Covered Entity Details

CH04166I COMMUNITY HEALTH CENTERS, INC. (Terminated) - information as of 5/23/2025 12:06:41 AM

Main Details

Name

COMMUNITY HEALTH CENTERS, INC.

Subdivision Name

COMMUNITY HEALTH CENTER - EATONVILLE FAMILY & DENTAL CARE

Type

HRSA-Funded Health Center

Site ID

BPS-H80-002510

340B ID

CH04166I

Grant Number

H80CS00809

Additional Details

Current Program Status

Terminated

Registration Date

11/22/2005

Participating Start Date

11/22/2005

Participating Approval Date

11/22/2005

Last Recertification Date

2/15/2016

Termination Date
Termination Reason

7/1/2016
Site closure

Contacts

Authorizing Official

COMMUNITY HEALTH CENTERS, INC.
MARGARET BRENNAN, PRESIDENT/CEO
(407) 905-8827 Ext: 1060

Primary Contact

Community Health Centers, Inc.
Darren Marsh, 340B Compliance Administrator
(407) 905-8827 Ext: 1111

Addresses

Street Address

434 Kennedy Blvd
Orlando, FL 32810-6272

Billing Address

COMMUNITY HEALTH CENTERS, INC.
110 SOUTH WOODLAND STREET
WINTER GARDEN, FL 34787

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites 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?
Yes

