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BALAJI PHARMA LLC
STD335113 Doctor's Goodwill Foundation Inc
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Covered Entity Details
Entity Name
Doctor's Goodwill Foundation Inc
Subdivision Name
Santurce
Type
Sexually Transmitted Diseases
340B ID
STD335113
Entity Address
500 Vonderburg Dr #305E
Brandon, FL 33511
Grant Number
H25PS005131
Participating Start Date
8/21/2020
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
BALAJI PHARMA LLC
Pharmacy Address
D/B/A PALM PLAZA PHARMACY
162 N. PARSONS AVE.
BRANDON, FL 33510
Pharmacy Comments
Contract Details
Approval Date
5/16/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Palm Plaza Pharmacy.
Dipesh Patel, Owner
(813) 689-7700
Signed By Date
5/16/2023
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