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RX-MART PHARMACY
STD3280611 Positive Assistance, Inc.
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Covered Entity Details
Entity Name
Positive Assistance, Inc.
Subdivision Name
Sunshine Specialty Health Care
Type
Sexually Transmitted Diseases
340B ID
STD3280611
Entity Address
2884 S Osceola Avenue
Orlando, FL 32806
Grant Number
5NU62PS924532-02
Participating Start Date
1/1/2022
Last Recertification Date
5/10/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
RX-MART PHARMACY
Pharmacy Address
RX MART PHARMACY
665 STATE ROAD 207
STE 101
SAINT AUGUSTINE, FL 32084
Pharmacy Comments
Contract Details
Approval Date
12/2/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Andre J Antenor, President
(863) 242-3322
Contract Pharmacy Representative
HEALTHYRX PHARMACY LLC
Sowjanya Shakhamoori, PHARMACIST
(813) 626-7353
Signed By Date
10/14/2021
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