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PRONTO-MED INC
STD333052 Independent Medical Group, LLC
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Covered Entity Details
Entity Name
Independent Medical Group, LLC
Subdivision Name
Fort Lauderdale
Type
Sexually Transmitted Diseases
340B ID
STD333052
Entity Address
3800 Inverrary Blve
109
Fort Lauderdale, FL 33319
Grant Number
NH25PS004342-04-01
Participating Start Date
9/17/2019
Last Recertification Date
5/9/2022
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
PRONTO-MED INC
Pharmacy Address
BIO-CARE PHARMACY
1409 NE 26TH ST
WILTON MANORS, FL 33305-1321
Pharmacy Comments
Contract Details
Approval Date
9/17/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2021
Business decision by covered entity and/or pharmacy
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
9/17/2019
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