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HV33975E FDOH POLK (Active)
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Main Details
Name
FDOH POLK
Subdivision Name
Haines City Clinic
Type
Ryan White Part C
340B ID
HV33975E
Grant Number
H76HA00596
Additional Details
Current Program Status
Active
Registration Date
1/11/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/1/2019
Last Recertification Date
2/12/2025
Time Period the Assistance was Received
4/1/2018 - 3/31/2025
Contacts
Authorizing Official
Florida Department of Health
Nathan Scott Sjoblom, Assistant Director
(863) 578-2103
Primary Contact
Florida Department of Health
Gabriella Amador, Health Center Administrator
(863) 578-2243
Addresses
Street Address
1700 BAKER AVE EAST
HAINES CITY, FL 33844
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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May 2025
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