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SUPERIOR PHARMACY OF TEMPLE TERRACE
STD336172 Doctor's Goodwill Foundation Inc
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation Inc
Subdivision Name
Superior Medical Clinic
Type
Sexually Transmitted Diseases
340B ID
STD336172
Entity Address
9780 N 56th St Ste C
Temple Terrace, FL 33617
Grant Number
H25PS005131
Participating Start Date
1/1/2021
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
SUPERIOR PHARMACY OF TEMPLE TERRACE
Pharmacy Address
DBA TEMPLE TERRACE PHARMACY
9780 N 56TH ST STE D
TEMPLE TERRACE, FL 33617-5508
Pharmacy Comments
Contract Details
Approval Date
12/1/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Superior Pharmacy
Ike Okeke, Owner
(813) 368-2746
Signed By Date
10/15/2020
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