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JTJ MEDICAL SUPPLY, INC
STD235101 LGBT Life Center
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Covered Entity Details
Entity Name
LGBT Life Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD235101
Entity Address
5360 Robin Hood Rd
Suite 200
Norfolk, VA 23513
Grant Number
NU62PS924552
Participating Start Date
4/1/2017
Last Recertification Date
6/4/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
JTJ MEDICAL SUPPLY, INC
Pharmacy Address
DBA MAIL-MEDS CLINICAL PHARMACY
6315 N CENTER DR STE 100
NORFOLK, VA 23502
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
4/22/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/19/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stacie Walls-Beegle, CEO
(757) 640-0929 Ext: 215
Contract Pharmacy Representative
JTJ Medical Supply, Inc.
Mark J. Theobald, Owner
(800) 939-2022 Ext: 111
Signed By Date
4/14/2020
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