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L VASSAR
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
L VASSAR
Pharmacy Address
DBA SOUTH BROWARD MEDICAL ARTS PHARMACY
599 S FEDERAL HWY
STE 103
DANIA, FL 33004-4174
Pharmacy Comments
Contract Details
Approval Date
9/13/2023
Contract Begin Date
9/14/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Tarver, Director
(904) 659-2475
Contract Pharmacy Representative
L Vassar, Inc DBA South Broward Medical Arts Pharmacy
Robert Kusher, President
(954) 923-6322
Signed By Date
9/13/2023
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