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FAMILY PHYSICIANS RX
STD333055 The Poverello Center Inc.
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Covered Entity Details
Entity Name
The Poverello Center Inc.
Subdivision Name
EXTRA Care Clinic
Type
Sexually Transmitted Diseases
340B ID
STD333055
Entity Address
2056 N Dixie Hwy
Wilton Manors, FL 33305
Grant Number
NH25PS005131
Participating Start Date
2/9/2022
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
FAMILY PHYSICIANS RX
Pharmacy Address
DBA PHARMCORX 1204
901 N MIAMI BEACH BLVD STE 1
NORTH MIAMI BEACH, FL 33162-3720
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas S Pietrogallo, CEO
(954) 561-3663 Ext: 101
Contract Pharmacy Representative
pharmco LLC
Pamela Roberts, COO
(303) 919-7399 Ext: 210
Signed By Date
10/15/2024
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