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MY PHARMACY OF BRANDON
STD349501 In the Image of Christ
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Covered Entity Details
Entity Name
In the Image of Christ
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD349501
Entity Address
707 North 7th St.
Fort Pierce, FL 34950
Grant Number
NH25PS005131
Participating Start Date
4/1/2021
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
MY PHARMACY OF BRANDON
Pharmacy Address
MY PHARMACY OF BRANDON
1420 W WATERS AVE
STE 101
TAMPA, FL 33604
Pharmacy Comments
Contract Details
Approval Date
5/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hazel Hoylman, Executive Director
(772) 461-7788 Ext: 109
Contract Pharmacy Representative
My Pharmacy of Brandon
Preeti Philip, Manager
(610) 639-5321
Signed By Date
5/5/2021
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