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OLD TOWN PHARMACY INC
CH042710 TRENTON MEDICAL CENTER
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Covered Entity Details
Entity Name
TRENTON MEDICAL CENTER
Subdivision Name
Palms Medical Group - Trenton
Type
HRSA-Funded Health Center
340B ID
CH042710
Entity Address
911 South Main street
Trenton, FL 32693
Grant Number
H80CS00691
Participating Start Date
10/1/1997
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
OLD TOWN PHARMACY INC
Pharmacy Address
NORTH FLORIDA PHARMACY
26064 SE HIGHWAY 19
OLD TOWN, FL 32680
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anita Rembert, CEO
(352) 463-4501
Contract Pharmacy Representative
North Florida Pharmacy
Joel Rosenfeld, Pharmacist
(352) 490-7700
Signed By Date
4/13/2020
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