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DS RX LLC
STD33543 Doctors Goodwill Foundation, Inc.
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Covered Entity Details
Entity Name
Doctors Goodwill Foundation, Inc.
Subdivision Name
Traci's House
Type
Sexually Transmitted Diseases
340B ID
STD33543
Entity Address
904 East Henry Avenue
Tampa, FL 33543
Grant Number
NH25PS005131
Participating Start Date
7/1/2024
Last Recertification Date
6/2/2025
Pharmacy Details
Pharmacy Name
DS RX LLC
Pharmacy Address
ACME PHARMACY
1548 E FOWLER AVE
TAMPA, FL 33612-5416
Pharmacy Comments
Contract Details
Approval Date
5/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kantilal Bhalani, CEO
(321) 298-5531 Ext: 9414416212
Contract Pharmacy Representative
Acme Pharmacy
Dipal Patel, OWNER
(813) 971-6565
Signed By Date
4/12/2024
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