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RX-MART PHARMACY
STD328059 Positive Assistance, Inc.
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Covered Entity Details
Entity Name
Positive Assistance, Inc.
Subdivision Name
Positive Assistance Health Center
Type
Sexually Transmitted Diseases
340B ID
STD328059
Entity Address
750 S. Orange Blossom Trail
Suite 222
Orlando, FL 32805
Grant Number
NU62PS924532-02
Participating Start Date
7/1/2019
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
RX-MART PHARMACY
Pharmacy Address
RX MART PHARMACY
665 STATE ROAD 207
STE 101
SAINT AUGUSTINE, FL 32084
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andre Junior Antenor, President
(863) 242-3322
Contract Pharmacy Representative
RX-Mart Pharmacy
Billy Miller, CEO
(904) 342-2162
Signed By Date
7/12/2019
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