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BRIOVARX OF FLORIDA, INC
CAN100079-00 UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN100079-00
Entity Address
1475 NW 12th Avenue
2080A
Miami, FL 33136
Medicare Provider Number
100079
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
BRIOVARX OF FLORIDA, INC
Pharmacy Address
D/B/A BRIOVARX OF FLORIDA
9994 PREMIER PKWY
MIRAMAR, FL 33025
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/10/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Gittelman, CEO
(305) 326-6111
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
4/15/2019
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