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GUARDIAN PHARMACY LLC
STD328059 Positive Assistance, Inc.
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Covered Entity Details
Entity Name
Positive Assistance, Inc.
Subdivision Name
Positive Assistance Health Center
Type
Sexually Transmitted Diseases
340B ID
STD328059
Entity Address
750 S. Orange Blossom Trail
Suite 222
Orlando, FL 32805
Grant Number
5NU62PS924532-02
Participating Start Date
7/1/2019
Last Recertification Date
5/15/2024
Pharmacy Details
Pharmacy Name
GUARDIAN PHARMACY LLC
Pharmacy Address
483 N SEMORAN BLVD STE 109
WINTER PARK, FL 32792-3800
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
Andre Junior Antenor, President
(863) 242-3322
Contract Pharmacy Representative
Guardian Pharmacy LLC
Siva Kondapalli, President
(407) 790-4509
Signed By Date
10/14/2019
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