Contract Pharmacy Details

CENTRAL PHARMACY
STD338441 Diversity Healthcare

Covered Entity Details

Entity Name

Diversity Healthcare

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD338441

Entity Address

1011 E Main St Suite A
Haines City, FL 33844

Grant Number

NH25PS005131

Participating Start Date

7/1/2024

Last Recertification Date

Pharmacy Details

Pharmacy Name

CENTRAL PHARMACY

Pharmacy Address

1671 EAST HINSON AVE
HAINES CITY, FL 33844-4908

Pharmacy Comments

Contract Details

Approval Date

6/5/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/28/2024
Agreement registered in error

Contacts

Covered Entity Signing Official

Clayton Dale Reedy, Owner/Provider
(937) 307-7891

Contract Pharmacy Representative

Central Pharmacy
Abish Thomas, PharmD.
(863) 419-7777

Signed By Date

6/5/2024