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DS RX LLC
STD335115 Doctor's Goodwill Foundation Inc
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation Inc
Subdivision Name
Dr. Prasad Gastro
Type
Sexually Transmitted Diseases
340B ID
STD335115
Entity Address
1172 Nikki View Dr
Brandon, FL 33511
Grant Number
H25PS005131
Participating Start Date
4/1/2021
Last Recertification Date
5/7/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
DS RX LLC
Pharmacy Address
ACME PHARMACY
1548 E FOWLER AVE
TAMPA, FL 33612-5416
Pharmacy Comments
Contract Details
Approval Date
2/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Acme Pharmacy 2
Siddharth Patel, Owner
(813) 966-3195
Signed By Date
1/5/2021
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