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URBAN SPECIALTY PHARMACY, LLC
RWI33712A 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 A
340B ID
RWI33712A
Entity Address
5771 Roosevelt Blvd
720
Clearwater, FL 33760
Grant Number
H89HA00024
Participating Start Date
10/1/2015
Last Recertification Date
1/31/2019
Entity Termination Date
1/1/2020
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
1/1/2020
Covered Entity Terminated
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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