Contract Pharmacy Details

NORTH FL PHARMACY OF MAYO
CH04038E NORTH FLORIDA MEDICAL CENTERS, INC.

Covered Entity Details

Entity Name

NORTH FLORIDA MEDICAL CENTERS, INC.

Subdivision Name

River Valley Medical Center

Type

HRSA-Funded Health Center

340B ID

CH04038E

Entity Address

710 W Main St
Mayo, FL 32066-4127

Grant Number

H80CS00693

Participating Start Date

7/1/2000

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

NORTH FL PHARMACY OF MAYO

Pharmacy Address

PO BOX 1510
229 WEST MAIN STREET
MAYO, FL 32066-1510

Pharmacy Comments

Contract Details

Approval Date

3/21/2006

Contract Begin Date

3/21/2006

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

3/10/2006

340B Drug Pricing Program Database