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BAYCARE HOME CARE, INC.
RWI33614 St Josephs Hospital
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Covered Entity Details
Entity Name
St Josephs Hospital
Subdivision Name
Tampa Care Clinic
Type
Ryan White Part A
340B ID
RWI33614
Entity Address
4600 North Habana Avenue
Suite 15
Tampa, FL 33614
Grant Number
H89HA00024
Participating Start Date
7/1/2016
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
BAYCARE HOME CARE, INC.
Pharmacy Address
D/B/A BAYCARE PHARMACY
3003 W DR MARTIN LUTHER KING JR. BLVD
TAMPA, FL 33607
Pharmacy Comments
Contract Details
Approval Date
4/20/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2017
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Iqbal Burney, Director of Pharmacy
(727) 394-6577
Signed By Date
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