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KTJ ENTERPRISES LLC
STD349721 Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD349721
Entity Address
113 NE 19TH DRIVE
OKEECHOBEE, FL 34972
Grant Number
NH25PS005131
Participating Start Date
10/1/2018
Last Recertification Date
5/12/2020
Entity Termination Date
1/1/2021
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
1/1/2021
Covered Entity Terminated
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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