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FAMILY PHYSICIANS RX
STD328091 Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
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Covered Entity Details
Entity Name
Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
Subdivision Name
Orlando
Type
Sexually Transmitted Diseases
340B ID
STD328091
Entity Address
130 E Marks St
Orlando, FL 32803
Grant Number
NH25PS004342-04-01
Participating Start Date
7/1/2020
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
FAMILY PHYSICIANS RX
Pharmacy Address
DBA PHARMCORX 1204
901 N MIAMI BEACH BLVD STE 1
NORTH MIAMI BEACH, FL 33162-3720
Pharmacy Comments
Contract Details
Approval Date
9/19/2023
Contract Begin Date
9/20/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Vixamar, COO
(954) 529-1178
Contract Pharmacy Representative
pharmco LLC
Pamela Roberts, COO
(303) 919-7399 Ext: 210
Signed By Date
9/19/2023
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