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PINES HEALTH MART PHARMACY
STD334302 Crossing Bridges of Palm Beaches
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Covered Entity Details
Entity Name
Crossing Bridges of Palm Beaches
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD334302
Entity Address
1100 North Main Street
Suite C
Bella Glade, FL 33430
Grant Number
5NU62PS92453202
Participating Start Date
1/1/2021
Last Recertification Date
6/3/2024
Pharmacy Details
Pharmacy Name
PINES HEALTH MART PHARMACY
Pharmacy Address
2301 N UNIVERSITY DR STE 112
PEMBROKE PINES, FL 33024-3617
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Coretha Smith, Chief Executive Officer
(561) 889-4815
Contract Pharmacy Representative
Pines Health Mart Pharmacy
Mohammed Arshad Ali, CEO
(954) 404-6610
Signed By Date
4/15/2021
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