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  5. DIABETIC SUPPLY & SUPPORT, INC.

DIABETIC SUPPLY & SUPPORT, INC.

Company Details

Entity Name: DIABETIC SUPPLY & SUPPORT, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 29 Jun 2006 (19 years ago)
Date of dissolution: 11 Feb 2021 (4 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 11 Feb 2021 (4 years ago)
Document Number: P06000087936
FEI/EIN Number 205146397
Address: 10365 HOOD RD S, STE 103, JACKSONVILLE, FL, 32257
Mail Address: 10365 HOOD RD S, STE 103, JACKSONVILLE, FL, 32257
ZIP code: 32257
County: Duval
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1033134952 2006-07-12 2016-04-13 10365 HOOD RD S, SUITE 103, JACKSONVILLE, FL, 322573259, US 10365 HOOD RD S, SUITE 103, JACKSONVILLE, FL, 322573259, US

Contacts
Phone +1 904-448-3336

Authorized person
Name MRS. HOLLY NICOLE WALDROP
Role PRESIDENT
Phone 9044483336

Taxonomy
Taxonomy Code 332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary No
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
License Number PH26639
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 0319889900
State FL
Issuer MEDICAID
Number 606524935A
State GA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2018 205146397 2019-09-27 DIABETIC SUPPLY & SUPPORT, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9044483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Signature of
Role Plan administrator
Date 2019-09-27
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2018 205146397 2019-09-27 DIABETIC SUPPLY & SUPPORT, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9014483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Signature of
Role Plan administrator
Date 2019-09-27
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2017 205146397 2018-07-09 DIABETIC SUPPLY & SUPPORT, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9044483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Signature of
Role Plan administrator
Date 2018-07-09
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2016 205146397 2017-07-11 DIABETIC SUPPLY & SUPPORT, INC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9044483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Signature of
Role Plan administrator
Date 2017-07-11
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-11
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2015 205146397 2016-07-28 DIABETIC SUPPLY & SUPPORT, INC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9044483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-28
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2014 205146397 2015-09-30 DIABETIC SUPPLY & SUPPORT, INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9044483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Signature of
Role Plan administrator
Date 2015-09-30
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-09-30
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2013 205146397 2014-07-30 DIABETIC SUPPLY & SUPPORT, INC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9044483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Signature of
Role Plan administrator
Date 2014-07-30
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2012 205146397 2013-06-28 DIABETIC SUPPLY & SUPPORT, INC 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9044483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Signature of
Role Plan administrator
Date 2013-06-28
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-28
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature
DIABETIC SUPPLY & SUPPORT, INC. 401(K) PLAN 2011 205146397 2012-10-16 DIABETIC SUPPLY & SUPPORT, INC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2008-10-01
Business code 423990
Sponsor’s telephone number 9044483336
Plan sponsor’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257

Plan administrator’s name and address
Administrator’s EIN 205146397
Plan administrator’s name DIABETIC SUPPLY & SUPPORT, INC
Plan administrator’s address 10365 HOOD ROAD S, UNIT 103, JACKSONVILLE, FL, 32257
Administrator’s telephone number 9044483336

Signature of
Role Plan administrator
Date 2012-10-16
Name of individual signing VIVIAN GURGIS
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
WALDROP HOLLY Agent 10365 HOOD RD S, JACKSONVILLE, FL, 32257

Director

Name Role Address
WALDROP HOLLY Director 3860 Doctor's Lake Dr, Orange Park, FL, 32073
GURGIS VIVIAN Director 113 SEA ISLAND DR, PONTE VEDRA, FL, 32082

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2021-02-11 No data No data
CHANGE OF PRINCIPAL ADDRESS 2012-01-04 10365 HOOD RD S, STE 103, JACKSONVILLE, FL 32257 No data
CHANGE OF MAILING ADDRESS 2012-01-04 10365 HOOD RD S, STE 103, JACKSONVILLE, FL 32257 No data
REGISTERED AGENT NAME CHANGED 2012-01-04 WALDROP, HOLLY No data
REGISTERED AGENT ADDRESS CHANGED 2012-01-04 10365 HOOD RD S, STE 103, JACKSONVILLE, FL 32257 No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J14000703768 TERMINATED 1000000631585 DUVAL 2014-05-23 2034-05-29 $ 2,649.31 STATE OF FLORIDA, DEPARTMENT OF REVENUE, JACKSONVILLE SERVICE CENTER, 921 N DAVIS ST STE 250A, JACKSONVILLE FL322096825

Documents

Name Date
VOLUNTARY DISSOLUTION 2021-02-11
ANNUAL REPORT 2020-01-16
ANNUAL REPORT 2019-02-05
ANNUAL REPORT 2018-01-11
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-01-12
ANNUAL REPORT 2015-01-08
ANNUAL REPORT 2014-01-02
ANNUAL REPORT 2013-01-08
ANNUAL REPORT 2012-01-04

Related by officers

WALDROP HOLLY

B & H LEASING SERVICES, INC.

GURGIS VIVIAN

ALL CLEAR EMPLOYEE SCREENING, INC.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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