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PINELLAS PARK DRUGS LLC
STD337101 Advanced Bay Area Medical Associates
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Covered Entity Details
Entity Name
Advanced Bay Area Medical Associates
Subdivision Name
St Pete Office
Type
Sexually Transmitted Diseases
340B ID
STD337101
Entity Address
1700 66th Street North
Sute 510
St Petersburg, FL 33710
Grant Number
NH25PS005131
Participating Start Date
8/27/2020
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
PINELLAS PARK DRUGS LLC
Pharmacy Address
PINELLAS PARK DRUGS
6280 66TH ST N
PINELLAS PARK, FL 33781
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey R Levenson, President
(727) 384-2479
Contract Pharmacy Representative
Pinellas Park Pharmacy
Kevin Shukla, PharmD
(727) 544-4203
Signed By Date
4/14/2022
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