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JTJ MEDICAL SUPPLY, INC
STD349721 Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD349721
Entity Address
113 NE 19TH DRIVE
OKEECHOBEE, FL 34972
Grant Number
NH25PS005131
Participating Start Date
10/1/2018
Last Recertification Date
5/12/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC
Pharmacy Address
DBA MAIL MEDS CLINICAL PHARMACY
2692 OAK RIDGE CT
FORT MYERS, FL 33901
Pharmacy Comments
Contract Details
Approval Date
8/20/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Moti Ramgopal, CEO
(772) 464-9746
Contract Pharmacy Representative
JTJ Medical Supply, Inc.
Mark J. Theobald, Owner
(800) 939-2022 Ext: 111
Signed By Date
7/10/2018
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