Contract Pharmacy Details

XINIM-CORP
STD321271 Doctor's Goodwill Foundation Inc

Covered Entity Details

Entity Name

Doctor's Goodwill Foundation Inc

Subdivision Name

Advanced Gastroenterology & Endoscopy Centers

Type

Sexually Transmitted Diseases

340B ID

STD321271

Entity Address

1690 Dunlawton Ave
Ste 210
Port Orange, FL 32127

Grant Number

H25PS005131

Participating Start Date

4/1/2020

Last Recertification Date

5/3/2021

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

XINIM-CORP

Pharmacy Address

HOLLY HILL PHARMACY
1702 RIDGEWOOD AVE STE C-G
HOLLY HILL, FL 32117

Pharmacy Comments

Contract Details

Approval Date

3/5/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/2/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212

Contract Pharmacy Representative

XINIM-Corp Holly Hill Pharmacy
Tom Hill, Pharmicist in Charge
(386) 677-7377

Signed By Date

3/5/2020

340B Drug Pricing Program Database