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HM BLOOMINGDALE LLC
STD338441 Diversity Healthcare
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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
HM BLOOMINGDALE LLC
Pharmacy Address
DBA: BELL PHARMACY 001
3535 CENTRAL AVE
SAINT PETERSBURG, FL 33713
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clayton Dale Reedy, Owner/Provider
(937) 307-7891
Contract Pharmacy Representative
Bell Pharmacy
Matt Schneller, Senior Clinical Director
(608) 393-3886
Signed By Date
10/11/2024
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