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ANGELS PHARMACY III LLC
STD327961 Doctor's Goodwill Foundation
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation
Subdivision Name
Hope Recovery Clinic
Type
Sexually Transmitted Diseases
340B ID
STD327961
Entity Address
123 S. Park Ave.
Titusville, FL 32796
Grant Number
5H25PS004342
Participating Start Date
1/1/2020
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
ANGELS PHARMACY III LLC
Pharmacy Address
7455 S US HIGHWAY 1 STE A
TITUSVILLE, FL 32780
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
2/14/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Angel's Pharmacy I Inc.
Rajendra Patel, CEO
(407) 426-7000
Signed By Date
10/14/2019
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