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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
225 Bacom Point
Belle Glade, FL 33430
Grant Number
5NU62PS92453202
Participating Start Date
1/1/2021
Last Recertification Date
5/15/2025
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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