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MEDWINS PHARMACY INC
STD338251 J AGUSTIN LACSON MD INC
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Covered Entity Details
Entity Name
J AGUSTIN LACSON MD INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD338251
Entity Address
3300 US 27 SOUTH
AVON PARK, FL 33825
Grant Number
NH25PS005131
Participating Start Date
8/12/2020
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
MEDWINS PHARMACY INC
Pharmacy Address
CENTRAL PHARMACY
740 W MAIN ST UNIT 5
BUILDING 1
HAINES CITY, FL 33844
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
agustin juan lacson, president
(863) 835-0060
Contract Pharmacy Representative
Central Pharmacy
Abish Thomas, PharmD.
(863) 419-7777
Signed By Date
1/17/2023
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