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BALAJI PHARMA 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
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
5/15/2024
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
Palm Plaza Pharmacy.
Dipesh Patel, Owner
(813) 689-7700
Signed By Date
4/12/2024
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