340B Drug Pricing Program Database


DSH100022 JACKSON HEALTH SYSTEM (Active) - information as of 4/25/2025 5:36:57 PM

Main Details
JACKSON HEALTH SYSTEM
JACKSON MEMORIAL HOSPITAL
Disproportionate Share Hospital
Yes
DSH100022
100022


Additional Details
Active
12/5/2006
12/1/1992
12/5/2006
9/9/2024

Contacts

Jackson Health System
Carlos A. Migoya, CEO
(305) 585-6754

Jackson Health System
VENESSA GOODNOW, AVP & CHIEF PHARMACY OFFICER
(305) 585-7411

Addresses

1611 NW 12 AVE.
MIAMI, FL 33136

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
9/17/08-REVISED NAME (WAS JACKSON MEMORIAL HOSPITAL); 7/1/08-ADDED NPI 156857836712/05/2006
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
FL0010042100,0010042101,003420600,104702700,003420602,111250700,003419200,1094980001063586543,1225033020,1568578367,1720149818,1790856458,1730767971,1295806016,1952434631
Shipping Addresses

Public Health Trust of Dade County DBA Jackson Pharmacy Solutions
901 NW 17th Street
UNIT O
Miami, FL 33136

JACKSON MEMORIAL HOSPITAL CO HOSP PHARMACY (ACC BLDG) DBA Jackson Memorial Pharmacy
901 NW 17th St
Suite N
Miami, FL 33136

PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY Jackson West Retail Pharmacy
2801 NW 79TH AVENUE
DORAL, FL 33122

Metro West Detention Center Pharmacy
13850 NW 41st Street
Miami, FL 33178

PUBLIC HEALTH TRUST OF DADE COUNTY JACKSON MEM HOSP-HIGHLAND PARK PHARMACY
1695 N. W. 9TH AVENUE
Miami, FL 33136-1420

PUBLIC HEALTH TRUST Jackson North Medical Center Pharmacy
160 NW 170th Street
N. MIAMI BEACH, FL 33169

PUBLIC HEALTH TRUST OF MIAMI: DADE COUNTY Jackson South Medical Center Pharmacy
9333 S.W. 152ND STREET
MIAMI, FL 33157

