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PRAXIS SPECIALTY PHARMACY LLC
CH05972AB AUNT MARTHA'S HEALTH & WELLNESS, INC.
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Covered Entity Details
Entity Name
AUNT MARTHA'S HEALTH & WELLNESS, INC.
Subdivision Name
Great River Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05972AB
Entity Address
120 E Court St
Toulon, IL 61483-5388
Grant Number
H80CS00685
Participating Start Date
7/1/2014
Last Recertification Date
2/25/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
PRAXIS SPECIALTY PHARMACY LLC
Pharmacy Address
PRAXIS RX PHARMACY
5455 W WATERS AVE STE 214
TAMPA, FL 33634
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Audrey Pennington, Chief Operating Officer
(708) 747-7100
Contract Pharmacy Representative
William Scott Bailey, Pharmacist in Charge
(888) 903-7453
Signed By Date
10/15/2015
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