Contract Pharmacy Details

COMMUNITY HEALTH OF SOUTH FLORIDA, 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

COMMUNITY HEALTH OF SOUTH FLORIDA, INC

Pharmacy Address

MARATHON COMMUNITY HEALTH CENTER PHARMAC
2805 OVERSEAS HWY
MARATHON, FL 33050-2239

Pharmacy Comments

Contract Details

Approval Date

2/16/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Community Health of South Florida
Samuel K James, Pharmacy Director
(305) 254-7166 Ext: 4831

Signed By Date

2/16/2023

340B Drug Pricing Program Database