Implementing evidence-based public health strategies results in a greater likelihood of success for local health departments and is consistent with health department accreditation standards. Social media has the potential to allow local health departments to connect with one another and share evidence-based strategies. We sought to examine patterns of social media connections among local health departments on Twitter. Descriptive and visual network approaches were used to examine the network; exponential random graph modeling was used to model the likelihood of a Twitter connection between departments. Larger departments were central to the network and departments sharing a border were more likely connected, as were health departments in the same state. Dissemination across this network would be facilitated by larger departments and between departments in the same state. By developing the network beyond these typical connections, health departments could be exposed to new strategies or new ways of implementing existing strategies.