Public Health Trust of Miami-Dade County
Jackson Health System Infusion Services
1611 NW 12TH AVE
Suite T-277
Miami, FL 33136
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/13/201610/01/2016  05/11/2017
Contract DetailACCREDO HEALTH GROUP INC201 GREAT CIRCLE ROAD
NASHVILLETN3722807/13/201610/01/2016 10/09/201704/13/2018
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/13/201610/01/2016  05/11/2017
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/13/201707/01/2017  05/11/2017
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/13/201610/01/2016 09/01/202310/17/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/13/201610/01/2016  05/11/2017
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/13/201610/01/2016  05/11/2017
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607510/17/202301/01/2024  01/01/2024
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280901/12/201804/01/2018 06/02/202007/14/2021
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280904/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/12/201804/01/2018 04/13/201804/13/2018
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/20/202207/01/2022  07/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/20/202207/01/2022  07/01/2022
Contract DetailCORAM ALTERNATE SITE SERVICES, INCDBA CORAM CVS/SPECIALTY INFUSION SERVICE 9143 PHILLIPS HIGHWAY
SUITE 300 		JACKSONVILLEFL3225601/12/201804/01/2018 04/11/201804/13/2018
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 3439 NORTH 12TH AVENUE
SUITE A AND B 		PENSACOLAFL32503-400801/12/201804/01/2018 04/11/201804/13/2018
Contract DetailCORAM HEALTHCARE CORPORATION OF FLORIDADBA CORAM CVS/SPECIALTY INFUSION SERVICE 8508 BENJAMIN RD
SUITE C 		TAMPAFL33634-124101/12/201804/01/2018 04/11/201804/13/2018
Contract DetailCORAM HEALTHCARE CORPORATION OF SOUTHERNDBA CORAM CVS/SPECIALTY INFUSION SERVICE 12006 MIRAMAR PARKWAY
MIRAMARFL33025-700501/12/201804/01/2018 04/11/201804/13/2018
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/20/202207/01/2022  07/01/2022
Contract DetailCYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503304/14/201607/01/2016 06/02/202007/14/2021
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/14/202110/01/2021  10/01/2021
Contract DetailGENOA HEALTHCARE LLC5711 SOUTH DIXIE HIGHWAY
MIAMIFL3314301/27/202504/01/2025  04/01/2025
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00567 591 NE 79TH STREET
MIAMIFL3313804/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00931 101 HIALEAH DR
HIALEAHFL3301004/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05125 735 NW 119TH ST
NORTH MIAMIFL3316804/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04032 855 E 8TH AVE
HIALEAHFL3301004/20/202207/01/2022 07/17/202412/09/2024
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05924 8765 S. DIXIE HWY
PINECRESTFL3315604/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05786 16550 NE 6TH AVE, NORTH
MIAMIFL3316204/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00580 4800 BISCAYNE BLVD
MIAMIFL3313704/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05897 3700 NW 199TH ST.
MIAMI GARDENSFL3305504/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 02895 19800 NW 2ND AVE.
MIAMI GARDENSFL3316904/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05233 650 NW 27TH AVE
MIAMIFL3312504/20/202207/01/2022  07/01/2022
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00402 170 SE 3RD AVE
MIAMIFL3313101/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.NAVARRO DISCOUNT PHARMACY # 10723 13250 BISCAYNE BLVD
NORTH MIAMIFL3318101/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 02897 15395 NW 82ND AVE.
MIAMI LAKESFL3301601/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04249 11890 BISCAYNE BLVD
MIAMIFL3318101/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00628 600 NE 128TH ST
NORTH MIAMIFL3316101/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05136 11398 QUAIL ROOST DR
MIAMIFL3315701/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00564 2500 SW 22ND ST
MIAMIFL3314501/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04613 200 BISCAYNE BLVD
MIAMIFL3313201/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 03672 13749 SW 152ND ST
MIAMIFL3317701/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 03443 5695 SW 8TH ST
MIAMIFL3314401/17/202304/01/2023  04/01/2023
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 01127 6780 S W 40TH ST
MIAMIFL3315501/17/202304/01/2023  04/01/2023
Contract DetailOPTUM INFUSION SERVICES 203 INC9984 PREMIER PKWY
MIRAMARFL33025-320901/27/202504/01/2025  04/01/2025
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135101/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276501/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705801/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302501/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520401/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824901/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970501/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729801/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110101/27/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508501/27/202504/01/2025  04/01/2025
