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EZ RX HALLANDALE LLC
STD33029 First Class OBGYN
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Covered Entity Details
Entity Name
First Class OBGYN
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33029
Entity Address
1951 SW 172nd avenue
Suite 212
Miramar, FL 33029
Grant Number
NH25PS005131
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
EZ RX HALLANDALE LLC
Pharmacy Address
1550 W 84TH ST STE 62
HIALEAH, FL 33014-3379
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Darlene Yvette Mejia, office manager
(954) 507-4494 Ext: 202
Contract Pharmacy Representative
EZRX PHARMACY
MIRTHA GONZALEZ, PHARMACY TECH
(786) 259-3076
Signed By Date
4/15/2025
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