020	01/01/2021	01/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01274	2790 N ROOSEVELT BLVD	KEY WEST	FL	33040	07/15/2020	10/01/2020	01/01/2021	01/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02893	4040 PRAIRIE AVE.	MIAMI BEACH	FL	33140	07/15/2020	10/01/2020	01/01/2021	01/01/2021
Contract Detail	JACKSON DRUGS, LLC	2301 OKEECHOBEE RD		FORT PIERCE	FL	34950-6554	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	JTJ MEDICAL SUPPLY, INC	DBA MAIL MEDS CLINICAL PHARMACY	2692 OAK RIDGE CT	FORT MYERS	FL	33901	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	KTJ ENTERPRISES LLC	PRESCRIPTION SHOP OF STUART	622 COLORADO AVE D B A PRESCRIPTION SHOP STUART	STUART	FL	34994-3016	10/10/2019	01/01/2020	01/01/2021	01/01/2021
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	10/14/2019	01/01/2020	01/01/2021	01/01/2021
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/14/2019	01/01/2020	01/01/2021	01/01/2021
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/15/2020	10/01/2020	01/01/2021	01/01/2021
Contract Detail	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	07/15/2020	10/01/2020	01/01/2021	01/01/2021
Contract Detail	PHARMA BUDDIES CORP	ROSEMONT SPECIALTY PHARMACY	1727 ORLANDO CENTRAL PKWY	ORLANDO	FL	32809	04/13/2019	07/01/2019	01/01/2021	01/01/2021
Contract Detail	PILLS, POTIONS & LOTIONS, INC	DBA CROSSTOWN PHARMACY	8701 S US HIGHWAY 1	PORT ST LUCIE	FL	34952-3333	04/13/2019	07/01/2019	01/01/2021	01/01/2021
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	NAVARRO SPECIALTY SERVICES # 10727	7205 CORPORATE CENTER DRIVE SUITE 104	MIAMI	FL	33126	07/15/2019	10/01/2019	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13849	2540 NE 15TH AVE	WILTON MANORS	FL	33305	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04075	100 NW PARK STREET	OKEECHOBEE	FL	34972	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05451	315 W. PLATT STREET	TAMPA	FL	33606	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04391	2501 VIRGINIA AVE.	FT PIERCE	FL	34981	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13981	1515 N FLAGLER DR STE 120	WEST PALM BEACH	FL	33401	08/20/2018	10/01/2018	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07089	527 DUVAL STREET	KEY WEST	FL	33040	10/12/2018	01/01/2019	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #12146	1200 KUHL AVE	ORLANDO	FL	32806	10/12/2018	01/01/2019	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21359	275 NE 35TH ST	MIAMI	FL	33137	10/12/2018	01/01/2019	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15300	2100 N ORANGE AVE STE B	ORLANDO	FL	32804	10/12/2018	01/01/2019	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02777	2805 N ROOSEVELT BLVD	KEY WEST	FL	33040	10/12/2018	01/01/2019	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15301	3030 1ST AVE N	ST PETERSBURG	FL	33713	10/12/2018	01/01/2019	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03574	10870 OVERSEAS HIGHWAY	MARATHON	FL	33050	10/14/2019	01/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13078	5271 OVERSEAS HWY.	MARATHON	FL	33050	10/14/2019	01/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10983	1011 ALTON RD.	MIAMI BEACH	FL	33139	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03565	18590 SOUTH DIXIE HWY.	CUTLER BAY	FL	33157-6818	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02790	3103 BISCAYNE BLVD	MIAMI	FL	33137	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21226	1506 W KENNEDY BLVD STE A	TAMPA	FL	33606	04/03/2020	07/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/15/2020	04/01/2020	01/01/2021	01/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/15/2020	04/01/2020	01/01/2021	01/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		9/1/2020 12:00:00 AM	10/14/2020 2:33 PM
Details	State	Update	Termination Request	Active	To Be Terminated	10/14/2020 2:33 PM
