| Details | Last Recertification Date | Update | Recertification | 5/30/2024 1:14:58 PM | 5/20/2025 4:47:40 PM | 5/20/2025 4:47 PM |
| Details | Nature of Support: Support Received To Date | Update | Change Request | 1/31/2025 12:00:00 AM | 2/28/2026 12:00:00 AM | 3/20/2025 5:00 PM |
| Details | Last Recertification Date | Update | Recertification | 5/19/2023 3:37:26 PM | 5/30/2024 1:14:58 PM | 5/30/2024 1:14 PM |
| Contacts | Primary Contact | Update | Change Request | Robinson, Jialexy
Assistant County Health Department Director
Florida Department of Health Osceola
4073432040 | O'Connor, Ayanna
Director of Nursing
Florida Department of Health Osceola
4073432047 | 5/2/2024 8:44 AM |
| Details | Nature of Support: Support Received From Date | Update | Change Request | 1/1/2023 12:00:00 AM | 1/1/2024 12:00:00 AM | 2/8/2024 4:25 PM |
| Details | Nature of Support: Support Received To Date | Update | Change Request | 12/31/2023 12:00:00 AM | 1/31/2025 12:00:00 AM | 2/8/2024 4:25 PM |
| Details | Nature of Support: Support Received From Date | Update | Recertification | 1/1/2021 12:00:00 AM | 1/1/2023 12:00:00 AM | 5/19/2023 3:37 PM |
| Details | Nature of Support: Support Received To Date | Update | Recertification | 12/31/2021 12:00:00 AM | 12/31/2023 12:00:00 AM | 5/19/2023 3:37 PM |
| Details | Last Recertification Date | Update | Recertification | 5/11/2022 11:30:08 AM | 5/19/2023 3:37:26 PM | 5/19/2023 3:37 PM |
| Contacts | Primary Contact | Update | Change Request | Smith, Michael J
Senior Community Health Nursing Director
DOH-Osceola
4073432047 | Robinson, Jialexy
Assistant County Health Department Director
Florida Department of Health Osceola
4073432040 | 5/3/2023 4:27 PM |
| Details | Last Recertification Date | Update | Recertification | 5/28/2021 4:39:47 PM | 5/11/2022 11:30:08 AM | 5/11/2022 11:30 AM |
| Contacts | Primary Contact | Update | Change Request | Whitston, Shannon
Assistant Nursing Director
State of Florida Department of Health Osceola
4073432148 | Smith, Michael J
Senior Community Health Nursing Director
DOH-Osceola
4073432047 | 5/5/2022 9:31 AM |
| Details | Nature of Support: Support Received From Date | Update | Recertification | | 1/1/2021 12:00:00 AM | 5/28/2021 4:39 PM |
| Details | Nature of Support: Support Received To Date | Update | Recertification | | 12/31/2021 12:00:00 AM | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1730194374 ( ) | | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1487629200 | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | FL | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1730194374 | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | FL | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1750556130 | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | FL | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1750556130 ( ) | | 5/28/2021 4:39 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1487629200 ( ) | | 5/28/2021 4:39 PM |
| Contacts | Primary Contact | Update | Recertification | Albert, Michele
Senior Community Health Nursing Director
Florida Department of Health
4073432047 | Whitston, Shannon
Assistant Nursing Director
State of Florida Department of Health Osceola
4073432148 | 5/28/2021 4:39 PM |
| Details | Last Recertification Date | Update | Recertification | 5/28/2020 3:13:24 PM | 5/28/2021 4:39:47 PM | 5/28/2021 4:39 PM |
| Details | NOFO Number | Update | Recertification | | CDC-RFA-PS19-1901 | 5/28/2021 4:39 PM |
| Details | Last Recertification Date | Update | Recertification | 5/29/2019 10:29:41 AM | 5/28/2020 3:13:24 PM | 5/28/2020 3:13 PM |
| Medicaid Billing | Medicaid: Number | Update | Recertification | 27959500 | 027959500 | 5/29/2019 10:29 AM |
| Contacts | Primary Contact | Update | Recertification | Krysinski, Stephanie
Registered Nurse
Florida Department of Health
4073432047 | Albert, Michele
Senior Community Health Nursing Director
Florida Department of Health
4073432047 | 5/29/2019 10:29 AM |
| Details | Last Recertification Date | Update | Recertification | 5/8/2018 9:30:44 PM | 5/29/2019 10:29:41 AM | 5/29/2019 10:29 AM |
| Details | Grant Number | Update | Recertification | STD-FL | NH25PS005131 | 5/29/2019 10:29 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Albert, Michele
Senior Community Health Nursing Director
Florida Department of Health
4073432047 | McCluskey, Vianca
Administrator
Florida Department of Health Osceola
4073432020 | 5/24/2019 8:21 AM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 027959590 (FL) | | 5/8/2018 9:30 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 027959505 (FL) | | 5/8/2018 9:30 PM |
