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JACKSON DRUGS, LLC
FQHCLA356A Whole Family Health Center, Inc.
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Covered Entity Details
Entity Name
Whole Family Health Center, Inc.
Subdivision Name
Whole Family Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA356A
Entity Address
981 37th Place
Vero Beach, FL 32960-6541
Grant Number
LALCS31468
Participating Start Date
10/24/2017
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
JACKSON DRUGS, LLC
Pharmacy Address
2301 OKEECHOBEE RD
FORT PIERCE, FL 34950-6554
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gerald Pierone Jr., M.D.
(772) 257-5785
Contract Pharmacy Representative
Jackson Drugs, LLC
Kenneth Jackson, Managing Member
(772) 464-3784
Signed By Date
10/15/2018
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