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PALMS HEALTH SERVICES LLC
STD333051 Midway Specialty Care Center
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Covered Entity Details
Entity Name
Midway Specialty Care Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD333051
Entity Address
2608 NE 16th Avenue
WILTON MANORS, FL 33334
Grant Number
NH25PS005131
Participating Start Date
4/1/2018
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
PALMS HEALTH SERVICES LLC
Pharmacy Address
PALMS PHARMACY
3491 S CONGRESS AVE
PALM SPRINGS, FL 33461-3021
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Palms Pharmacy
Anand Tripathi, Owner
(561) 513-9161
Signed By Date
7/15/2019
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