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JTJ MEDICAL SUPPLY, INC
RWI00053 LGBT Life Center
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Covered Entity Details
Entity Name
LGBT Life Center
Subdivision Name
Type
Ryan White Part A
340B ID
RWI00053
Entity Address
248 W. 24th St.
Norfolk, VA 23517
Grant Number
H89HA00053
Participating Start Date
4/1/2013
Last Recertification Date
2/21/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC
Pharmacy Address
DBA MAIL-MEDS CLINICAL PHARMACY
6315 N CENTER DR STE 100
NORFOLK, VA 23502
Pharmacy Comments
Contract Details
Approval Date
1/19/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stacie Walls-Beegle, CEO
(757) 640-0929 Ext: 215
Contract Pharmacy Representative
JTJ Medical Supply, Inc.
Mark J. Theobald, Owner
(800) 939-2022 Ext: 111
Signed By Date
1/19/2020
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