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POMP PHARMACY LLC
STD33319 Independent Medical Group, LLC
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Covered Entity Details
Entity Name
Independent Medical Group, LLC
Subdivision Name
Inverrary
Type
Sexually Transmitted Diseases
340B ID
STD33319
Entity Address
3800 Inverrary Blvd
Ste. 400R
Lauderhill, 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
POMP PHARMACY LLC
Pharmacy Address
POMPANO PHARMACY
60 NE 1ST ST
POMPANO BEACH, FL 33060
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
10/17/2022
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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