State	Medicaid Number	NPI Number
FL	681969900
		1790874956

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH041660	Active	BPS-H80-002351	Community Health Centers, Inc.	COMMUNITY HEALTH CENTERS, INC.	110 S Woodland St	Winter Garden	FL
CH04166A	Active	BPS-H80-003302	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - APOPKA FAMILY & OB CARE	225 E 7th St	Apopka	FL
CH04166AA	Active	BPS-H80-028323	Community Health Centers, Inc.	CHC Admin - Purchasing	603 S Main St Ste 150	Winter Garden	FL
CH04166AB	Active	BPS-H80-030813	Community Health Centers, Inc.	Four Corners Health Center	509 Cagan View Rd	Clermont	FL
CH04166AC	ToBeTerminated	BPS-H80-032670	Community Health Centers, Inc.	ELC at West Lakes	600 S Dollins Ave	Orlando	FL
CH04166AD	Active	BPS-H80-036142	COMMUNITY HEALTH CENTERS INC	Community Health Centers - West Lakes	710 S. Tampa Ave.	Orlando	FL
CH04166C	Active	BPS-H80-013775	Community Health Centers, Inc.	Community Health Centers-Winter Garden Family and Dental Care	13275 W COLONIAL DR	WINTER GARDEN	FL
CH04166D	Active	BPS-H80-000653	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - GROVELAND FAMILY, PEDIATRIC & DENTAL CARE	1296 W Broad St	Groveland	FL
CH04166F	Active	BPS-H80-001417	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - LEESBURG FAMILY MEDICAL AND DENTAL	225 N 1st St	Leesburg	FL
CH04166H	Active	BPS-H80-018524	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - PINE HILLS	840 MERCY DR	ORLANDO	FL
CH04166I	Terminated	BPS-H80-002510	COMMUNITY HEALTH CENTERS, INC.	COMMUNITY HEALTH CENTER - EATONVILLE FAMILY & DENTAL CARE	434 Kennedy Blvd	Orlando	FL
CH04166L	Active	BPS-H80-000502	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - APOPKA PEDIATRIC CARE	618 S Forest Ave	Apopka	FL
CH04166M	Active	BPS-H80-011182	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - BITHLO FAMILY CARE	19108 E. Colonial Dr	Orlando	FL
CH04166N	Active	BPS-H80-011900	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - MEADOW WOODS PEDIATRIC & PEDIATRIC DENTAL CARE	849 Greenway Professional Ct	Orlando	FL
CH04166P	Active	BPS-H80-014775	Community Health Centers, Inc.	Community Health Centers-Tavares Family Medical and Dental	212 E. Main St.	Tavares	FL
CH04166R	Active	BPS-H80-008691	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - APOPKA DENTAL CARE	210 E. 7th St	Apopka	FL
CH04166S	Active	BPS-H80-008544	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - INFORMATION SERVICES CENTER	184 S Dillard St	Winter Garden	FL
CH04166T	Active	BPS-H80-003452	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER - LAKE ELLENOR PEDIATRIC DENTAL & ADULT EMERGENCY DENTAL CARE	6101 LAKE ELLENOR DR. STE 106	ORLANDO	FL
CH04166U	Terminated	BPS-H80-015083	COMMUNITY HEALTH CENTERS, INC.	Community Health Centers, Inc. Rosemont Pediatrics	5844 N ORANGE BLOSSOM TRL	ORLANDO	FL
CH04166V	Terminated	BPS-H80-015266	COMMUNITY HEALTH CENTERS, INC.	CHC Administrative Annex	130 S. Main St.	Winter Garden	FL
CH04166W	Active	BPS-H80-017623	Community Health Centers, Inc.	Community Health Center - Forest City Family & Dental Care	7900 Forest City Road	Orlando	FL
CH04166X	Active	BPS-H80-018381	Community Health Centers, Inc.	COMMUNITY HEALTH CENTER -Call Center	301 SW Crown Point Road	WINTER GARDEN	FL
CH04166Y	Active	BPS-H80-017804	Community Health Centers, Inc.	Community Health Centers, Inc. Forest City - Optometry and Behavioral Health	7912 Forest City Rd	Orlando	FL
CH04166Z	Active	BPS-H80-021740	Community Health Centers, Inc.	Community Health Centers Clermont	2140 N Don Wickham Dr. Suite C	Clermont	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH041660	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2024
CH041660	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2024
CH041660	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2025
CH041660	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH041660	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH041660	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	01/01/2019	07/01/2021
CH041660	DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER	DIPLOMAT SPECIALTY PHARMACY	15471 SW 12TH ST STE 207	SUNRISE	FL	33326	01/01/2019	07/01/2021
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03748	65 E MAIN ST	APOPKA	FL	32703	10/01/2018
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03225	2311 E. SEMORAN BLVD.	APOPKA	FL	32703	01/01/2019
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00497	17021 US HWY 441	MOUNT DORA	FL	32757	01/01/2019	11/22/2021
