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SUNRISE PHARMACY OF KISSIMMEE LLC
STD327031 Positive Assistance, INC.
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Covered Entity Details
Entity Name
Positive Assistance, INC.
Subdivision Name
Health Specialists Of Central Florida
Type
Sexually Transmitted Diseases
340B ID
STD327031
Entity Address
1120 S Park Ave
Orlando, FL 32703
Grant Number
5NU62PS924532-02
Participating Start Date
7/1/2020
Last Recertification Date
5/11/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
SUNRISE PHARMACY OF KISSIMMEE LLC
Pharmacy Address
SUNRISE PHARMACY
4543 PLEASANT HILL RD STE D
KISSIMMEE, FL 34759-3406
Pharmacy Comments
Contract Details
Approval Date
6/1/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Andre J Antenor, President
(863) 242-3322
Contract Pharmacy Representative
Sunrise Pharmacy
Ajay Kolla, CEO
(407) 343-4434
Signed By Date
5/29/2020
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