Pharmacy Details

CARL D ACQUAVIVA - information as of 4/25/2025 8:43:52 PM

Name
CARL D ACQUAVIVA

Address

ACQUAVIVA'S PHARMACY
1555 PORT MALABAR BLVD NE STE 101
PALM BAY, FL 32905-5407

Comments

Contracts
History

Contracts

Contract Detail	340B ID	Entity Name	Sub Name	Entity Type	Address	Address Cont.	City	State	Begin Date	Term Date	Edit Date
Details	CH043823A	BREVARD HEALTH ALLIANCE INC., THE	BHA Melbourne Clinic	HRSA-Funded Health Center	17 Silver Palm Avenue		Melbourne	FL	04/01/2017	06/30/2018	7/2/2018 3:23 PM
Details	CH043823M	BREVARD HEALTH ALLIANCE INC., THE	BHA Sarno Regional Clinic	HRSA-Funded Health Center	2120 Sarno Road, Ste 2120		Melbourne	FL	10/01/2016	06/30/2018	7/2/2018 3:23 PM

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Pharmacy Address	Insert			CARL D ACQUAVIVA ACQUAVIVA'S PHARMACY 1555 PORT MALABAR BLVD NE STE 101 PALM BAY, FL 32905-5407	7/22/2020 11:13 AM
Addresses	Pharmacy Address	Insert			CARL D ACQUAVIVA ACQUAVIVA'S PHARMACY 1555 PORT MALABAR BLVD SUITE 101 PALM BAY, FL 32905-5407	7/13/2020 7:48 AM
Addresses	Pharmacy Address	Insert			CARL D ACQUAVIVA ACQUAVIVA'S PHARMACY 1555 PORT MALABAR BLVD SUITE 101 PALM BAY, FL 32905-3290	9/29/2017 6:44 AM
Addresses	Pharmacy Address	Update		CARL D ACQUAVIVA ACQUAVIVA'S PHARMACY 1555 PORT MALABAR BLVD PALM BAY, FL 32905	CARL D ACQUAVIVA ACQUAVIVA'S PHARMACY 1555 PORT MALABAR BLVD SUITE 101 PALM BAY, FL 32905	3/28/2013 4:11 PM
Details	Comments	Insert				3/28/2013 4:11 PM
Details	Is Deleted	Insert			False	3/28/2013 4:11 PM
Addresses	Pharmacy Address	Insert			CARL D ACQUAVIVA ACQUAVIVA'S PHARMACY 1555 PORT MALABAR BLVD PALM BAY, FL 32905	3/28/2013 4:11 PM
Details	Name	Insert			CARL D ACQUAVIVA	3/28/2013 4:11 PM