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URBAN SPECIALTY PHARMACY, LLC
RWII34982B Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII34982B
Entity Address
1801 SE Hillmoor Drive
C207
Port St Lucie, FL 34952
Grant Number
X07HA00057
Participating Start Date
10/1/2018
Last Recertification Date
2/12/2025
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
10/14/2020
Contract Begin Date
11/6/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/11/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Urban Specialty Pharmacy
Paresh Shukla, PIC
(813) 928-4382
Signed By Date
10/14/2020
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