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870 SOUTHERN DRUG CORP
STD328089 Doctors United Group Inc
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Covered Entity Details
Entity Name
Doctors United Group Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD328089
Entity Address
3300 W Colonial Drive
Orlando, FL 32808
Grant Number
NH25PS004342
Participating Start Date
1/1/2020
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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