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UNITED PHARMACY LLC
STD333091 Positive Health Alliance, Inc.
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Covered Entity Details
Entity Name
Positive Health Alliance, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD333091
Entity Address
4055 North Andrews Avenue
Fort Lauderdale, FL 33309
Grant Number
NH25PS004342
Participating Start Date
1/1/2020
Last Recertification Date
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
UNITED PHARMACY LLC
Pharmacy Address
3951 N. HAVERHILL ROAD #300
SUITE 120-121
WEST PALM BEACH, FL 33417
Pharmacy Comments
Contract Details
Approval Date
11/20/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gary G Kogan, Executive Director
(888) 752-2267
Contract Pharmacy Representative
UNITED PHARMACY
ANDY TRIGGS, MANAGER
(855) 445-4401 Ext: 121
Signed By Date
10/9/2019
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