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URBAN SPECIALTY PHARMACY, LLC
STD337101 Advanced Bay Area Medical Associates
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Covered Entity Details
Entity Name
Advanced Bay Area Medical Associates
Subdivision Name
St Pete Office
Type
Sexually Transmitted Diseases
340B ID
STD337101
Entity Address
1700 66th Street North
Sute 510
St Petersburg, FL 33710
Grant Number
NH25PS005131
Participating Start Date
8/27/2020
Last Recertification Date
6/2/2025
Pharmacy Details
Pharmacy Name
URBAN SPECIALTY PHARMACY, LLC
Pharmacy Address
1617 34TH ST S STE A
ST PETERSBURG, FL 33711-2855
Pharmacy Comments
Contract Details
Approval Date
8/27/2020
Contract Begin Date
8/27/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey R Levenson, President
(727) 384-2479
Contract Pharmacy Representative
Urban Specialty Pharmacy
Paresh Shukla, PIC
(813) 928-4382
Signed By Date
7/7/2020
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