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ELSA PHARMACY INC
STD333012 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
STD333012
Entity Address
3215 NW 10th Terrace
Suite 209-B
Oakland Park, FL 33301
Grant Number
NH25PS004342
Participating Start Date
7/1/2019
Last Recertification Date
5/10/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
ELSA PHARMACY INC
Pharmacy Address
1802 E 4TH AVE
HIALEAH, FL 33010
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
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
Elsa Pharmacy Inc
David Sampedro, Pharmacy Manager
(305) 691-1968
Signed By Date
7/15/2020
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