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AMAZON PHARMACY #009
STD331391 PREVENTION 305
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Covered Entity Details
Entity Name
PREVENTION 305
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD331391
Entity Address
407 Lincoln Road, Suite 6D
MIAMI BEACH, FL 33139
Grant Number
NU62PS924532
Participating Start Date
5/8/2020
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
AMAZON PHARMACY #009
Pharmacy Address
7469 KINGSPOINTE PKWY STE 400
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Whiteside, Chief Executive Officer
(866) 773-7305 Ext: 100
Contract Pharmacy Representative
PillPack LLC
Bridget O'Connell, Authorized Signatory
(714) 380-0579
Signed By Date
1/15/2025
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