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PALMS HEALTH SERVICES LLC
RWII34982D 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
RWII34982D
Entity Address
1434 Kennedy Drive
Key West, FL 33040
Grant Number
X07HA00057
Participating Start Date
4/1/2020
Last Recertification Date
2/20/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
PALMS HEALTH SERVICES LLC
Pharmacy Address
PALMS PHARMACY
3491 S CONGRESS AVE
PALM SPRINGS, FL 33461-3021
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
11/9/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Palms Pharmacy
Anand Tripathi, Owner
(561) 513-9161
Signed By Date
10/14/2020
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