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FAMILY PHYSICIANS RX
STD335632 Lifeline Health, Inc.
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Covered Entity Details
Entity Name
Lifeline Health, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD335632
Entity Address
2005 W. Reynolds St
Plant City, FL 33563
Grant Number
NH25PS005131
Participating Start Date
8/18/2020
Last Recertification Date
5/19/2025
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
8/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2020
Business decision by covered entity and/or pharmacy
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
7/1/2020
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