Contract Pharmacy Details

LARKIN COMMUNITY HOSPITAL PALM SPRINGS C
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

LARKIN COMMUNITY HOSPITAL PALM SPRINGS C

Pharmacy Address

1475 W 49TH ST
HIALEAH, FL 33012

Pharmacy Comments

Contract Details

Approval Date

10/14/2024

Contract Begin Date

10/16/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Larkin Community Hospital
Yoely Hernandez, Chief Executive Officer
(305) 284-7500

Signed By Date

10/14/2024

340B Drug Pricing Program Database