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31ST & 3RD PHARMACY INC
STD32905 Healthcare Unity Group Inc
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Covered Entity Details
Entity Name
Healthcare Unity Group Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD32905
Entity Address
1920 S. Babcock Street
Melbourne, FL 32901
Grant Number
H25PS005131
Participating Start Date
9/23/2022
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
31ST & 3RD PHARMACY INC
Pharmacy Address
D/B/A AVITA PHARMACY 1063
1860 WALT WHITMAN RD STE 700
MELVILLE, NY 11747
Pharmacy Comments
Contract Details
Approval Date
1/3/2023
Contract Begin Date
1/3/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthony John Walko III, Chief Executive Officer
(201) 783-3126
Contract Pharmacy Representative
Avita Pharmacy
Shawn Smith, Account Executive
(305) 906-2937
Signed By Date
1/3/2023
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