Terminations	Termination Date	Update	Termination Request		1/1/2021 12:00:00 AM	10/14/2020 2:33 PM
Terminations	Termination Effective Date	Update	Termination Request		9/1/2020 12:00:00 AM	10/14/2020 2:33 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	10/14/2020 2:33 PM
Details	Last Recertification Date	Update	Recertification	5/14/2019 8:16:47 AM	5/12/2020 1:21:04 PM	5/12/2020 1:21 PM
Details	Grant Number	Update	Recertification	NH25PS004342	NH25PS005131	5/12/2020 1:21 PM
Contacts	Primary Contact	Update	Profile Change Request	Sukhram, Anand Financial Director Midway Specialty Care Center 7724649746	Sukhram, Anand CEO Midway Specialty Care Center 7724649746	1/28/2020 11:56 AM
Contacts	Authorizing Official	Update		Hayden, Kathryn E COO Midway Specialty Care Center Inc 7727429276	Hayden, Kathryn E CFO Midway Specialty Care Center Inc 7727429276	1/28/2020 11:36 AM
Details	Last Recertification Date	Update	Recertification		5/14/2019 8:16:47 AM	5/14/2019 8:16 AM
Contacts	Authorizing Official	Update	Change Request	Ramgopal, Moti CEO Midway Specialty Care Center 7724649746	Hayden, Kathryn E COO Midway Specialty Care Center Inc 7727429276	10/10/2018 1:04 PM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Ramgopal, Moti CEO Midway Specialty Care Center 7724649746	8/20/2018 9:17 AM
Details	340B ID	Update	New Registration		STD349721	8/20/2018 9:17 AM
Dates	Participating Approval Date	Update	New Registration		8/20/2018 9:17:17 AM	8/20/2018 9:17 AM
Details	State	Update	New Registration	Pending	Approved	8/20/2018 9:17 AM
Dates	Signed By Date	Update	New Registration		7/10/2018 11:43:32 AM	8/20/2018 9:17 AM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	8/20/2018 9:17 AM
Addresses	Main Address	Insert	New Registration		113 NE 19TH DRIVE OKEECHOBEE, FL 34972	7/10/2018 11:43 AM
Addresses	Billing Address	Insert	New Registration		Midway Specialty Care Center Inc 356 E Midway Road Ft Pierce, FL 34982	7/10/2018 11:43 AM
Details	Nature Of Support	Insert	New Registration		In-Kind products or services (see note below; must have been purchased with section 318 funds)	7/10/2018 11:43 AM
Contacts	Primary Contact	Insert	New Registration		Sukhram, Anand Financial Director Midway Specialty Care Center 7724649746	7/10/2018 11:43 AM
Contacts	Authorizing Official	Insert	New Registration		Ramgopal, Moti CEO Midway Specialty Care Center 7724649746	7/10/2018 11:43 AM
Details	Last Recertification Date	Insert	New Registration			7/10/2018 11:43 AM
Details	Grant Number	Insert	New Registration		NH25PS004342	7/10/2018 11:43 AM
Details	340B ID	Insert	New Registration			7/10/2018 11:43 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/10/2018 11:43 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/10/2018 11:43 AM
Details	Medicare Provider Number	Insert	New Registration			7/10/2018 11:43 AM
Details	Entity Name	Insert	New Registration		Midway Specialty Care Center Inc	7/10/2018 11:43 AM
Details	Program Code	Insert	New Registration		STD	7/10/2018 11:43 AM
Details	Entity Subname	Insert	New Registration			7/10/2018 11:43 AM
Dates	Participating Approval Date	Insert	New Registration			7/10/2018 11:43 AM
Details	State	Insert	New Registration		Pending	7/10/2018 11:43 AM
Dates	Registration Date	Insert	New Registration		7/10/2018 11:43:30 AM	7/10/2018 11:43 AM
Dates	Signed By Date	Insert	New Registration			7/10/2018 11:43 AM
Dates	Start Date	Insert	New Registration			7/10/2018 11:43 AM
Terminations	Termination Comments	Insert	New Registration			7/10/2018 11:43 AM
Terminations	Termination Date	Insert	New Registration			7/10/2018 11:43 AM
Terminations	Termination Effective Date	Insert	New Registration			7/10/2018 11:43 AM
Terminations	Termination Reason	Insert	New Registration			7/10/2018 11:43 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History