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INFINITI PHARMACY AND INFUSION SERVICES
RWII34982 Midway Specialty Care Center Inc
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Covered Entity Details
Entity Name
Midway Specialty Care Center Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII34982
Entity Address
356 E MIDWAY RD
Fort Pierce, FL 34982
Grant Number
X07HA00057
Participating Start Date
1/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
INFINITI PHARMACY AND INFUSION SERVICES
Pharmacy Address
1338 NORTH FEDERAL HIGHWAY
POMPANO BEACH, FL 33062
Pharmacy Comments
Contract Details
Approval Date
4/16/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Moti Ramgopal, CEO
(772) 464-9746
Contract Pharmacy Representative
Ravikumar Baskaran, Comptroller
(954) 414-9901
Signed By Date
4/16/2015
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