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SUNRISE PHARMACY OF KISSIMMEE LLC
STD328101 Positive Assistance, Inc.
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Covered Entity Details
Entity Name
Positive Assistance, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD328101
Entity Address
5844 N Orange Blossom Trail
Orlando, FL 32810
Grant Number
5NU62PS924532-02
Participating Start Date
7/1/2019
Last Recertification Date
5/19/2020
Entity Termination Date
4/1/2021
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
Contract Termination Date
Termination Reason
4/1/2021
Covered Entity Terminated
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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