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RXHEALTHCARE SYSTEM LLC
STD321172 Live Love Life, Inc
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Covered Entity Details
Entity Name
Live Love Life, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD321172
Entity Address
1702 Ridgewood Ave
Suite J
Holly Hill, FL 32117
Grant Number
NH25PS005131
Participating Start Date
7/1/2020
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
RXHEALTHCARE SYSTEM LLC
Pharmacy Address
DBA:COMMUNITY PHARMACY OF PORT ORANGE
3755 S NOVA RD STE A
PORT ORANGE, FL 32129
Pharmacy Comments
Contract Details
Approval Date
3/4/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARK A WALCZYK, CHIEF EXECUTIVE OFFICER
(585) 233-0105
Contract Pharmacy Representative
Pharmacy
Tejas Mehta, Pharmacy Manager
(386) 256-3177
Signed By Date
3/4/2025
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