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WELLDYNERX
CH04168D FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
FORT MYERS CENTER - DOWNTOWN
Type
HRSA-Funded Health Center
340B ID
CH04168D
Entity Address
2232 GRAND AVE
FORT MYERS, FL 33901-3717
Grant Number
H80CS00185
Participating Start Date
4/1/1995
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WELLDYNERX
Pharmacy Address
7472 S. TUSCON WAY
SUITE 100-A
CENTENNIAL, CO 80112
Pharmacy Comments
Contract Details
Approval Date
7/15/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/17/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Frank Mazzeo Jr., CEO
(239) 278-3600
Contract Pharmacy Representative
Brent Boudreaux, Pharmacist In Charge
(888) 479-2000 Ext: 8020
Signed By Date
7/15/2013
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