| Entity Name: | ABACOA MEDICAL SUPPLIES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 17 Aug 2017 (7 years ago) |
| Document Number: | P17000069418 |
| FEI/EIN Number | 82-2517077 |
| Address: | 3100 NW BOCA RATON BLVD, #213, BOCA RATON, FL 33431 |
| Mail Address: | P O BOX 294009, BOCA RATON, FL 33429-4009 |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1619465689 | 2018-04-25 | 2024-05-15 | 3100 NW BOCA RATON BLVD STE 213, BOCA RATON, FL, 334316658, US | 3100 NW BOCA RATON BLVD STE 213, BOCA RATON, FL, 334316658, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-994-2302 |
| Fax | 8882044514 |
Authorized person
| Name | LAWRENCE A DICKSON |
| Role | PRESIDENT |
| Phone | 5619942302 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 2018106632 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
Other Provider Identifiers
| Issuer | PK |
| Number | 2177429 |
| Issuer | MEDICAID |
| Number | 2483871 |
| State | LA |
| Issuer | MEDICAID |
| Number | DM1616 |
| State | SC |
| Issuer | BOARD OF PHARMACY |
| Number | NPC-0004670 |
| State | OR |
| Issuer | MEDICAID |
| Number | 10026761200 |
| State | NE |
| Issuer | MEDICAID |
| Number | 300019499 |
| State | IN |
| Issuer | MEDICAID |
| Number | 500758565 |
| State | OR |
| Issuer | MEDICAID |
| Number | 067848214 |
| State | DC |
| Issuer | MEDICAID |
| Number | 0698636 |
| State | NJ |
| Issuer | MEDICAID |
| Number | 1480327 |
| State | ND |
| Issuer | MEDICAID |
| Number | 200806460A |
| State | OK |
| Issuer | MEDICAID |
| Number | 435148 |
| State | AZ |
| Issuer | MEDICAID |
| Number | 53407334 |
| State | NM |
| Issuer | MEDICAID |
| Number | 6710681 |
| State | VT |
| Issuer | MEDICAID |
| Number | 7100570080 |
| State | KY |
| Issuer | MEDICAID |
| Number | 900017037 |
| State | CO |
| Issuer | MEDICAID |
| Number | 0393111 |
| State | OH |
| Issuer | MEDICAID |
| Number | 101491800 |
| State | FL |
| Issuer | MEDICAID |
| Number | 151768600 |
| State | WY |
| Issuer | MEDICAID |
| Number | 250572523 |
| State | DE |
| Issuer | MEDICAID |
| Number | 282023400 |
| State | MD |
| Issuer | MEDICAID |
| Number | 396703601 |
| State | TX |
| Issuer | MEDICAID |
| Number | 006887 |
| State | HI |
| Issuer | MEDICAID |
| Number | 100092814 |
| State | WI |
| Issuer | MEDICAID |
| Number | 2124621 |
| State | WA |
| Issuer | MEDICAID |
| Number | 234796741 |
| State | AR |
| Issuer | NCPDP |
| Number | 5737727 |
| Issuer | MEDICAID |
| Number | 937133 |
| State | CA |
| Issuer | MEDICAID |
| Number | 006058509 |
| State | MS |
| Issuer | MEDICAID |
| Number | 620065893 |
| State | MO |
| Issuer | MEDICAID |
| Number | 3002474 |
| State | SD |
| Issuer | MEDICAID |
| Number | 003227252A |
| State | GA |
| Issuer | MEDICAID |
| Number | 1036577000001 |
| State | PA |
| Issuer | MEDICAID |
| Number | 225119 |
| State | AL |
| Issuer | MEDICAID |
| Number | 30004619230001 |
| State | KS |
| Issuer | MEDICAID |
| Number | Q047492 |
| State | TN |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ABACOA MEDICAL SUPPLIES INC. 401(K) PROFIT SHARING PLAN & TRU | 2023 | 822517077 | 2024-05-30 | ABACOA MEDICAL SUPPLIES, INC. | 6 | |||||||||||||||||||||||
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||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-05-30 |
| Name of individual signing | LAWRENCE DICKSON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 5612711645 |
| Plan sponsor’s address | 751 PARK OF COMMERCE, STE 138, BOCA RATON, FL, 33487 |
Signature of
| Role | Plan administrator |
| Date | 2023-06-26 |
| Name of individual signing | LAWRENCE DICKSON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 5612711645 |
| Plan sponsor’s address | 751 PARK OF COMMERCE DR - STE 138, BOCA RATON, FL, 33487 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-28 |
| Name of individual signing | LAWRENCE A DICKSON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 5612711645 |
| Plan sponsor’s address | 751 PARK OF COMMERCE DR - STE 138, BOCA RATON, FL, 33487 |
Signature of
| Role | Plan administrator |
| Date | 2021-05-07 |
| Name of individual signing | LAWRENCE A DICKSON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 5612711645 |
| Plan sponsor’s address | 751 PARK OF COMMERCE DR - STE 138, BOCA RATON, FL, 33487 |
Signature of
| Role | Plan administrator |
| Date | 2020-04-07 |
| Name of individual signing | LAWRENCE A DICKSON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 5612711645 |
| Plan sponsor’s address | 751 PARK OF COMMERCE DR - STE 138, BOCA RATON, FL, 33487 |
Signature of
| Role | Plan administrator |
| Date | 2019-07-23 |
| Name of individual signing | LAWRENCE DICKSON |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| DICKSON, LAWRENCE A | Agent | 3100 NW BOCA RATON BLVD, SUITE 213, BOCA RATON, FL 33431 |
| Name | Role | Address |
|---|---|---|
| DICKSON, CHRISTINA M | Vice President | 245 SOUTH COUNTRY CLUB BLVD, BOCA RATON, FL 33487 |
| Name | Role | Address |
|---|---|---|
| DICKSON, CHRISTINA M | Secretary | 245 SOUTH COUNTRY CLUB BLVD, BOCA RATON, FL 33487 |
| Name | Role | Address |
|---|---|---|
| DICKSON, LAWRENCE A | President | 834 NE BAY ISLE DR, BOCA RATON, FL 33487 |
| Name | Role | Address |
|---|---|---|
| DICKSON, LAWRENCE A | Treasurer | 834 NE BAY ISLE DR, BOCA RATON, FL 33487 |
| Name | Role | Address |
|---|---|---|
| DICKSON, JANINE C | DIRECTOR | 834 NE BAY ISLE DR, BOCA RATON, FL 33487 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-03 | 3100 NW BOCA RATON BLVD, SUITE 213, BOCA RATON, FL 33431 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-11 | 3100 NW BOCA RATON BLVD, #213, BOCA RATON, FL 33431 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-12 | 3100 NW BOCA RATON BLVD, #213, BOCA RATON, FL 33431 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-04 | DICKSON, LAWRENCE A | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-01-12 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-01-31 |
| ANNUAL REPORT | 2018-01-10 |
| Domestic Profit | 2017-08-17 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
