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LARKIN COMMUNITY HOSPITAL PALM SPRINGS C
STD33012 Project Access Foundation, Inc
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Covered Entity Details
Entity Name
Project Access Foundation, Inc
Subdivision Name
Hialeah Medical
Type
Sexually Transmitted Diseases
340B ID
STD33012
Entity Address
1435 W 49TH STREET
503
HIALEAH, FL 33012
Grant Number
NH25PS004342-04-01
Participating Start Date
10/1/2018
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
LARKIN COMMUNITY HOSPITAL PALM SPRINGS C
Pharmacy Address
1475 W 49TH ST
HIALEAH, FL 33012
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jorge Carballo, CEO
(954) 445-2902
Contract Pharmacy Representative
LARKIN COMMUNITY HOSPITAL PALM SPRINGS CAMPUS
GIJO MATHEW, DIRECTOR OF PHARMACY
(305) 824-4728
Signed By Date
10/12/2023
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