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LENO RX
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
5/6/2024
Pharmacy Details
Pharmacy Name
LENO RX
Pharmacy Address
1640 NE 148TH ST
SUITE 4
NORTH MIAMI, FL 33181
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
LENO RX
SHAVEL SHELLY-ANN CLARKE, PIC
(786) 488-9030
Signed By Date
4/15/2024
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