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SKYEMED-PALM BEACH, INC
RW423036 CHILDREN'S DIAGNOSTIC & TREATMENT CENTER
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Covered Entity Details
Entity Name
CHILDREN'S DIAGNOSTIC & TREATMENT CENTER
Subdivision Name
Type
Ryan White Part D
340B ID
RW423036
Entity Address
1401 SOUTH FEDERAL HWY
FT LAUDERDALE, FL 33316
Grant Number
H12HA24787
Participating Start Date
7/1/2009
Last Recertification Date
2/6/2024
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
SKYEMED-PALM BEACH, INC
Pharmacy Address
2330 S CONGRESS AVE, SUITE 237
WEST PALM BEACH, FL 33406-7608
Pharmacy Comments
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/29/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ana E. Calderon, ADMINISTRATOR
(954) 728-1060
Contract Pharmacy Representative
Deepak Ranade, President & Clinical Pharmacist
(866) 778-8255
Signed By Date
4/4/2017
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