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MY PHARMACY OF BRANDON
STD32324 North Florida Rural Health Corp
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Covered Entity Details
Entity Name
North Florida Rural Health Corp
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD32324
Entity Address
680 Maple Street
Chattahoochee, FL 32324
Grant Number
NH25PS005131
Participating Start Date
7/1/2023
Last Recertification Date
5/10/2025
Pharmacy Details
Pharmacy Name
MY PHARMACY OF BRANDON
Pharmacy Address
MY PHARMACY OF BRANDON
1420 W WATERS AVE
STE 101
TAMPA, FL 33604
Pharmacy Comments
Contract Details
Approval Date
5/30/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Walter Kyles, Executive Director
(850) 999-3181
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
5/2/2023
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