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FAMILY PHYSICIANS RX
STD339013 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
STD339013
Entity Address
3660 Central Ave
Unit 6
Fort Myers, FL 33901
Grant Number
NH25PS005131
Participating Start Date
5/8/2020
Last Recertification Date
Entity Termination Date
10/1/2020
Pharmacy Details
Pharmacy Name
FAMILY PHYSICIANS RX
Pharmacy Address
PHARMCORX 1103
1160 S SEMORAN BLVD STE DEF
ORLANDO, FL 32807
Pharmacy Comments
Contract Details
Approval Date
5/6/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gary G Kogan, Executive Director
(888) 752-2267
Contract Pharmacy Representative
Pharmco, LLC
Armen Karapetyan, General Manager
(305) 919-7399 Ext: 201
Signed By Date
4/14/2020
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