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URBAN SPECIALTY PHARMACY, LLC
STD33712 Empath Health, Inc.
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Covered Entity Details
Entity Name
Empath Health, Inc.
Subdivision Name
AIDS Service Association of Pinellas dba EPIC
Type
Sexually Transmitted Diseases
340B ID
STD33712
Entity Address
3050 1st Ave S
St. Petersburg, FL 33712
Grant Number
1NU62PS924687-1-00
Participating Start Date
4/1/2018
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
URBAN SPECIALTY PHARMACY, LLC
Pharmacy Address
1617 34TH ST S STE A
ST PETERSBURG, FL 33711-2855
Pharmacy Comments
Contract Details
Approval Date
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mitchel Morel, CFO
(727) 523-3339
Contract Pharmacy Representative
Urban Specialty Pharmacy
Paresh Shukla, PIC
(813) 928-4382
Signed By Date
10/16/2018
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