Contract Pharmacy Details

MAHEEM ENTERPRISE LLC
STD329402 Doctor's Goodwill Foundation

Covered Entity Details

Entity Name

Doctor's Goodwill Foundation

Subdivision Name

Omni - Melbourne Clinic

Type

Sexually Transmitted Diseases

340B ID

STD329402

Entity Address

6300 N. Wickham Rd.
132A
Melbourne, FL 32940

Grant Number

5H25PS004342

Participating Start Date

1/1/2020

Last Recertification Date

Entity Termination Date

4/1/2020

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

12/4/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
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