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PINE HILLS DRUGS
STD321172 Live Love Life, Inc
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Covered Entity Details
Entity Name
Live Love Life, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD321172
Entity Address
1702 Ridgewood Ave
Suite J
Holly Hill, FL 32117
Grant Number
NH25PS005131
Participating Start Date
7/1/2020
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
PINE HILLS DRUGS
Pharmacy Address
5000 W COLONIAL DR STE 100
ORLANDO, FL 32808-7602
Pharmacy Comments
Contract Details
Approval Date
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARK A WALCZYK, CHIEF EXECUTIVE OFFICER
(585) 233-0105
Contract Pharmacy Representative
Pine Hills Drugs, Inc
Oscar Mbionwu, Pharmacy Manager
(407) 291-1236
Signed By Date
7/13/2023
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