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CARL D ACQUAVIVA
CH043823A BREVARD HEALTH ALLIANCE INC., THE
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Covered Entity Details
Entity Name
BREVARD HEALTH ALLIANCE INC., THE
Subdivision Name
BHA Melbourne Clinic
Type
HRSA-Funded Health Center
340B ID
CH043823A
Entity Address
17 Silver Palm Avenue
Melbourne, FL 32901-3123
Grant Number
H80CS04213
Participating Start Date
4/1/2005
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CARL D ACQUAVIVA
Pharmacy Address
ACQUAVIVA'S PHARMACY
1555 PORT MALABAR BLVD NE STE 101
PALM BAY, FL 32905-5407
Pharmacy Comments
Contract Details
Approval Date
1/16/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Austin Helton, CEO
(321) 241-6868
Contract Pharmacy Representative
Carl Acquaviva, Owner
(321) 693-4329
Signed By Date
1/16/2017
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