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DANIA REXALL PHARMACY & MEDICAL SUPPLY,
STD320971 904 Health, Inc
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Covered Entity Details
Entity Name
904 Health, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD320971
Entity Address
96040 Lofton Square
Yulee, FL 32097
Grant Number
NH25PS005131
Participating Start Date
5/31/2023
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
DANIA REXALL PHARMACY & MEDICAL SUPPLY,
Pharmacy Address
DANIA DISCOUNT DRUGS,INC.
5420 NW 33RD AVE STE 7A
FORT LAUDERDALE, FL 33309
Pharmacy Comments
Contract Details
Approval Date
7/16/2023
Contract Begin Date
9/6/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Tarver, Director
(904) 659-2475
Contract Pharmacy Representative
Dania Discount Drugs
Robert Kusher, President
(954) 921-4661
Signed By Date
7/16/2023
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