| Entity Name: | AETNA RX HOME DELIVERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 21 Jan 2003 (22 years ago) |
| Date of dissolution: | 14 Nov 2023 (a year ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 14 Nov 2023 (a year ago) |
| Document Number: | M03000000218 |
| FEI/EIN Number | N/A |
| Address: | 151 Farmington Avenue, Hartford, CT 06156 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427096809 | 2006-06-04 | 2019-03-01 | 1600 SW 80TH TER FL 2, PLANTATION, FL, 333244049, US | 1600 SW 80TH TER, 2ND FLOOR, PLANTATION, FL, 333244049, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 866-612-3862 |
| Phone | +1 954-693-2800 |
| Fax | 9546932905 |
Authorized person
| Name | TOKUNBO NIKE KASSIM |
| Role | DIR, PHARMACIST IN CHARGE |
| Phone | 9592993008 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| License Number | PH21465 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336M0002X - Mail Order Pharmacy |
| License Number | PH21465 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | PH21465 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Aetna Health Holdings, LLC | Sole Member | 151 Farmington Avenue, Hartford, CT 06156 |
| Name | Role | Address |
|---|---|---|
| Lee, Edward Chung-I | President | 151 Farmington Avenue, RW61, Hartford, CT 06156 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2023-11-14 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-12 | 151 Farmington Avenue, Hartford, CT 06156 | No data |
| Name | Date |
|---|---|
| WITHDRAWAL | 2023-11-14 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-05-04 |
| ANNUAL REPORT | 2019-03-22 |
| ANNUAL REPORT | 2018-04-03 |
| ANNUAL REPORT | 2017-04-03 |
| ANNUAL REPORT | 2016-04-01 |
| ANNUAL REPORT | 2015-04-09 |
Date of last update: 06 Jan 2025
Sources: Florida Department of State