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03757	1401 DUTCH ELM DRIVE	ALTAMONTE SPRINGS	FL	32714	01/01/2019
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05853	13960 LANDSTAR BLVD.	ORLANDO	FL	32824	01/01/2019
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07991	13300 E. COLONIAL DR.	ORLANDO	FL	32826	01/01/2019	06/01/2024
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03150	221 S STATE RD 434	ALTAMONTE SPRINGS	FL	32714	01/01/2019
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02829	3502 EDGEWATER DR.	ORLANDO	FL	32804	01/01/2019
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00605	1235 N 14TH ST	LEESBURG	FL	34748	01/01/2019	06/01/2024
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04465	550 W BURLEIGH BLVD	TAVARES	FL	32778	01/01/2019
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01820	13697 W. COLONIAL DR.	WINTER GARDEN	FL	34787	04/01/2022
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02904	6354 N. ORANGE BLOSSOM TRAIL	ORLANDO	FL	32810	04/01/2022	06/01/2024
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04238	1612 E SILVER STAR RD	OCOEE	FL	34761	04/01/2022
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05817	1800 E. HWY 50	CLERMONT	FL	34711	04/01/2022
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02291	6217 SILVER STAR RD	ORLANDO	FL	32808	04/01/2022
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05218	7665 W COLONIAL DR	ORLANDO	FL	32818	04/01/2022	10/10/2024
CH041660	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05901	7001 OLD WINTER GARDEN RD.	ORLANDO	FL	32835	04/01/2022
CH04166Z	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04238	1612 E SILVER STAR RD	OCOEE	FL	34761	07/01/2025
CH04166N	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05817	1800 E. HWY 50	CLERMONT	FL	34711	07/01/2025
CH04166S	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03150	221 S STATE RD 434	ALTAMONTE SPRINGS	FL	32714	07/01/2025
CH04166Y	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05901	7001 OLD WINTER GARDEN RD.	ORLANDO	FL	32835	07/01/2025
CH04166L	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03748	65 E MAIN ST	APOPKA	FL	32703	07/01/2025
CH04166AA	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03757	1401 DUTCH ELM DRIVE	ALTAMONTE SPRINGS	FL	32714	07/01/2025
CH04166X	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04465	550 W BURLEIGH BLVD	TAVARES	FL	32778	07/01/2025
CH04166T	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02291	6217 SILVER STAR RD	ORLANDO	FL	32808	07/01/2025
CH041660	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH041660	WAL-MART PHARMACY #10-4160	1101 S. GOLDWYN		ORLANDO	FL	32805	01/01/2018	03/01/2023
CH041660	WAL-MART PHARMACY 10-0705	17030 U.S. HWY 441		MOUNT DORA	FL	32757	01/01/2015
CH041660	WAL-MART PHARMACY 10-0800	2501 CITRUS BLVD		LEESBURG	FL	34748	01/01/2015
CH041660	WAL-MART PHARMACY 10-0859	2000 STATE ROAD 60 EAST		LAKE WALES	FL	33898	01/01/2018	05/31/2020
CH041660	WAL-MART PHARMACY 10-0942	10500 W. COLONIAL DRIVE		OCOEE	FL	34761	04/01/2014
CH041660	WAL-MART PHARMACY 10-0955	1700 S ORANGE BLOSOOM TRAIL		APOPKA	FL	32703	04/01/2014
CH04166R	WAL-MART PHARMACY 10-0955	1700 S ORANGE BLOSOOM TRAIL		APOPKA	FL	32703	07/01/2025
CH041660	WAL-MART PHARMACY 10-1220	2500 SO. KIRKMAN ROAD		ORLANDO	FL	32811	01/01/2015
CH041660	WAL-MART PHARMACY 10-1374	200 SOUTH STATE RD 434		ALTAMONTE SPRINGS	FL	32714	01/01/2015
CH041660	WAL-MART PHARMACY 10-2695	1450 JOHNS LAKE ROAD		CLERMONT	FL	34711	04/01/2014	01/01/2018
CH041660	WAL-MART PHARMACY 10-3817	433 SOUTH AVALON PARK BLVD		ORLANDO(AVALON PKWY)	FL	32828	01/01/2018	05/31/2020
CH041660	WAL-MART PHARMACY 10-4211	5559 CLARCONA-OCOEE ROAD		ORLANDO	FL	32810	04/01/2014
CH041660	WAL-MART PHARMACY 10-4425	7818 W.COLONIAL DRIVE		ORLANDO	FL	32818	01/01/2015	03/01/2023
CH041660	WAL-MART PHARMACY 10-4588	3101 WEST PRINCETON STREET		ORLANDO	FL	32808	01/01/2015
CH041660	WAL-MART PHARMACY 10-5299	550 US HIGHWAY 27		CLERMONT	FL	34711	01/01/2018	03/01/2023
CH041660	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH041660	WALGREEN CO	DBA: WALGREENS #10556	5903 S ORANGE BLOSSOM TRAIL	ORLANDO	FL	32809	10/19/2012	10/22/2018
CH041660	WALGREEN CO	DBA: WALGREENS #11484	200 SOUTHERN BREEZE DR	MINNEOLA	FL	34715	10/19/2012
CH041660	WALGREEN CO	DBA: WALGREENS #12105	680 E BURLEIGH BLVD	TAVARES	FL	32778	10/01/2017
CH041660	WALGREEN CO	DBA: WALGREENS #10951	550 S. ORLANDO AVE	WINTER PARK	FL	32789-3664	07/01/2018
CH041660	WALGREEN CO	DBA: WALGREENS #11221	13989 LANDSTAR BLVD	ORLANDO	FL	32824	10/01/2018
