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BELL PHARMACY 002 LLC
STD337134 Professional Health Care of Pinellas, LLC
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Covered Entity Details
Entity Name
Professional Health Care of Pinellas, LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD337134
Entity Address
1839 Central Ave
St Petersburg, FL 33713
Grant Number
NH25PS005131
Participating Start Date
7/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
BELL PHARMACY 002 LLC
Pharmacy Address
DBA: BELL PHARMACY 002
8702 HUNTERS LAKE DR STE 140
TAMPA, FL 33647
Pharmacy Comments
Contract Details
Approval Date
9/18/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Bill Fuller, Provider Services Represnetative
(603) 494-1458
Contract Pharmacy Representative
Bell Pharmacy
Matt Schneller, Senior Clinical Director
(608) 393-3886
Signed By Date
9/18/2024
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