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MAHANT RX INC
STD33493 L.O.T. Health Services
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Covered Entity Details
Entity Name
L.O.T. Health Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33493
Entity Address
845 West Palm Beach Rd
South Bay, FL 33493
Grant Number
NH25PS005131
Participating Start Date
12/9/2019
Last Recertification Date
5/30/2024
Pharmacy Details
Pharmacy Name
MAHANT RX INC
Pharmacy Address
DBA BELLE GLADE PHARMACY
136 S MAIN ST STE B
BELLE GLADE, FL 33430-3424
Pharmacy Comments
Contract Details
Approval Date
11/20/2019
Contract Begin Date
10/9/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maggie Louis, Executive Director
(561) 693-5143
Contract Pharmacy Representative
Mahant Rx, Inc
Dhruvang Patel, Vice President
(561) 571-9105
Signed By Date
10/9/2019
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