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IC PHARMACY LLC
CHC12859 HEART OF FLORIDA HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
HEART OF FLORIDA HEALTH CENTER, INC.
Subdivision Name
Heart of Florida Health Center
Type
HRSA-Funded Health Center
340B ID
CHC12859
Entity Address
1025 SW 1st Avenue
Ocala, FL 34471-0900
Grant Number
H80CS12859
Participating Start Date
10/1/2011
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
IC PHARMACY LLC
Pharmacy Address
AMAZON PHARMACY #004
34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYN, NY 11232
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matt Clay, CEO
(352) 433-2867
Contract Pharmacy Representative
PillPack by Amazon Pharmacy
John Lavin, Vice President
(714) 380-0579
Signed By Date
1/16/2024
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