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RWII34982A Midway Specialty Care Center Inc (Terminated)
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Main Details
Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII34982A
Grant Number
X07HA00057
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/22/2018
Last Recertification Date
1/28/2020
Time Period the Assistance was Received
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
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