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COMPREHENSIVE HEMATOLOGY ONCOLOGY PHARMA
STD327963 Doctor's Goodwill Foundation Inc
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation Inc
Subdivision Name
Comprehensive Hematology Oncology
Type
Sexually Transmitted Diseases
340B ID
STD327963
Entity Address
5000 Park St N Ste 1017
Saint Petersburg, FL 33709
Grant Number
H25PS005131
Participating Start Date
4/1/2021
Last Recertification Date
5/3/2021
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
COMPREHENSIVE HEMATOLOGY ONCOLOGY PHARMA
Pharmacy Address
COMPREHENSIVE HEMATOLOGY ONCOLOGY LLC
5000 PARK ST N STE 1025
ST PETERSBURG, FL 33709-2236
Pharmacy Comments
Contract Details
Approval Date
4/2/2021
Contract Begin Date
4/2/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
CHO
Suraj Patel, Manager
(850) 260-2470
Signed By Date
4/2/2021
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