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870 SOUTHERN DRUG CORP
STD331501 Doctors United group
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Covered Entity Details
Entity Name
Doctors United group
Subdivision Name
62nd
Type
Sexually Transmitted Diseases
340B ID
STD331501
Entity Address
714 NW 62nd street
Miami, FL 33150
Grant Number
NH25PS004342
Participating Start Date
1/1/2022
Last Recertification Date
5/5/2025
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
2/11/2022
Carve-In Effective Date
Contract Comments
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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