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983801/27/202504/01/2025  04/01/2025
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999210/10/201901/01/2020 10/01/202201/17/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/12/201804/01/2018 04/13/201804/13/2018
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/20/202207/01/2022  07/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/20/202207/01/2022  07/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/20/202207/01/2022  07/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/20/202207/01/2022  07/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.NAVARRO SPECIALTY SERVICES # 10727 7205 CORPORATE CENTER DRIVE
SUITE 104 		MIAMIFL3312601/17/202304/01/2023  04/01/2023
Contract DetailWALGREEN CODBA: WALGREENS #10470 16795 S DIXIE HWY
MIAMIFL3315704/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CODBA WALGREENS SPECIALTY PHARMACY #16297 9400 NORTHWEST 12TH AVE BAY 5
MIAMIFL3315004/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CODBA: WALGREENS #09401 15711 SW 152ND ST
MIAMIFL33187-541710/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CODBA WALGREENS SPECIALTY PHARMACY #16297 9400 NORTHWEST 12TH AVE BAY 5
MIAMIFL3315007/14/202110/01/2021  10/01/2021
Contract DetailWALGREEN CODBA: WALGREENS #10470 16795 S DIXIE HWY
MIAMIFL3315710/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 00622 3715 N.W. 7TH ST
MIAMIFL3312604/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 00748 12295 BISCAYNE BLVD
NORTH MIAMIFL3318104/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02128 1845 ALTON ROAD
MIAMI BEACHFL3313904/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #15994 801 SW 8TH ST
MIAMIFL3313004/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02545 1480 NE MIAMI GARDENS DR
NORTH MIAMI BEACHFL3317904/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 02719 791 NE 167TH ST
NORTH MIAMI BEACHFL3316204/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02790 3103 BISCAYNE BLVD
MIAMIFL3313704/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02973 11398 QUAIL ROOST DR
MIAMIFL3315704/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03162 524 JEFFERSON AVE.
MIAMI BEACHFL3313904/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03173 9020 BISCAYNE BLVD
MIAMI SHORESFL3313804/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03250 18300 NW 37TH AVE.
MIAMI GARDENSFL33056-510104/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03301 1695 NW 20TH STREET
MIAMIFL3314204/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03316 2700 W. FLAGLER STREET
MIAMIFL3313504/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03371 7910 NW 27TH AVENUE
MIAMIFL3314704/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03493 9498 NW 7TH AVE
MIAMIFL3315004/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03527 567 NE 125TH STREET
NORTH MIAMIFL3316104/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03565 18590 SOUTH DIXIE HWY.
CUTLER BAYFL33157-681804/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03678 1501 NE 163RD STREET
NORTH MIAMI BEACHFL3316204/14/201607/01/2016 08/19/202109/24/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 03679 161 NE 54TH STREET
MIAMIFL3313704/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03835 19935 NW 2ND AVE
MIAMIFL3316904/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03854 15900 NW 27TH AVE
OPA LOCKAFL3305404/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03943 200 SW 13TH ST
MIAMIFL3313004/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04728 6200 NW 7TH AVE
MIAMIFL3315004/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04915 750 NW 119TH ST.
MIAMIFL3316804/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04917 690 NW 183RD ST
MIAMI GARDENSFL3316904/14/201607/01/2016 02/22/202404/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 05250 1699 NW 7TH ST
MIAMIFL3312504/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05251 1 E FLAGLER ST
MIAMIFL3313104/14/201607/01/2016 06/02/202007/14/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 05845 14901 NE 6TH AVE
MIAMIFL3316104/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06873 1201 SW 1ST STREET
MIAMIFL33135-240104/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09206 8650 SW 132ND ST
MIAMIFL33156-650704/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #10983 1011 ALTON RD.
MIAMI BEACHFL3313904/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #11304 15043 S. DIXIE HWY.
PALMETTO BAYFL3317604/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #12463 501 COLLINS AVE.
MIAMI BEACHFL3313904/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREEN CO.WALGREENS SPECIALTY PHARMACY #15106 1250 NW 7TH STREET SUITE 205
