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PRONTO-MED INC
STD330601 Independent Medical Group, LLC
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Covered Entity Details
Entity Name
Independent Medical Group, LLC
Subdivision Name
Coconut Creek
Type
Sexually Transmitted Diseases
340B ID
STD330601
Entity Address
3880 Coconut Creek Parkway
Unit 100
Coconut Creek, FL 33060
Grant Number
NH25PS004342-04-01
Participating Start Date
9/19/2019
Last Recertification Date
5/18/2022
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
9/19/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2021
Ownership change
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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