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ST.CLOUD PHARMACY&WELLNESS CENTER INC
CH0418990 PRIMARY CARE MEDICAL SERVICES OF POINCIANA, INC.
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Covered Entity Details
Entity Name
PRIMARY CARE MEDICAL SERVICES OF POINCIANA, INC.
Subdivision Name
PRIMARY CARE MEDICAL SERVICES OF POINCIA
Type
HRSA-Funded Health Center
340B ID
CH0418990
Entity Address
1877 Fortune Rd
Kissimmee, FL 34744-4428
Grant Number
H80CS30749
Participating Start Date
1/1/2009
Last Recertification Date
1/29/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
ST.CLOUD PHARMACY&WELLNESS CENTER INC
Pharmacy Address
ST.CLOUD PHARMACY&WELLNESS CENTER INC
2801 13TH STREET
SAINT CLOUD, FL 34769
Pharmacy Comments
Contract Details
Approval Date
11/20/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/14/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Belinda Johnson-Cornett, CEO
(407) 414-9760
Contract Pharmacy Representative
St. Cloud Pharmacy&Wellness Center
Siby Thomas Puthenpurayil, RPH
(407) 923-3867
Signed By Date
11/20/2017
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