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LORDONI DISCOUNT PHARMACY
STD329071 Doctor's Goodwill Foundation
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation
Subdivision Name
Malabar Medical Clinic
Type
Sexually Transmitted Diseases
340B ID
STD329071
Entity Address
1663 Georgia St. NE
400
Palm Pay, FL 32907
Grant Number
5H25PS004342
Participating Start Date
1/1/2020
Last Recertification Date
5/8/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
LORDONI DISCOUNT PHARMACY
Pharmacy Address
LORDONI DISCOUNT PHARMACY
6300 N WICKHAM RD STE 126
MELBOURNE, FL 32940-3294
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/8/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Lordoni Discount Pharmacy
Olu Oni, Pharmacist in Charge
(321) 610-3117
Signed By Date
1/15/2020
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