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CITI EXPRESS PHARMACY AND MEDICAL SUPPLI
STD33142 Doctors United Group Inc
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Covered Entity Details
Entity Name
Doctors United Group Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33142
Entity Address
1498 NW 54th Street
Suite C
Miami, FL 33142
Grant Number
NH25PS004342
Participating Start Date
7/1/2019
Last Recertification Date
5/4/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
CITI EXPRESS PHARMACY AND MEDICAL SUPPLI
Pharmacy Address
4217 CHURCH AVE
BROOKLYN, NY 11203
Pharmacy Comments
Contract Details
Approval Date
7/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Augustine Carbon, President
(305) 206-6196
Contract Pharmacy Representative
Citi Express Pharmacy and Medical Supplies, LLC
Marlyjean Raymond-Joseph, Head pharmacist
(718) 355-8800
Signed By Date
7/10/2020
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