CH041660	WALGREEN CO.	DBA: WALGREENS # 06723	890 N US HIGHWAY 27/441	LADY LAKE	FL	32159	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 06922	113 MAITLAND AVE	ALTAMONTE SPRINGS	FL	32701-4901	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 03166	125 EAST MAIN STREET	APOPKA	FL	32703	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 05246	1490 ROCK SPRINGS RD	APOPKA	FL	32712	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 07944	1201 W STATE ROAD 436	ALTAMONTE SPRINGS	FL	32714-2736	10/19/2012	04/25/2019
CH041660	WALGREEN CO.	DBA: WALGREENS # 05779	101 W. ARDICE AVENUE	EUSTIS	FL	32726	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 04959	330 S ORLANDO AVE	MAITLAND	FL	32751	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 02928	18910 US HWY 441	MT DORA	FL	32757	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 04648	11101 US HWY 441	TAVARES	FL	32778	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 03650	2420 E COLONIAL DRIVE	ORLANDO	FL	32803	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 05658	408 E MICHIGAN STREET	ORLANDO	FL	32806	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS #21144	2300 S GOLDENROD RD	ORLANDO	FL	32822-7902	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 03745	5185 NORTH LANE	ORLANDO	FL	32808	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 07686	2814 W KENNEDY BLVD	ORLANDO	FL	32810	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 15332	4720 S KIRKMAN RD	ORLANDO	FL	32811	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 06505	920 S KIRKMAN ROAD	ORLANDO	FL	32811	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS #16514	4300 CURRY FORD RD	ORLANDO	FL	32806-2700	10/19/2012	03/01/2023
CH041660	WALGREEN CO.	DBA: WALGREENS # 03576	2550 N. HIAWASSEE RD.	ORLANDO	FL	32818	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 07165	5601 N HIAWASSEE ROAD	ORLANDO	FL	32818	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 07694	16900 E COLONIAL DR	ORLANDO	FL	32820-1911	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 04526	8000 LAKE UNDERHILL ROAD	ORLANDO	FL	32822	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 04554	12279 LAKE UNDERHILL RD	ORLANDO	FL	32825	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 03554	6651 OLD WINTER GARDEN RD.	ORLANDO	FL	32835	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 03811	4502 S ORANGE BLOSSOM TRAIL	ORLANDO	FL	32839-1704	10/19/2012	04/13/2023
CH041660	WALGREEN CO.	DBA: WALGREENS # 04906	5280 S JOHN YOUNG PKWY	ORLANDO	FL	32839	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 16051	699 E HIGHWAY 50	CLERMONT	FL	34711	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS #12317	7777 STATE ROAD 50	GROVELAND	FL	34736	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 06163	2010 CITRUS BLVD	LEESBURG	FL	34748	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 06887	27440 US HWY 27	LEESBURG	FL	34748	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 06940	901 S 14TH STREET	LEESBURG	FL	34748-6615	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 04961	1669 E SILVER STAR RD	OCOEE	FL	34761	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS #12884	2353 OCOEE APOPKA RD.	OCOEE	FL	34761	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 11105	8802 WEST COLONIAL DRIVE	OCOEE	FL	34761	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS # 03989	13720 W COLONIAL DR	WINTER GARDEN	FL	34787	10/19/2012
CH041660	WALGREEN CO.	DBA: WALGREENS #11921	7301 STATE ROAD 535	WINDERMERE	FL	34786	04/01/2014
CH041660	WALGREEN CO.	DBA: WALGREENS # 05809	2005 N SR 19	EUSTIS	FL	32726	10/01/2017
CH041660	WALGREEN CO.	DBA: WALGREENS # 13920	3301 EDGEWATER DRIVE	ORLANDO	FL	32804	01/01/2018
CH041660	WALGREEN CO.	DBA: WALGREENS # 09016	200 W STATE RD 436	ALTAMONTE SPRINGS	FL	32714-4202	07/01/2018
CH041660	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #12146	1200 KUHL AVE	ORLANDO	FL	32806	07/01/2018
CH041660	WALGREEN CO.	WALGREENS #16404	885 W STATE ROAD 436	ALTAMONTE SPRINGS	FL	32714	04/01/2022
CH041660	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	01/01/2023
CH041660	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/19/2012	06/25/2015
CH041660	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	06/25/2015
CH041660	WALGREENS.COM, INC.	WALGREENS #02445	8337 S PARK CIRCLE	ORLANDO	FL	32819	04/01/2020	07/02/2020
CH041660	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH041660	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Marsh, Darren Director of Pharmacy Community Health Centers, Inc. 4079058827-1111	Marsh, Darren 340B Compliance Administrator Community Health Centers, Inc. 4079058827-1111	2/23/2023 7:06 PM
