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BENZER FL3 LLC
STD32256 Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
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Covered Entity Details
Entity Name
Healthy MD Clinical, LLC (f.k.a. Independent Medical Group, LLC)
Subdivision Name
Jacksonville
Type
Sexually Transmitted Diseases
340B ID
STD32256
Entity Address
7933 Baymeadows Way
Ste 7
Jacksonville, FL 32256
Grant Number
NH25PS004342-04-01
Participating Start Date
1/1/2024
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
BENZER FL3 LLC
Pharmacy Address
ELITE PHARMACY
901 W INDIANTOWN RD STE 23
JUPITER, FL 33458
Pharmacy Comments
Contract Details
Approval Date
11/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steve Vixamar, COO
(954) 529-1178
Contract Pharmacy Representative
Benzer fl 3 llc
Tejas Patel, Pharmacist
(561) 529-2851
Signed By Date
10/16/2023
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