Contract Pharmacy Details

EMPATH HEALTH PHARMACEUTICALS, LLC
RWI33712B Empath Health, Inc.

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

RWI33712B

Entity Address

4600 N. Habana Ave.
Tampa, FL 33614

Grant Number

H89HA00024

Participating Start Date

10/1/2015

Last Recertification Date

2/6/2017

Entity Termination Date

10/1/2017

Pharmacy Details

Pharmacy Name

EMPATH HEALTH PHARMACEUTICALS, LLC

Pharmacy Address

EMPATH HEALTH PHARMACY
PHARMACY DEPARTMENT
3050 1ST AVE S
ST PETERSBURG, FL 33712

Pharmacy Comments

Contract Details

Approval Date

4/7/2016

Contract Begin Date

7/1/2016

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

Empath Health Pharmaceuticals
Aaron Rigali, Pharmacy Manager
(727) 209-3500

Signed By Date

4/7/2016

340B Drug Pricing Program Database