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RXHEALTHCARE SYSTEM LLC
STD321141 Outreach Community Care Network
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Covered Entity Details
Entity Name
Outreach Community Care Network
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD321141
Entity Address
240 N. Frederick Avenue
Daytona Beach, FL 32114
Grant Number
1H25PS75095001550
Participating Start Date
1/1/2020
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
RXHEALTHCARE SYSTEM LLC
Pharmacy Address
DBA:COMMUNITY PHARMACY OF PORT ORANGE
3755 S NOVA RD STE A
PORT ORANGE, FL 32129
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Latreace Flynt, Clinical Director
(386) 235-1911 Ext: 216
Contract Pharmacy Representative
Pharmacy
Tejas Mehta, Pharmacy Manager
(386) 256-3177
Signed By Date
7/14/2022
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