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HM BLOOMINGDALE LLC
STD337813 Inclusive Care Group
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Covered Entity Details
Entity Name
Inclusive Care Group
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD337813
Entity Address
7800 66th street North
Suite 204
Pinellas Park, FL 33781
Grant Number
NH25PS005131
Participating Start Date
4/1/2024
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
HM BLOOMINGDALE LLC
Pharmacy Address
DBA: BELL PHARMACY 001
3535 CENTRAL AVE
SAINT PETERSBURG, FL 33713
Pharmacy Comments
Contract Details
Approval Date
2/5/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Antonio Luis, Phycisian, Excecutive Director
(727) 753-7787
Contract Pharmacy Representative
Bell Pharmacy
Anthony Pasquale Trunzo, Mananger
(813) 689-2273
Signed By Date
1/15/2024
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