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PRAXIS SPECIALTY PHARMACY LLC
FP604668 AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
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Covered Entity Details
Entity Name
AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP604668
Entity Address
233 WEST JOE ORR ROAD
CHICAGO HEIGHTS, IL 60411
Grant Number
FPHPA056060
Participating Start Date
1/1/1998
Last Recertification Date
5/10/2024
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
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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