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MAGGIE'S PHARMACY INC
STD33020 Comprehensive Health Center
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Covered Entity Details
Entity Name
Comprehensive Health Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33020
Entity Address
4101 S Hospital Drive
Suite 2
Plantation, FL 33317
Grant Number
NH25P5004342-04-01
Participating Start Date
1/1/2019
Last Recertification Date
5/1/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
MAGGIE'S PHARMACY INC
Pharmacy Address
7590 NW 186TH ST STE 109
HIALEAH, FL 33015
Pharmacy Comments
Contract Details
Approval Date
5/21/2020
Contract Begin Date
5/21/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mary Ballantine, Executive Director
(305) 688-0811
Contract Pharmacy Representative
Physician Preferred Pharmacy
Twiggi Batista Batista, CEO
(786) 523-8752
Signed By Date
5/21/2020
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