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RX CARE FOUR LLC
STD329072 Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
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Covered Entity Details
Entity Name
Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
Subdivision Name
Palm Bay
Type
Sexually Transmitted Diseases
340B ID
STD329072
Entity Address
7436 S Federal Highway
Port St Lucie, FL 34952
Grant Number
NH25PS004342-04-01
Participating Start Date
1/1/2021
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
RX CARE FOUR LLC
Pharmacy Address
PALM BAY PHARMACY
1270 MALABAR RD SE STE 2
PALM BAY, FL 32907-3407
Pharmacy Comments
Contract Details
Approval Date
11/17/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2021
Ownership change
Contacts
Covered Entity Signing Official
Steve Vixamar, COO
(954) 529-1178
Contract Pharmacy Representative
Benzer Pharmacy
Mrugesh Amin, 340B & Business Development Specialist
(813) 304-2221 Ext: 264
Signed By Date
10/2/2020
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