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BRIOVARX OF MAINE INC
CAN100079-00 UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY OF MIAMI HOSPITAL AND CLINICS
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN100079-00
Entity Address
1475 NW 12th Avenue
2080A
Miami, FL 33136
Medicare Provider Number
100079
Participating Start Date
1/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
BRIOVARX OF MAINE INC
Pharmacy Address
DBA BRIOVARX
53 DARLING AVE
SOUTH PORTLAND, ME 04106
Pharmacy Comments
Contract Details
Approval Date
1/16/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/10/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Gittelman, CEO
(305) 326-6111
Contract Pharmacy Representative
Briova Rx
Joe Iovino, Manager
(412) 445-4495
Signed By Date
1/16/2018
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