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KTJ ENTERPRISES LLC
STD34982 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
STD34982
Entity Address
356 E MIDWAY ROAD
FORT PIERCE, FL 34982
Grant Number
NH25PS005131
Participating Start Date
1/1/2018
Last Recertification Date
5/8/2025
Pharmacy Details
Pharmacy Name
KTJ ENTERPRISES LLC
Pharmacy Address
PRESCRIPTION SHOP OF STUART
622 COLORADO AVE
D B A PRESCRIPTION SHOP STUART
STUART, FL 34994-3016
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
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
KTJ Enterprises LLC
Kim Jones, Owner
(772) 287-3443
Signed By Date
10/10/2019
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