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PINES HEALTH MART PHARMACY
STD33016 Doctors United Group Inc
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Covered Entity Details
Entity Name
Doctors United Group Inc
Subdivision Name
Doctors United Group Inc hialeah
Type
Sexually Transmitted Diseases
340B ID
STD33016
Entity Address
2150 W 76th street
suite 100
hialeah, FL 33016
Grant Number
NH25PS004342
Participating Start Date
10/1/2021
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
PINES HEALTH MART PHARMACY
Pharmacy Address
2301 N UNIVERSITY DR STE 112
PEMBROKE PINES, FL 33024-3617
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
11/21/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Augustine Carbon, President
(305) 788-0007
Contract Pharmacy Representative
Pineshealthmartpharmacy@gmail.com
Arshad Mohammed, Pharmacist/ owner
(954) 404-6610
Signed By Date
10/14/2022
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