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XINIM-CORP
STD320971 904 Health, Inc
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Covered Entity Details
Entity Name
904 Health, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD320971
Entity Address
96040 Lofton Square
Yulee, FL 32097
Grant Number
NH25PS005131
Participating Start Date
5/31/2023
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
XINIM-CORP
Pharmacy Address
HOLLY HILL PHARMACY
1702 RIDGEWOOD AVE STE C-G
HOLLY HILL, FL 32117
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
James Tarver, Director
(904) 659-2475
Contract Pharmacy Representative
XINIM-Corp Holly Hill Pharmacy
Tom Hill, Pharmicist in Charge
(386) 677-7377
Signed By Date
4/15/2024
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