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POMP PHARMACY LLC
STD333081 Independent Medical Group, LLC
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Covered Entity Details
Entity Name
Independent Medical Group, LLC
Subdivision Name
East Commercial Blvd
Type
Sexually Transmitted Diseases
340B ID
STD333081
Entity Address
2151 E Commercial Blvd Suite 203
Fort Lauderdale, FL 33308
Grant Number
NH25PS004342-04-01
Participating Start Date
9/15/2019
Last Recertification Date
5/17/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
POMP PHARMACY LLC
Pharmacy Address
POMPANO PHARMACY
60 NE 1ST ST
POMPANO BEACH, FL 33060
Pharmacy Comments
Contract Details
Approval Date
9/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Steve Vixamar, COO
(954) 529-1178
Contract Pharmacy Representative
Benzer Pharmacy
Komal Patel, Pharmacist
(786) 615-8627
Signed By Date
9/12/2019
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