Covered Entity Details

Comprehensive Health Center, LLC (Rejected) - information as of 4/23/2025 10:53:29 PM

Main Details

Name

Comprehensive Health Center, LLC

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

Grant Number

NH25P5004342-04-01

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.
Lab services and HIV,STD and Hep-C testing kits also training on all services
1/9/2018 - 5/7/2025

Additional Details

Current Program Status

Rejected

Registration Date

1/14/2025

Participating Start Date

Participating Approval Date

Last Recertification Date

Notice of Funding Opportunity (NOFO) Number

PS19-1901

Contacts

Authorizing Official

Comprehensive Health Center, LLC
Mary Ballantine, Executive Director
(305) 688-0811

Primary Contact

Comprehensive Health Center
Rudolph Moise, CEO
(305) 219-3582

Addresses

Street Address

10004 North Dale Mabry Hwy
Ste 101
Tampa, FL 33618

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update	New Registration	Pending	Rejected	2/19/2025 11:52 AM
Addresses	Main Address	Insert	New Registration		10004 North Dale Mabry Hwy Ste 101 Tampa, FL 33618	2/17/2025 11:36 AM
Addresses	Main Address	Insert	New Registration		10004 North Dale Mabry Hwy Ste 101 Tampa, FL 33618	1/14/2025 11:36 AM
Details	Nature of Support: In Kind Support Description	Insert	New Registration		Lab services and HIV,STD and Hep-C testing kits also training on all services	1/14/2025 11:36 AM
Details	Nature Of Support	Insert	New Registration		In-Kind products or services (see note below; must have been purchased with section 318 funds)	1/14/2025 11:36 AM
Details	Nature of Support: Support Received From Date	Insert	New Registration		1/9/2018 12:00:00 AM	1/14/2025 11:36 AM
Details	Nature of Support: Support Received To Date	Insert	New Registration		5/7/2025 12:00:00 AM	1/14/2025 11:36 AM
Contacts	Authorizing Official	Insert	New Registration		Ballantine, Mary Executive Director Comprehensive Health Center, LLC 3056880811	1/14/2025 11:36 AM
Contacts	Primary Contact	Insert	New Registration		Moise, Rudolph CEO Comprehensive Health Center 3052193582	1/14/2025 11:36 AM
Details	Assistance Received From Date	Insert	New Registration			1/14/2025 11:36 AM
Details	Assistance Received To Date	Insert	New Registration			1/14/2025 11:36 AM
Details	Last Recertification Date	Insert	New Registration			1/14/2025 11:36 AM
Details	Grant Number	Insert	New Registration		NH25P5004342-04-01	1/14/2025 11:36 AM
Details	340B ID	Insert	New Registration			1/14/2025 11:36 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2025 11:36 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2025 11:36 AM
Details	Medicare Provider Number	Insert	New Registration			1/14/2025 11:36 AM
Details	Entity Name	Insert	New Registration		Comprehensive Health Center, LLC	1/14/2025 11:36 AM
Details	NOFO Number	Insert	New Registration		PS19-1901	1/14/2025 11:36 AM
Details	Program Code	Insert	New Registration		STD	1/14/2025 11:36 AM
Details	Entity Subname	Insert	New Registration			1/14/2025 11:36 AM
Dates	Participating Approval Date	Insert	New Registration			1/14/2025 11:36 AM
Details	State	Insert	New Registration		Pending	1/14/2025 11:36 AM
Dates	Registration Date	Insert	New Registration		1/14/2025 11:36:08 AM	1/14/2025 11:36 AM
Dates	Signed By Date	Insert	New Registration			1/14/2025 11:36 AM
Dates	Start Date	Insert	New Registration			1/14/2025 11:36 AM
Terminations	Termination Comments	Insert	New Registration			1/14/2025 11:36 AM
Terminations	Termination Date	Insert	New Registration			1/14/2025 11:36 AM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2025 11:36 AM
Terminations	Termination Reason	Insert	New Registration			1/14/2025 11:36 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History