Contract Pharmacy Details

WINN DIXIE STORES, INC.
RWIID32304 FLORIDA DEPARTMENT OF HEALTH

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

WINN DIXIE STORES, INC.

Pharmacy Address

WINN DIXIE PHARMACY #199
703 CHAFFEE ROAD S
JACKSONVILLE, FL 32221

Pharmacy Comments

Contract Details

Approval Date

7/14/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/31/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

JIMMY ROGER LLAQUE, ADAP STATE PROGRAM DIRECTOR
(850) 545-6836

Contract Pharmacy Representative

Winn-Dixie Stores, Inc.
Gayle Shields, VP, Pharmacy
(904) 783-5000

Signed By Date

7/14/2022

340B Drug Pricing Program Database