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870 SOUTHERN DRUG CORP
STD33030 Doctor United Group, Inc.
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Covered Entity Details
Entity Name
Doctor United Group, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33030
Entity Address
974 old dixie hwy
STE A
Homestead, FL 33030
Grant Number
NH25PS004342
Participating Start Date
1/1/2019
Last Recertification Date
5/22/2023
Entity Termination Date
7/1/2023
Pharmacy Details
Pharmacy Name
870 SOUTHERN DRUG CORP
Pharmacy Address
D/B/A AVITA PHARMACY 1064
924 MYRTLE AVE
BROOKLYN, NY 11206
Pharmacy Comments
Contract Details
Approval Date
2/8/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Augustine Carbon, President
(305) 788-0007
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
2/8/2022
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