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PICH KTM CORP
STD322078 River Region Human Services
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Covered Entity Details
Entity Name
River Region Human Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD322078
Entity Address
3901 Carmichael Avenue
Jacksonville, FL 32207
Grant Number
NH25PS005131
Participating Start Date
3/6/2023
Last Recertification Date
5/11/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
PICH KTM CORP
Pharmacy Address
DBA MEDTOWN PHARMACY
11643 BEACH BLVD
UNIT A
JACKSONVILLE, FL 32246
Pharmacy Comments
Contract Details
Approval Date
2/23/2023
Contract Begin Date
3/6/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jacqueline Dowdy Denise Dowdy, CEO
(850) 264-4701
Contract Pharmacy Representative
Medtown Pharmacy
Nakry Oeur, Owner
(904) 551-5870
Signed By Date
1/12/2023
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