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SUNRISE PHARMACY OF KISSIMMEE LLC
STD328181 Positive Assistance, Inc.
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Covered Entity Details
Entity Name
Positive Assistance, Inc.
Subdivision Name
Positive Assistance
Type
Sexually Transmitted Diseases
340B ID
STD328181
Entity Address
7156 W Colonial Drive
Orlando, FL 32818
Grant Number
5nu62ps924532-02
Participating Start Date
4/1/2021
Last Recertification Date
5/15/2024
Pharmacy Details
Pharmacy Name
SUNRISE PHARMACY OF KISSIMMEE LLC
Pharmacy Address
SUNRISE PHARMACY
4543 PLEASANT HILL RD STE D
KISSIMMEE, FL 34759-3406
Pharmacy Comments
Contract Details
Approval Date
4/10/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andre J Antenor, President
(863) 242-3322
Contract Pharmacy Representative
Sunrise Pharmacy
Ajay Kolla, CEO
(407) 343-4434
Signed By Date
4/10/2021
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