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ECKERDS RX 108 LLC
STD335113 Doctor's Goodwill Foundation Inc
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation Inc
Subdivision Name
Santurce
Type
Sexually Transmitted Diseases
340B ID
STD335113
Entity Address
500 Vonderburg Dr #305E
Brandon, FL 33511
Grant Number
H25PS005131
Participating Start Date
8/21/2020
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
ECKERDS RX 108 LLC
Pharmacy Address
ECKERDS PHARMACY 108
14614 LIVINGSTON AVE
LUTZ, FL 33559
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/25/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Eckerd's Pharmacy
Vikram Rao, Administrator
(941) 900-4410
Signed By Date
7/15/2021
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