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ACARIAHEALTH PHARMACY, INC.
CH043823A BREVARD HEALTH ALLIANCE INC., THE
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Covered Entity Details
Entity Name
BREVARD HEALTH ALLIANCE INC., THE
Subdivision Name
BHA Melbourne Clinic
Type
HRSA-Funded Health Center
340B ID
CH043823A
Entity Address
17 Silver Palm Avenue
Melbourne, FL 32901-3123
Grant Number
H80CS04213
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY, INC.
Pharmacy Address
6923 LEE VISTA BLVD STE 200
ORLANDO, FL 32822-4703
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/25/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Austin Helton, CEO
(321) 241-6854
Contract Pharmacy Representative
Acaria Health
Philip Gofman, Regional VP
(917) 312-5263
Signed By Date
4/10/2020
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