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RX-MART PHARMACY
STD327501 26Health, Inc.
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Covered Entity Details
Entity Name
26Health, Inc.
Subdivision Name
West Orange Nephrology, LLC
Type
Sexually Transmitted Diseases
340B ID
STD327501
Entity Address
6909 Old Hwy 441
223
Mount Dora, FL 32750
Grant Number
1H25PS004342-02
Participating Start Date
1/1/2019
Last Recertification Date
5/4/2020
Entity Termination Date
7/1/2021
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
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David Baker-Hargrove, President/Co-CEO
(321) 800-2922
Contract Pharmacy Representative
rx-mart pharmacy
Nagesh Shakamoori, president
(904) 342-2162
Signed By Date
10/14/2019
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