Contract Pharmacy Details

CENTRAL PHARMACY
HV33830B FDOH Polk

Covered Entity Details

Entity Name

FDOH Polk

Subdivision Name

Lakeland satellite clinic

Type

Ryan White Part C

340B ID

HV33830B

Entity Address

3241 Lakeland Hills Blvd
Lakeland, FL 33805

Grant Number

H76HA00596

Participating Start Date

4/1/2016

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

CENTRAL PHARMACY

Pharmacy Address

1671 EAST HINSON AVE
HAINES CITY, FL 33844-4908

Pharmacy Comments

Contract Details

Approval Date

4/9/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/13/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Joy Jackson, Director
(863) 578-2101

Contract Pharmacy Representative

Central Pharmacy
Abish Thomas, PharmD.
(863) 419-7777

Signed By Date

4/9/2020