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MAHANT RX INC
STD333055 The Poverello Center Inc.
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Covered Entity Details
Entity Name
The Poverello Center Inc.
Subdivision Name
EXTRA Care Clinic
Type
Sexually Transmitted Diseases
340B ID
STD333055
Entity Address
2056 N Dixie Hwy
Wilton Manors, FL 33305
Grant Number
NH25PS005131
Participating Start Date
2/9/2022
Last Recertification Date
5/10/2024
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
2/9/2022
Contract Begin Date
2/9/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas S Pietrogallo, CEO
(954) 561-3663 Ext: 101
Contract Pharmacy Representative
Mahant Rx, Inc
Dhruvang Patel, Vice President
(561) 571-9105
Signed By Date
1/17/2022
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