Contract Pharmacy Details

MAGGIE'S PHARMACY INC
STD33142 Doctors United Group Inc

Covered Entity Details

Entity Name

Doctors United Group Inc

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD33142

Entity Address

1498 NW 54th Street
Suite C
Miami, FL 33142

Grant Number

NH25PS004342

Participating Start Date

7/1/2019

Last Recertification Date

5/4/2021

Entity Termination Date

7/1/2022

Pharmacy Details

Pharmacy Name

MAGGIE'S PHARMACY INC

Pharmacy Address

7590 NW 186TH ST STE 109
HIALEAH, FL 33015

Pharmacy Comments

Contract Details

Approval Date

5/20/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Augustine Carbon, President
(305) 206-6196

Contract Pharmacy Representative

None
Michael Bogdan, Mgr
(954) 552-1003

Signed By Date

4/12/2019