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ADVANCECARE WEST HOLLYWOOD INC
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
ADVANCECARE WEST HOLLYWOOD INC
Pharmacy Address
MISTR
8700 SANTA MONICA BLVD
WEST HOLLYWOOD, CA 90069
Pharmacy Comments
Contract Details
Approval Date
6/29/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Augustine Carbon, President
(305) 788-0007
Contract Pharmacy Representative
AdvanceCare Pharmacy
Kyle Bernier, Director of Operations
(508) 971-8380
Signed By Date
6/29/2023
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