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PRX INCORPORATED
STD33013 Barroso Medical Services,LLC
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Covered Entity Details
Entity Name
Barroso Medical Services,LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33013
Entity Address
4835 E 4th Ave
Suite B
Hialeah, FL 33013
Grant Number
NH25PS005131
Participating Start Date
7/1/2020
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
PRX INCORPORATED
Pharmacy Address
PRX PHARMACY
5040 NW 7TH ST SUITE 470
MIAMI, FL 33126
Pharmacy Comments
Contract Details
Approval Date
5/27/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ihosvani Barroso, MD,CEO
(786) 899-0119
Contract Pharmacy Representative
PRX Incorporated
Francisco Urteaga, CEO
(305) 496-9038
Signed By Date
5/27/2020
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