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BUTTERFIELD PHARMACY AT SLW LLC
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
BUTTERFIELD PHARMACY AT SLW LLC
Pharmacy Address
BUTTERFIELD PHARMACY & MEDICAL SUPPLY SL
1707 NW ST LUCIE WEST BLVD
SUITE 166
PORT ST LUCIE, FL 34986
Pharmacy Comments
Contract Details
Approval Date
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Moti Ramgopal, CEO
(772) 464-9746
Contract Pharmacy Representative
Dave Wright, Owner
(772) 879-3355
Signed By Date
10/14/2015
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