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RX-MART PHARMACY
STD32763 26Health, Inc.
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Covered Entity Details
Entity Name
26Health, Inc.
Subdivision Name
Gastroenterology of Greater Orlando, LLC
Type
Sexually Transmitted Diseases
340B ID
STD32763
Entity Address
2884 Wellness Ave
402
Orange City, FL 32763
Grant Number
1H25PS004342-02
Participating Start Date
7/1/2019
Last Recertification Date
5/4/2020
Entity Termination Date
10/1/2020
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
10/1/2020
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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