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TITUSVILLE DISCOUNT PHARMACY
HV32935B Unconditional Love, Inc.
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Covered Entity Details
Entity Name
Unconditional Love, Inc.
Subdivision Name
Type
Ryan White Part C
340B ID
HV32935B
Entity Address
1513 N. Harbor City Blvd.
Administration
Melbourne, FL 32935
Grant Number
H76HA00615
Participating Start Date
4/1/2021
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
TITUSVILLE DISCOUNT PHARMACY
Pharmacy Address
2175 CHENEY HWY
TITUSVILLE, FL 32780-6792
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
4/21/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jessica J Seidita, CEO
(321) 259-8928 Ext: 206
Contract Pharmacy Representative
Titusville Discount Pharmacy
Arvindbhai Patel, Manager
(321) 268-0911
Signed By Date
1/15/2021
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