MIAMIFL3312504/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15299 1201 NE 26TH ST STE 110
WILTON MANORSFL3330504/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21359 275 NE 35TH ST
MIAMIFL3313704/14/201607/01/2016  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS SPECIALTY PHARMACY #12146 1200 KUHL AVE
ORLANDOFL3280604/14/201607/01/2016 04/01/202204/01/2022
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #13072 8333 N DAVIS HWY STE 50
PENSACOLAFL3251404/14/201607/01/2016 04/01/202204/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 00621 5731 BIRD ROAD
MIAMIFL3315501/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03105 11920 NW 27TH AVENUE
MIAMIFL3316701/13/201704/01/2017 02/28/202404/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03239 1 SE 3RD AVE STE 100
MIAMIFL3313101/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03721 15255 SW 137TH AVENUE
MIAMIFL3317701/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03782 5701 NW 183RD ST
HIALEAHFL3301501/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03784 3655 S DIXIE HWY
MIAMIFL3313301/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04384 400 HIALEAH DRIVE
HIALEAHFL3301001/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04654 861 NE 8TH STREET
HOMESTEADFL3303001/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04808 20340 OLD CUTLER RD
CUTLER BAYFL3318901/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #11938 10700 W FLAGLER ST
MIAMIFL3317401/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #12723 23201 SW 112TH AVE.
HOMESTEADFL3303201/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16331 5361 NW 22ND AVE STE 2
MIAMIFL3314201/13/201704/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05130 6800 W 28TH AVE
HIALEAHFL3301804/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.WALGREENS #16541 1400 NW 12TH AVE STE 2002
MIAMIFL3313604/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #10264 28875 S. DIXIE HWY
HOMESTEADFL3303304/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06012 655 NW 57TH AVE
MIAMIFL3312604/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05198 7340 COLLINS AVE
MIAMI BEACHFL3314104/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09361 3090 NE 43RD AVE
HOMESTEADFL33033-302804/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02832 4010 S W 137TH AVE
MIAMIFL3317504/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03317 4200 SW 8TH STREET
CORAL GABLESFL3313404/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04809 3595 CORAL WAY
MIAMIFL3314504/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06013 13698 SW 8TH STREET
MIAMIFL3318404/13/201707/01/2017  05/11/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 12285 780 EAST 9TH STREET
HIALEAHFL3301007/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02184 8327 W FLAGLER ST
MIAMIFL3314407/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 01600 14720 N KENDALL DR
MIAMIFL3319607/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05050 1610 W 49TH ST
HIALEAHFL3301207/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04385 770 W 29TH ST
HIALEAHFL3301207/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03566 4451 W. 12TH AVE.
HIALEAHFL3301207/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #11920 12711 SW 200TH ST
MIAMIFL3317707/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.WALGREENS #16542 1475 NW 12TH AVE STE 2307B
MIAMIFL3313607/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05293 4895 PALM AVENUE
HIALEAHFL3301207/12/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03318 11690 SW 72ND ST
MIAMIFL3317310/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03211 9675 NW 41ST STREET
DORALFL33178-297410/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #10793 15705 SW 72ND ST
MIAMIFL3319310/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04569 3895 W BROWARD BLVD
FORT LAUDERDALEFL33312-101710/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02743 998 SW 67TH AVE
MIAMIFL3314410/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 15914 1669 COLLINS AVENUE
MIAMI BEACHFL3313910/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #11657 2000 NORMANDY DR.
MIAMI BEACHFL3314110/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04597 1 WEST SUNRISE BLVD.
FT LAUDERDALEFL3331110/12/201701/01/2018 04/01/202204/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 02129 17534 COLLINS AVE
SUNNY ISLES BEACHFL3316010/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06011 8001 MIRAMAR PKWY
MIRAMARFL33025-300410/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #09018 1155 W. 68TH ST
HIALEAHFL33014-515210/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #11481 52 EAST PALM DRIVE
FLORIDA CITYFL3303410/12/201701/01/2018  10/12/2017
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21155 5966 S DIXIE HWY STE 103B
SOUTH MIAMIFL3314307/14/202110/01/2021 04/01/202204/01/2022
Contract DetailWALGREEN CO.DBA WALGREENS #16543 5555 PONCE DE LEON BLVD.
