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STATE OF FLORIDA DEPARTMENT OF HEALTH DO
RWIID32304 FLORIDA DEPARTMENT OF HEALTH
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Covered Entity Details
Entity Name
FLORIDA DEPARTMENT OF HEALTH
Subdivision Name
AIDS Drug Assistance Program (ADAP)
Type
Ryan White Part B ADAP Direct Purchase
340B ID
RWIID32304
Entity Address
4052 BALD CYPRESS WAY
BIN A-09
TALLAHASSEE, FL 32399
Grant Number
X07HA00057
Participating Start Date
1/1/2009
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
STATE OF FLORIDA DEPARTMENT OF HEALTH DO
Pharmacy Address
DOH BROWARD
2421 SW 6 AVENUE
FORT LAUDERDALE, FL 33315
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JIMMY ROGER LLAQUE, ADAP STATE PROGRAM DIRECTOR
(850) 545-6836
Contract Pharmacy Representative
Florida Department of Health - Broward County
Matthew Allen Reik, Pharmacy Director
(954) 650-9777
Signed By Date
7/12/2022
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