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PREVENT RX 3, LLC
STD330563 Optimal Health Foundation Inc
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Covered Entity Details
Entity Name
Optimal Health Foundation Inc
Subdivision Name
Optimal Health Foundation
Type
Sexually Transmitted Diseases
340B ID
STD330563
Entity Address
17235 NW 27th Avenue
Miami Gardens, FL 33056
Grant Number
NH25PS005131
Participating Start Date
4/1/2021
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
PREVENT RX 3, LLC
Pharmacy Address
DBA ADVANCECARE FT. LAUDERDALE
2372 WILTON DR
WILTON MANORS, FL 33305
Pharmacy Comments
Contract Details
Approval Date
6/2/2023
Contract Begin Date
6/5/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristen Hollist, Program Director
(727) 463-2477
Contract Pharmacy Representative
AdvanceCare Pharmacy
Kyle Bernier, Director of Operations
(508) 971-8380
Signed By Date
6/2/2023
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