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KAILASHRX LLC
STD321146 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
STD321146
Entity Address
1445 Dunn Ave
Suite B
Daytona Beach, FL 32114
Grant Number
NH25PS005131
Participating Start Date
4/1/2025
Last Recertification Date
5/30/2025
Pharmacy Details
Pharmacy Name
KAILASHRX LLC
Pharmacy Address
DBA: COMMUNITY PHARMACY OF DELTONA
1240 PROVIDENCE BLVD UNIT 1&2
DELTONA, FL 32725
Pharmacy Comments
Contract Details
Approval Date
3/4/2025
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
Deltona Pharmacy
jayesh mehta, Pharmacy
(407) 729-2870
Signed By Date
3/4/2025
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