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XINIM-CORP
RWII34982D Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII34982D
Entity Address
1434 Kennedy Drive
Key West, FL 33040
Grant Number
X07HA00057
Participating Start Date
4/1/2020
Last Recertification Date
2/20/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
XINIM-CORP
Pharmacy Address
HOLLY HILL PHARMACY
1702 RIDGEWOOD AVE STE C-G
HOLLY HILL, FL 32117
Pharmacy Comments
Contract Details
Approval Date
4/16/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/20/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
XINIM-Corp Holly Hill Pharmacy
Tom Hill, Pharmicist in Charge
(386) 677-7377
Signed By Date
4/16/2023
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