Contract Pharmacy Details

MAHEEM ENTERPRISE LLC
STD32826 Doctor's Goodwill Foundation

Covered Entity Details

Entity Name

Doctor's Goodwill Foundation

Subdivision Name

Avalon Medical Clinic

Type

Sexually Transmitted Diseases

340B ID

STD32826

Entity Address

14807 East Colonial Dr.
112
Orlando, FL 32826

Grant Number

5H25PS004342

Participating Start Date

1/1/2020

Last Recertification Date

Entity Termination Date

7/1/2020

Pharmacy Details

Pharmacy Name

MAHEEM ENTERPRISE LLC

Pharmacy Address

BABCOCK PHARMACY & SURGICALS
1515 PALM BAY RD STE 108
MELBOURNE, FL 32905

Pharmacy Comments

Contract Details

Approval Date

12/3/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212

Contract Pharmacy Representative

Babcock Pharmacy & Surgicals
Devang Modi, Owner/Manager
(321) 499-3999

Signed By Date

10/14/2019

340B Drug Pricing Program Database