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BALAJI PHARMA 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
Pharmacy Details
Pharmacy Name
BALAJI PHARMA LLC
Pharmacy Address
D/B/A PALM PLAZA PHARMACY
162 N. PARSONS AVE.
BRANDON, FL 33510
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
8/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Palm Plaza Pharmacy
Dhwanit Sahita, Manager
(813) 689-7700
Signed By Date
1/5/2021
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