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BENZER FL3 LLC
STD336073 Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
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Covered Entity Details
Entity Name
Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
Subdivision Name
Lakeland
Type
Sexually Transmitted Diseases
340B ID
STD336073
Entity Address
3900 S. Florida Avenue
Suite 205
Lakeland, FL 33813
Grant Number
NH25PS004342-04-01
Participating Start Date
1/1/2021
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
BENZER FL3 LLC
Pharmacy Address
ELITE PHARMACY
901 W INDIANTOWN RD STE 23
JUPITER, FL 33458
Pharmacy Comments
Contract Details
Approval Date
11/18/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Vixamar, COO
(954) 529-1178
Contract Pharmacy Representative
Benzer fl 3 llc
Tejas Patel, Pharmacist
(561) 529-2851
Signed By Date
10/2/2020
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