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KAILASH PHARMACY LLC
STD321172 Live Love Life, Inc
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Covered Entity Details
Entity Name
Live Love Life, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD321172
Entity Address
1702 Ridgewood Ave
Suite J
Holly Hill, FL 32117
Grant Number
NH25PS005131
Participating Start Date
7/1/2020
Last Recertification Date
5/13/2024
Pharmacy Details
Pharmacy Name
KAILASH PHARMACY LLC
Pharmacy Address
COMMUNITY PHARMACY OF HOLLY HILL
1107 N NOVA RD
DAYTONA BEACH, FL 32117
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARK A WALCZYK, CHIEF EXECUTIVE OFFICER
(585) 233-0105
Contract Pharmacy Representative
KAILASH PHARMACY LLC
KALPESH PATEL, PHARMACY OWNER
(321) 946-6332
Signed By Date
1/15/2025
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