SUITE 186 		CORAL GABLESFL3314607/14/202110/01/2021 04/01/202204/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #12260 11700 SW 104TH ST
MIAMIFL3318610/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #10983 1011 ALTON RD.
MIAMI BEACHFL3313910/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09788 2800 NE 8TH STREET
HOMESTEADFL3303310/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 02416 10609 SW 40TH ST
MIAMIFL3316510/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06949 2499 S PALM AVE
MIRAMARFL3302510/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 04955 18665 BISCAYNE BLVD
AVENTURAFL3318010/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07844 7605 W 33RD CT
HIALEAHFL3301810/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 03302 9701 SW 24TH STREET
MIAMIFL3316510/13/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 11939 8450 CORAL WAY
MIAMIFL3315501/13/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 04003 3015 S. UNIVERSITY DR.
DAVIEFL3332801/13/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #11880 6701 MILLER DR
MIAMIFL3315501/13/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15300 2100 N ORANGE AVE STE B
ORLANDOFL3280401/17/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA WALGREENS #16543 5555 PONCE DE LEON BLVD.
SUITE 186 		CORAL GABLESFL3314601/17/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21155 5966 S DIXIE HWY STE 103B
SOUTH MIAMIFL3314301/17/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #13849 2540 NE 15TH AVE
WILTON MANORSFL3330501/17/202304/01/2023  04/01/2023
Contract DetailWalgreens #21395Walgreens Central Fill #21395 5710 Young Pine Rd
OrlandoFL3282901/17/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/14/201607/01/2016 10/10/201701/12/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/14/201607/01/2016 04/01/202204/01/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH100022AChildDSHJACKSON HEALTH SYSTEMPUBLIC HEALTH TRUST OF DADE COUNTY NORTH DADE HEALTH CENTER16555 N.W. 25TH AVEOpa LockaFLActive
DSH100022AAChildDSHJACKSON HEALTH SYSTEMJNMC EMERGENCY DEPARTMENT160 NW 170 STREETNORTH MIAMI BEACHFLActive
DSH100022ABChildDSHJACKSON HEALTH SYSTEMMiami Transplant Institute1801 NW 9th AvenueMiamiFLActive
DSH100022ACChildDSHJACKSON HEALTH SYSTEMJACKSON URGENT CARE-COUNTRY WALK13707 SW 152 STREETMIAMIFLTerminated
DSH100022ADChildDSHJACKSON HEALTH SYSTEMJackson North Medical Center - Surgery Separate160 NW 170 StNorth Miami BeachFLActive
DSH100022AEChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Ambulatory Surgery9333 SW 152nd StMiamiFLActive
DSH100022AFChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Ultrasonic Unit9333 SW 152nd StMiamiFLTerminated
DSH100022AGChildDSHJACKSON HEALTH SYSTEMJackson North Medical Center - Ultrasound160 NW 170 StNorth Miami BeachFLTerminated
DSH100022AHChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Surgery Unit9333 152nd StMiamiFLActive
DSH100022AJChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Nuclear Medicine9333 SW 152nd StMiamiFLActive
DSH100022AKChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - JS Trauma OR9333 SW 152nd StMiamiFLActive
DSH100022ALChildDSHJACKSON HEALTH SYSTEMJackson Memorial Hospital - Ryder Trauma Center - Ryder Trauma Center1800 NW 10th AveMiamiFLActive
DSH100022AMChildDSHJACKSON HEALTH SYSTEMJackson North Medical Center - Delivery Room160 NW 170 StNorth Miami BeachFLActive
DSH100022ANChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER - MRI160 NW 170TH STREETNORTH MIAMI BEACHFLTerminated
DSH100022APChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Anesthesia Unit9333 SW 152nd StMiamiFLTerminated
DSH100022AQChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Respiratory Therapy Unit9333 SW 152nd StMiamiFLActive
DSH100022ARChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - MRI Unit9333 SW 152nd StMiamiFLTerminated
DSH100022ASChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Cardiac9333 SW 152nd StMiamiFLActive
DSH100022ATChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - JS Intake9333 SW 152nd StMiamiFLActive
DSH100022AUChildDSHJACKSON HEALTH SYSTEMJackson North Medical Center - Anesthesia160 NW 170 StNorth Miami BeachFLTerminated
DSH100022AVChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER - Nuclear Medicine160 NW 170TH STREETNORTH MIAMI BEACHFLActive
DSH100022AWChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER - Dialysis160 NW 170TH STREETNORTH MIAMI BEACHFLActive
DSH100022AXChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Interventional Radiology9333 SW 152nd StMiamiFLTerminated
DSH100022AYChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - EKG Cardiopulmonary9333 SW 152nd StMiamiFLTerminated
DSH100022AZChildDSHJACKSON HEALTH SYSTEMJackson North Medical Center - Recovery Separate160 NW 170 StNorth Miami BeachFLActive
DSH100022BChildDSHJACKSON HEALTH SYSTEMMENTAL HEALTH HOSPITAL CENTER1695 N.W. 9TH AVENUEMIAMIFLActive
DSH100022BAChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER - Non Invasive Vascular160 NW 170TH STREETNORTH MIAMI BEACHFLTerminated
