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ALLIANCE PHARMACY AND WELLNESS INC
STD23435 Suffolk United, Inc
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Covered Entity Details
Entity Name
Suffolk United, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD23435
Entity Address
1900 Atlanta Avenue
Portsmouth, VA 23435
Grant Number
NU62PS924552
Participating Start Date
3/13/2023
Last Recertification Date
5/30/2024
Pharmacy Details
Pharmacy Name
ALLIANCE PHARMACY AND WELLNESS INC
Pharmacy Address
301 GOODE WAY STE 102
PORTSMOUTH, VA 23704
Pharmacy Comments
Contract Details
Approval Date
6/1/2023
Contract Begin Date
6/2/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ben Fitzgerald, Director
(757) 634-7550
Contract Pharmacy Representative
Alliance Pharmacy and Wellness Inc
Nakry Oeur, Pharmacy Manager
(757) 734-5550
Signed By Date
6/1/2023
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