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SUNRISE PHARMACY OF KISSIMMEE LLC
STD328059 Positive Assistance, Inc.
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Covered Entity Details
Entity Name
Positive Assistance, Inc.
Subdivision Name
Positive Assistance Health Center
Type
Sexually Transmitted Diseases
340B ID
STD328059
Entity Address
750 S. Orange Blossom Trail
Suite 222
Orlando, FL 32805
Grant Number
5NU62PS924532-02
Participating Start Date
7/1/2019
Last Recertification Date
5/15/2024
Pharmacy Details
Pharmacy Name
SUNRISE PHARMACY OF KISSIMMEE LLC
Pharmacy Address
SUNRISE PHARMACY
4543 PLEASANT HILL RD STE D
KISSIMMEE, FL 34759-3406
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andre Junior Antenor, President
(863) 242-3322
Contract Pharmacy Representative
Sunrise Pharmacy
Ajay Kolla, CEO
(407) 343-4434
Signed By Date
7/12/2019
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