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MAHANT RX INC
CAH101309-00 Hendry County Hospital Authority DBA Hendry Regional Medical Center
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Covered Entity Details
Entity Name
Hendry County Hospital Authority DBA Hendry Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH101309-00
Entity Address
524 W Sagamore Ave
Clewiston, FL 33440
Medicare Provider Number
101309
Participating Start Date
4/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
MAHANT RX INC
Pharmacy Address
DBA BELLE GLADE PHARMACY
136 S MAIN ST STE B
BELLE GLADE, FL 33430-3424
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Troy Eller, CFO
(863) 902-3082
Contract Pharmacy Representative
Mahant Rx, Inc
Dhruvang Patel, Vice President
(561) 571-9105
Signed By Date
7/14/2021
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