Contacts	Primary Contact	Update	Profile Change Request	MARSH, DARREN DIRECTOR OF PHARMACY Community Health Centers, Inc. 4079058827-1111	Marsh, Darren Director of Pharmacy Community Health Centers, Inc. 4079058827-1111	2/8/2020 7:36 AM
Contacts	Primary Contact	Update	Profile Change Request	MARSH, DARREN DIRECTOR OF PHARMACY Community Health Centers, Inc. 4076145304	MARSH, DARREN DIRECTOR OF PHARMACY Community Health Centers, Inc. 4079058827-1111	2/8/2020 7:35 AM
Contacts	Authorizing Official	Update		BRENNAN, MARGARET PRESIDENT/CEO 4079058827-1060	BRENNAN, MARGARET PRESIDENT/CEO COMMUNITY HEALTH CENTERS, INC. 4079058827-1060	9/29/2017 9:23 AM
Contacts	Primary Contact	Update		MARSH, DARREN DIRECTOR OF PHARMACY 4076145304	MARSH, DARREN DIRECTOR OF PHARMACY Community Health Centers, Inc. 4076145304	9/19/2017 6:08 AM
Contacts	Authorizing Official	Update		Dickinson, Mark Interim CEO 4079058827	BRENNAN, MARGARET PRESIDENT/CEO 4079058827-1060	8/9/2017 7:53 PM
Contacts	Primary Contact	Update		DELGADO, MARGARITA MEDICAL DIRECTOR 4076453989	MARSH, DARREN DIRECTOR OF PHARMACY 4076145304	8/9/2017 7:53 PM
Dates	Last Date That 340B Drugs Purchased	Update			4/8/2016 12:00:00 AM	4/28/2016 3:27 PM
Details	State	Update		Active	Terminated	4/28/2016 3:27 PM
Terminations	Termination Comments	Update			We've combined and closed our Eatonville and Rosemont locations (CH04166I and CH04166U) and relocated to our new Forest City location located at the address below. Thank you.7900 Forest City RoadOrlando, FL 32810	4/28/2016 3:27 PM
Terminations	Termination Date	Update			7/1/2016 12:00:00 AM	4/28/2016 3:27 PM
Terminations	Termination Effective Date	Update			4/11/2016 12:00:00 AM	4/28/2016 3:27 PM
Terminations	Termination Reason	Update			Site closure	4/28/2016 3:27 PM
Addresses	Main Address	Insert			434 Kennedy Blvd Orlando, FL 32810-6272	4/28/2016 3:27 PM
Addresses	Billing Address	Insert			COMMUNITY HEALTH CENTERS, INC. 110 SOUTH WOODLAND STREET WINTER GARDEN, FL 34787	4/28/2016 3:27 PM
Details	Last Recertification Date	Update		2/12/2015 12:00:00 AM	2/15/2016 12:00:00 AM	2/15/2016 11:01 AM
Medicaid Billing	NPI: Number	Insert			1790874956	2/19/2015 9:55 AM
Contacts	Authorizing Official	Insert			Dickinson, Mark Interim CEO 4079058827	2/12/2015 11:04 AM
Details	Last Recertification Date	Update		3/21/2014 12:00:00 AM	2/12/2015 12:00:00 AM	2/12/2015 11:04 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/21/2014 12:00:00 AM	3/21/2014 10:15 PM
Details	Entity Subname	Update		COMMUNITY HEALTH CENTERS-EATONVILLE FAMILY CARE	COMMUNITY HEALTH CENTER - EATONVILLE FAMILY & DENTAL CARE	3/21/2014 10:15 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/25/2013 8:31 AM
Details	Entity Subname	Update		EATONVILLE FAMILY HEALTH CENTER	COMMUNITY HEALTH CENTERS-EATONVILLE FAMILY CARE	11/21/2011 1:16 PM
Contacts	Primary Contact	Insert			DELGADO, MARGARITA MEDICAL DIRECTOR 4076453989	11/23/2005 4:20 PM
Details	Last Recertification Date	Insert				11/23/2005 4:20 PM
Details	Grant Number	Insert			H80CS00809	11/23/2005 4:20 PM
Details	340B ID	Insert			CH04166I	11/23/2005 4:20 PM
Details	Is Authorizing Official EHB Data	Insert				11/23/2005 4:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert				11/23/2005 4:20 PM
Details	Medicare Provider Number	Insert				11/23/2005 4:20 PM
Details	Entity Name	Insert			COMMUNITY HEALTH CENTERS, INC.	11/23/2005 4:20 PM
Details	Program Code	Insert			CH	11/23/2005 4:20 PM
Details	Entity Subname	Insert			EATONVILLE FAMILY HEALTH CENTER	11/23/2005 4:20 PM
Dates	Participating Approval Date	Insert			11/22/2005 12:00:00 AM	11/23/2005 4:20 PM
Details	State	Insert			Active	11/23/2005 4:20 PM
Dates	Registration Date	Insert			11/22/2005 12:00:00 AM	11/23/2005 4:20 PM
Dates	Signed By Date	Insert			11/8/2005 12:00:00 AM	11/23/2005 4:20 PM
Dates	Start Date	Insert			11/22/2005 12:00:00 AM	11/23/2005 4:20 PM
Terminations	Termination Comments	Insert				11/23/2005 4:20 PM
Terminations	Termination Date	Insert				11/23/2005 4:20 PM
Terminations	Termination Effective Date	Insert				11/23/2005 4:20 PM
Terminations	Termination Reason	Insert				11/23/2005 4:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/22/2005 3:41 PM
Medicaid Billing	Medicaid: Number	Insert			681969900	11/22/2005 3:41 PM
Medicaid Billing	Medicaid: State	Insert			FL	11/22/2005 3:41 PM

340B Drug Pricing Program Database

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