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PROPRIUM PHARMACY
STD327894 Midway Specialty Care Center
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Covered Entity Details
Entity Name
Midway Specialty Care Center
Subdivision Name
Sexually Transmitted Diseases
Type
Sexually Transmitted Diseases
340B ID
STD327894
Entity Address
1685 Lee Road
110
Winter Park, FL 32789
Grant Number
NH25PS005131
Participating Start Date
10/1/2022
Last Recertification Date
5/14/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
PROPRIUM PHARMACY
Pharmacy Address
535 INDEPENDENCE PKWY STE 400
CHESAPEAKE, VA 23320-5176
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kathryn E Hayden, CFO
(772) 742-9276
Contract Pharmacy Representative
Proprium Pharmacy
Jeremy Spires, Pharmacy Operations Manager
(757) 553-3514
Signed By Date
7/15/2024
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