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PHARMA, LLC
STD33870 Doctor's Goodwill Foundation Inc
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation Inc
Subdivision Name
Advanced Gastro & Hep Sebring
Type
Sexually Transmitted Diseases
340B ID
STD33870
Entity Address
3581 S Highlands Ave
Sebring, FL 33870
Grant Number
H25PS005131
Participating Start Date
7/1/2020
Last Recertification Date
5/11/2022
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
PHARMA, LLC
Pharmacy Address
SEBRING PHARMACY
3023 US HIGHWAY 27 N
SEBRING, FL 33870-1630
Pharmacy Comments
Contract Details
Approval Date
10/7/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Sebring Pharmacy
Pinel Shah, Owner
(863) 471-0007
Signed By Date
10/7/2020
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