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HV33830 FLORIDA DEPARTMENT OF HEALTH in POLK COUNTY (Active)
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Main Details
Name
FLORIDA DEPARTMENT OF HEALTH in POLK COUNTY
Subdivision Name
Type
Ryan White Part C
340B ID
HV33830
Grant Number
H76HA00596
Additional Details
Current Program Status
Active
Registration Date
1/1/2001
Participating Start Date
1/1/2001
Participating Approval Date
9/23/2010
Last Recertification Date
2/12/2025
Time Period the Assistance was Received
4/1/2009 - 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
1290 GOLFVIEW AVENUE - 4TH FLOOR
BARTOW, FL 33830
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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2/24/2006 - ADDR CH (WAS 1290 S. GOLF VIEW AVE, AREA 14), ADDED SHIP TO (HEALTH DEPT. PHARMACY), REMOVED MEDICAID # (WAS 0279633-08)
09/23/2010
May 2025
May 2025
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