Contract Pharmacy Details

BREVARD PHARMACY LLC
HV32935B Unconditional Love, Inc.

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

BREVARD PHARMACY LLC

Pharmacy Address

'DBA' COMMUNITY DISCOUNT PHARMACY
401 BARTON BLVD
ROCKLEDGE, FL 32955

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

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/15/2021

340B Drug Pricing Program Database