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URBAN SPECIALTY PHARMACY, LLC
RW424835 Empath Health, Inc.
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Covered Entity Details
Entity Name
Empath Health, Inc.
Subdivision Name
AIDS Service Association of Pinellas, Inc. dba EPIC
Type
Ryan White Part D
340B ID
RW424835
Entity Address
3050 1st Ave South
St. Petersburg, FL 33712
Grant Number
H12HA24835
Participating Start Date
7/1/2014
Last Recertification Date
2/1/2017
Entity Termination Date
10/1/2017
Pharmacy Details
Pharmacy Name
URBAN SPECIALTY PHARMACY, LLC
Pharmacy Address
1617 34TH ST S STE A
ST PETERSBURG, FL 33711-2855
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
Contacts
Covered Entity Signing Official
Rafael Sciullo, President/CEO, Empath Health, Inc
(727) 523-2101
Contract Pharmacy Representative
Urban Specialty Pharmacy
Paresh Shukla, PIC
(813) 928-4382
Signed By Date
4/17/2017
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