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CENTERWELL PHARMACY, INC.
CH04271J TRENTON MEDICAL CENTER
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Covered Entity Details
Entity Name
TRENTON MEDICAL CENTER
Subdivision Name
Palms Medical Group - Live Oak
Type
HRSA-Funded Health Center
340B ID
CH04271J
Entity Address
211 Ranchera ST NW
LIVE OAK, FL 32064-8463
Grant Number
H80CS00691
Participating Start Date
1/1/2015
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
CENTERWELL PHARMACY, INC.
Pharmacy Address
11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDO, FL 32824
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anita Rembert, CEO
(352) 463-4501
Contract Pharmacy Representative
CenterWell Pharmacy
Jay Duprey, ASSOCIATE DIRECTOR, CHANNEL DEVELOPMENT
(248) 921-7578
Signed By Date
1/16/2024
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