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DS RX LLC
STD335113 Doctor's Goodwill Foundation Inc
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation Inc
Subdivision Name
Santurce
Type
Sexually Transmitted Diseases
340B ID
STD335113
Entity Address
500 Vonderburg Dr #305E
Brandon, FL 33511
Grant Number
H25PS005131
Participating Start Date
8/21/2020
Last Recertification Date
6/2/2025
Pharmacy Details
Pharmacy Name
DS RX LLC
Pharmacy Address
ACME PHARMACY
1548 E FOWLER AVE
TAMPA, FL 33612-5416
Pharmacy Comments
Contract Details
Approval Date
8/5/2020
Contract Begin Date
8/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Acme Pharmacy 2
Siddharth Patel, Owner
(813) 966-3195
Signed By Date
7/2/2020
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