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ICARE RX LLC
STD331611 Flex 4 Medical Center Corp
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Covered Entity Details
Entity Name
Flex 4 Medical Center Corp
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD331611
Entity Address
900 NE 125 ST
STE 200
NORTH MIAMI, FL 33161
Grant Number
NH25PS005131
Participating Start Date
1/1/2022
Last Recertification Date
6/5/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
ICARE RX LLC
Pharmacy Address
14447 COUNTRY WALK DR
MIAMI, FL 33186
Pharmacy Comments
Contract Details
Approval Date
11/22/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
TRENISE BENNETT, EXECUTIVE DIRECTOR
(561) 560-7373
Contract Pharmacy Representative
Physicians Rx Pharmacy of Clinton
Chris Wakefield, Manager
(412) 357-5163
Signed By Date
10/15/2021
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