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HM BLOOMINGDALE LLC
STD336113 PREVENTION 305, Inc.
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Covered Entity Details
Entity Name
PREVENTION 305, Inc.
Subdivision Name
PREVENTION 813
Type
Sexually Transmitted Diseases
340B ID
STD336113
Entity Address
3317 West Gandy Blvd
Tampa, FL 33611
Grant Number
NH25PS005131
Participating Start Date
4/1/2024
Last Recertification Date
5/14/2024
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
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Whiteside, Chief Executive Officer
(866) 773-7305 Ext: 100
Contract Pharmacy Representative
Bell Pharmacy
Anthony Pasquale Trunzo, Mananger
(813) 689-2273
Signed By Date
4/15/2024
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