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UNIVV INC
STD336122 Blue Star Health, Inc
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Covered Entity Details
Entity Name
Blue Star Health, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD336122
Entity Address
1912 E Busch Blvd
Tampa, FL 33612
Grant Number
NH25PS005131
Participating Start Date
1/1/2021
Last Recertification Date
6/1/2021
Entity Termination Date
1/1/2022
Pharmacy Details
Pharmacy Name
UNIVV INC
Pharmacy Address
LEHIGH PHARMACY
2814 LEE BLVD STE 1
LEHIGH ACRES, FL 33971-1561
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Fabio Ruiz, CEO
(866) 725-4642
Contract Pharmacy Representative
UNIVV INC
ANIL HARKHANI, President
(443) 366-4496
Signed By Date
1/15/2021
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