Contract Pharmacy Details

PHARMACY OF TAMPA, INC
RWI30303 Aniz, Inc.

Covered Entity Details

Entity Name

Aniz, Inc.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI30303

Entity Address

236 Forsyth Street SW Suite 300
Atlanta, GA 30303

Grant Number

H89HA00007

Participating Start Date

10/1/2017

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

PHARMACY OF TAMPA, INC

Pharmacy Address

D.B.A HOPE AND PACIFIC PHARMACY
4433 GUNN HWY
TAMPA, FL 33618-3361

Pharmacy Comments

Contract Details

Approval Date

7/17/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/20/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Zina Age, President CEO
(404) 502-9982

Contract Pharmacy Representative

Pharmacy of Tampa, Inc
Brandon Behman, Vice President of Operation
(813) 559-9761

Signed By Date

7/17/2018

340B Drug Pricing Program Database