| Entity Name: | COMMCARE PHARMACY - FTL, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Sep 2005 (19 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 20 Nov 2015 (9 years ago) |
| Document Number: | L05000094583 |
| FEI/EIN Number | 20-3555611 |
| Mail Address: | 13034 Ballantyne Corporate Place, Charlotte, NC, 28277, US |
| Address: | 855 SW 78th Avenue, Suite C100, Plantation, FL, 33324, US |
| ZIP code: | 33324 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | COMMCARE PHARMACY - FTL, LLC, ALABAMA | 000-536-445 | ALABAMA |
| Headquarter of | COMMCARE PHARMACY - FTL, LLC, NEW YORK | 4859445 | NEW YORK |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1598762015 | 2005-06-30 | 2022-07-21 | 855 SW 78TH AVE, STE C100, PLANTATION, FL, 33324, US | 855 SW 78TH AVE, STE C100, PLANTATION, FL, 333243223, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-568-6212 |
| Fax | 9545682765 |
Authorized person
| Name | MR. ROBERT GEORGE RAFFALO JR. |
| Role | C.O.O. |
| Phone | 9542842384 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | NRX0000870 |
| State | DC |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 054.016610 |
| State | IL |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | A9-0001012 |
| State | DE |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 3817 |
| State | IA |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH21660 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 64000929A |
| State | IN |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PHNR000479 |
| State | GA |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 897 |
| State | CT |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 22-44984 |
| State | KS |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PMP591 |
| State | HI |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 5788 |
| State | CO |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | Y005081 |
| State | AZ |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 106493 |
| State | AK |
| Is Primary | Yes |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | NRP1817 |
| State | CA |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | 2293MS |
| State | ID |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031179100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 691438100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 031179101 |
| State | FL |
| Issuer | PK |
| Number | 2010319 |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 S. PINE ISLAND ROAD, PLANTATION, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| McKasson Craig | Manager | 855 SW 78th Avenue, Plantation, FL, 33324 |
| Alkire Michael | Manager | 855 SW 78th Avenue, Plantation, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| McKasson Craig | Treasurer | 855 SW 78th Avenue, Plantation, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| Alkire Michael | President | 855 SW 78th Avenue, Plantation, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| Goulding Sheila | Corp | 855 SW 78th Avenue, Plantation, FL, 33324 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000014393 | COMMCARE SPECIALTY PHARMACY | EXPIRED | 2016-02-09 | 2021-12-31 | No data | 855 SW 78 AVE., STE C100, PLANATION, FL, 33324 |
| G09110900210 | PULMONARY PRESCRIPTION PROVIDERS | EXPIRED | 2009-04-20 | 2014-12-31 | No data | 2817 EAST OAKLAND PARK BLVD., SUITE 303, FT. LAUDERDALE, FL, 33306 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-03 | 855 SW 78th Avenue, Suite C100, Plantation, FL 33324 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-03 | 855 SW 78th Avenue, Suite C100, Plantation, FL 33324 | No data |
| LC AMENDMENT | 2015-11-20 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-04-06 | 1200 S. PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-04-06 | CT CORPORATION SYSTEM | No data |
| LC AMENDED AND RESTATED ARTICLES | 2009-03-27 | No data | No data |
| LC NAME CHANGE | 2006-10-27 | COMMCARE PHARMACY - FTL, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-02-24 |
| ANNUAL REPORT | 2022-03-22 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-05-02 |
| ANNUAL REPORT | 2019-03-27 |
| ANNUAL REPORT | 2018-04-04 |
| ANNUAL REPORT | 2017-04-06 |
| AMENDED ANNUAL REPORT | 2016-08-26 |
| AMENDED ANNUAL REPORT | 2016-08-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
