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PREVENT RX
STD33023 Positive Health Alliance, Inc.
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Covered Entity Details
Entity Name
Positive Health Alliance, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33023
Entity Address
6245 Miramar Parkway
102
Miramar, FL 33023
Grant Number
NH25PS005131
Participating Start Date
1/1/2020
Last Recertification Date
6/1/2020
Entity Termination Date
7/1/2021
Pharmacy Details
Pharmacy Name
PREVENT RX
Pharmacy Address
906 W SUNRISE BLVD
STE B
FORT LAUDERDALE, FL 33311
Pharmacy Comments
Contract Details
Approval Date
1/23/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gary G Kogan, Executive Director
(888) 752-2267
Contract Pharmacy Representative
UNITED PHARMACY
ANDY TRIGGS, MANAGER
(855) 445-4401 Ext: 121
Signed By Date
1/23/2020
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