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MAHANT RX INC
STD334831 Treatment Outreach Program, Inc.
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Covered Entity Details
Entity Name
Treatment Outreach Program, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD334831
Entity Address
100 E Linton Blvd.
504B & 503A
Delray Beach, FL 33483
Grant Number
NH25PS004342
Participating Start Date
1/1/2018
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
MAHANT RX INC
Pharmacy Address
DBA BELLE GLADE PHARMACY
136 S MAIN ST STE B
BELLE GLADE, FL 33430-3424
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Demora Smith, Director
(561) 265-5306
Contract Pharmacy Representative
Mahant Rx, Inc
Dhruvang Patel, Vice President
(561) 571-9105
Signed By Date
10/15/2019
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