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EXCEL PHARMACY PARTNERS LLC
STD337134 Professional Health Care of Pinellas, LLC
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Covered Entity Details
Entity Name
Professional Health Care of Pinellas, LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD337134
Entity Address
1839 Central Ave
St Petersburg, FL 33713
Grant Number
NH25PS005131
Participating Start Date
7/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
EXCEL PHARMACY PARTNERS LLC
Pharmacy Address
DBA: STAT PHARMACY
6817 SOUTHPOINT PKWY STE 2204
JACKSONVILLE, FL 32216-8200
Pharmacy Comments
Contract Details
Approval Date
5/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bill Fuller, Provider Services Represnetative
(603) 494-1458
Contract Pharmacy Representative
STAT Pharmacy
Roy Principe, Pharmacy in Charge
(904) 800-2285
Signed By Date
4/12/2024
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