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PRESCRIPTION SHOP OF STUART, I
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
PRESCRIPTION SHOP OF STUART, I
Pharmacy Address
622 COLORADO AVE
STUART, FL 34994-3087
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Moti Ramgopal, CEO
(772) 464-9746
Contract Pharmacy Representative
KIM JONES, Owner
(772) 287-3443
Signed By Date
10/17/2016
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