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WINN-DIXIE STORES, INC.
STD322092 OverFlow Health Alliance Inc.
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Covered Entity Details
Entity Name
OverFlow Health Alliance Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD322092
Entity Address
3416 Moncrief Rd.
101
jacksonville, FL 32209
Grant Number
nh25ps005131
Participating Start Date
4/1/2020
Last Recertification Date
5/8/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WINN-DIXIE STORES, INC.
Pharmacy Address
PATHSTONE HEALTH SERVICES
5244 EDGEWOOD COURT, SUITE 2
JACKSONVILLE, FL 32254
Pharmacy Comments
Contract Details
Approval Date
2/18/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joshua Hardin-Givens, Executive Director
(904) 468-7944
Contract Pharmacy Representative
winn-dixe stores inc
Vallery Huston, Pharamacy Director
(904) 370-5016
Signed By Date
2/14/2020
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