| Details | Last Recertification Date | Update | Recertification | 5/1/2017 12:00:00 AM | 5/8/2018 9:30:44 PM | 5/8/2018 9:30 PM |
| Contacts | Primary Contact | Update | Recertification | Krysinski, Stephanie
Registered Nurse
4073432047 | Krysinski, Stephanie
Registered Nurse
Florida Department of Health
4073432047 | 5/8/2018 9:30 PM |
| Contacts | Authorizing Official | Update | | Albert, Michele
Senior Community Health Nursing Director
4073432047 | Albert, Michele
Senior Community Health Nursing Director
Florida Department of Health
4073432047 | 2/8/2018 8:03 AM |
| Contacts | Authorizing Official | Insert | | | Albert, Michele
Senior Community Health Nursing Director
4073432047 | 5/1/2017 5:03 PM |
| Addresses | Main Address | Insert | | |
1875 FORTUNE ROAD
KISSIMMEE, FL 34744 | 5/1/2017 2:55 PM |
| Addresses | Shipping Address | Insert | | | OSCEOLA COUNTY HEALTH DEPARTMENT - PHARMACY
1875 Fortune Road
KISSIMMEE, FL 34744 | 5/1/2017 2:55 PM |
| Contacts | Primary Contact | Update | | Rivera, Stephanie
Registered Nurse
4073432047 | Krysinski, Stephanie
Registered Nurse
4073432047 | 5/1/2017 2:55 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 5/1/2017 2:55 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 27959500 | 5/1/2017 2:55 PM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 5/1/2017 2:55 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 5/1/2017 2:55 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 027959505 | 5/1/2017 2:55 PM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 5/1/2017 2:55 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1750556130 | 5/1/2017 2:55 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1487629200 | 5/1/2017 2:55 PM |
| Details | Last Recertification Date | Update | | 2/17/2016 12:00:00 AM | 5/1/2017 12:00:00 AM | 5/1/2017 2:55 PM |
| Contacts | Primary Contact | Update | | BETTS, MARC
PHARMACY MANAGER
4073432184 | Rivera, Stephanie
Registered Nurse
4073432047 | 8/9/2016 3:21 PM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 2/17/2016 5:03 PM |
| Details | Last Recertification Date | Update | | 2/10/2015 12:00:00 AM | 2/17/2016 12:00:00 AM | 2/17/2016 5:03 PM |
| Details | Entity Name | Update | | OSCEOLA COUNTY HEALTH DEPARTMENT | Florida Department of Health | 9/4/2015 9:59 AM |
| Details | Entity Subname | Update | | | OSCEOLA COUNTY HEALTH DEPARTMENT | 9/4/2015 9:59 AM |
| Details | Nature Of Support | Insert | | | Direct Funding (dollars received from CDC or an intermediate organization) | 2/10/2015 11:34 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1730194374 | 2/10/2015 11:34 AM |
| Contacts | Primary Contact | Insert | | | BETTS, MARC
PHARMACY MANAGER
4073432184 | 2/10/2015 11:34 AM |
| Details | Last Recertification Date | Update | | 2/17/2014 12:00:00 AM | 2/10/2015 12:00:00 AM | 2/10/2015 11:34 AM |
| Details | Last Recertification Date | Update | | 1/1/2012 12:00:00 AM | 2/17/2014 12:00:00 AM | 2/17/2014 7:29 AM |
| Details | Last Recertification Date | Update | | 1/1/2011 12:00:00 AM | 1/1/2012 12:00:00 AM | 12/6/2011 9:37 AM |
| Details | Last Recertification Date | Insert | | | 1/1/2011 12:00:00 AM | 11/19/2010 8:21 AM |
| Details | Grant Number | Insert | | | STD-FL | 11/19/2010 8:21 AM |
| Details | 340B ID | Insert | | | STD347442 | 11/19/2010 8:21 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 11/19/2010 8:21 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 11/19/2010 8:21 AM |
| Details | Medicare Provider Number | Insert | | | | 11/19/2010 8:21 AM |
| Details | Entity Name | Insert | | | OSCEOLA COUNTY HEALTH DEPARTMENT | 11/19/2010 8:21 AM |
| Details | Program Code | Insert | | | STD | 11/19/2010 8:21 AM |
| Details | Entity Subname | Insert | | | | 11/19/2010 8:21 AM |
| Dates | Participating Approval Date | Insert | | | 8/2/2005 12:00:00 AM | 11/19/2010 8:21 AM |
| Details | State | Insert | | | Active | 11/19/2010 8:21 AM |
| Dates | Registration Date | Insert | | | 10/1/2005 12:00:00 AM | 11/19/2010 8:21 AM |
| Dates | Signed By Date | Insert | | | 1/1/2011 12:00:00 AM | 11/19/2010 8:21 AM |
| Dates | Start Date | Insert | | | 9/9/2005 12:00:00 AM | 11/19/2010 8:21 AM |
| Terminations | Termination Comments | Insert | | | | 11/19/2010 8:21 AM |
| Terminations | Termination Date | Insert | | | | 11/19/2010 8:21 AM |
| Terminations | Termination Effective Date | Insert | | | | 11/19/2010 8:21 AM |
| Terminations | Termination Reason | Insert | | | | 11/19/2010 8:21 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 10/1/2005 12:00 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 027959590 | 10/1/2005 12:00 AM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 10/1/2005 12:00 AM |