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SUNRISE PHARMACY OF KISSIMMEE LLC
STD347442 Florida Department of Health
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Covered Entity Details
Entity Name
Florida Department of Health
Subdivision Name
OSCEOLA COUNTY HEALTH DEPARTMENT
Type
Sexually Transmitted Diseases
340B ID
STD347442
Entity Address
1875 FORTUNE ROAD
KISSIMMEE, FL 34744
Grant Number
NH25PS005131
Participating Start Date
9/9/2005
Last Recertification Date
5/20/2025
Pharmacy Details
Pharmacy Name
SUNRISE PHARMACY OF KISSIMMEE LLC
Pharmacy Address
SUNRISE PHARMACY
4543 PLEASANT HILL RD STE D
KISSIMMEE, FL 34759-3406
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vianca McCluskey, Administrator
(407) 343-2020
Contract Pharmacy Representative
Pharma Buddies Corp
Nagesh Shakhamoori, CEO
(877) 592-7988
Signed By Date
10/14/2019
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