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FAMILY PHYSICIANS RX
STD339015 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
Fort Myers
Type
Sexually Transmitted Diseases
340B ID
STD339015
Entity Address
28420 Bonita Crossings Blvd
Ste 130
Bonita Springs, FL 34135
Grant Number
NH25PS004342-04-01
Participating Start Date
10/1/2020
Last Recertification Date
5/5/2025
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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