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CCN AMERICA, LP
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
CCN AMERICA, LP
Pharmacy Address
COORDINATED CARE NETWORK PHARMACY
1500 W CYPRESS CREEK RD STE 203
FT LAUDERDALE, FL 33309
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
CCN AMERICA LP
Thomas J. Pollack, Vice President and CFO
(412) 349-6303
Signed By Date
2/16/2023
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