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SIDDH INC
CH041700 COLLIER HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
COLLIER HEALTH SERVICES, INC.
Subdivision Name
COLLIER HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH041700
Entity Address
1454 Madison Ave W
Immokalee, FL 34142-2200
Grant Number
H80CS00735
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
SIDDH INC
Pharmacy Address
TOWN PHARMACY
107 W MAIN ST
IMMOKALEE, FL 34142-3414
Pharmacy Comments
Contract Details
Approval Date
7/9/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mike Ellis, President/CEO
(239) 658-3158
Contract Pharmacy Representative
Mahendra Chaudhari, Owner
(239) 658-1048
Signed By Date
7/9/2015
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