DSH100022BBChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Hemo Dialysis Unit9333 SW 152nd StMiamiFLActive
DSH100022BCChildDSHJACKSON HEALTH SYSTEMJackson Urgent Care - UCC Cutler Bay - UCC Cutler Bay18910 South Dixie HighwayCutler BayFLTerminated
DSH100022BDChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Radiology9333 SW 152nd StMiamiFLActive
DSH100022BEChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - JS Comprehensive Breast Center9333 SW 152nd StMiamiFLTerminated
DSH100022BFChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - JS Trauma ER9333 SW 152nd StMiamiFLActive
DSH100022BGChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER - Endoscopy160 NW 170TH STREETNORTH MIAMI BEACHFLActive
DSH100022BHChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Endoscopy9333 SW 152nd StMiamiFLActive
DSH100022BJChildDSHJACKSON HEALTH SYSTEMJackson North Medical Center - CT Scanner160 NW 170 StNorth Miami BeachFLActive
DSH100022BKChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER - Interventional Radiology160 NW 170TH STREETNORTH MIAMI BEACHFLActive
DSH100022BLChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Labor & Delivery9333 SW 152nd StMiamiFLTerminated
DSH100022BMChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Neurosurgery Clinic9333 SW 152nd StMiamiFLTerminated
DSH100022BNChildDSHJACKSON HEALTH SYSTEMJackson Urgent Care - UCC Keystone Point - UCC Keystone Point13120 Biscayne BlvdNorth MiamiFLTerminated
DSH100022BPChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER - Respiratory Therapy160 NW 170TH STREETNORTH MIAMI BEACHFLActive
DSH100022BQChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER - Cardiovascular Cath Lab160 NW 170TH STREETNORTH MIAMI BEACHFLActive
DSH100022BRChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Cat Scan Unit9333 SW 152nd StMiamiFLActive
DSH100022BSChildDSHJACKSON HEALTH SYSTEMJackson South Community Hospital - Recovery Unit9333 SW 152nd StMiamiFLActive
DSH100022BTChildDSHJACKSON HEALTH SYSTEMJackson Health System - JNMC Multi-Specialty Clinic100 N.W. 170th StreetMiamiFLTerminated
DSH100022BUChildDSHJACKSON HEALTH SYSTEMJackson Health System - MTI Clinic Plantation600 S Pine Island RdPlantationFLActive
DSH100022BVChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Electroencephalograph(EEG)2801 NW 79TH AVEDORALFLActive
DSH100022BWChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Physical Therapy2801 NW 79TH AVEDoralFLTerminated
DSH100022BXChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-X-Ray2801 NW 79TH AVEDORALFLActive
DSH100022BYChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JNMHC PHYSICAL THERAPY#1160 NW 170TH STNORTH MIAMI BEACHFLTerminated
DSH100022BZChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-CT Scan2801 NW 79TH AVEDORALFLActive
DSH100022CChildDSHJACKSON HEALTH SYSTEMJEFFERSON REAVES SR HLTH CTR 1009 NW 5TH AVENUEMIAMIFLActive
DSH100022CAChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Anesthesia2801 NW 79TH AVEDORALFLTerminated
DSH100022CBChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Nuclear Medicine2801 NW 79TH AVEDORALFLActive
DSH100022CCChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JS Multispecialty Clinic9333 SW 152ND STREETMiamiFLTerminated
DSH100022CDChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-MRI2801 NW 79TH AVEDORALFLTerminated
DSH100022CEChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - Jackson South Community Hospital- OB Triage9333 SW 152nd StMiamiFLActive
DSH100022CFChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Pathology2801 NW 79TH AVEDORALFLTerminated
DSH100022CGChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Hybrid Room2801 NW 79TH AVEDoralFLActive
DSH100022CHChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Dialysis2801 NW 79TH AVEDORALFLActive
DSH100022CJChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-GI Station2801 NW 79TH AVEDORALFLActive
DSH100022CKChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - Jackson South Community Hospital- Laboratory9333 SW 152nd StMiamiFLActive
DSH100022CLChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Echocardiography2801 NW 79TH AVEDORALFLActive
DSH100022CMChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Operating Room2801 NW 79TH AVEDORALFLActive
DSH100022CNChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Laboratory2801 NW 79TH AVEDORALFLActive
DSH100022CPChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Respiratory Therapy2801 NW 79TH AVEDORALFLActive
DSH100022CQChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Ultrasound2801 NW 79TH AVEDORALFLTerminated
DSH100022CRChildDSHJACKSON HEALTH SYSTEMJACKSON HEALTH SYSTEM - JW-Emergency Room2801 NW 79TH AVEDORALFLActive
DSH100022FChildDSHJACKSON HEALTH SYSTEMSTOCKADE DETENTION CENTER6950 NW 41ST STREETMIAMIFLActive
DSH100022HChildDSHJACKSON HEALTH SYSTEMTURNER GUILFORD KNIGHT CENTER7000 NW 41ST STREETMIAMIFLActive
DSH100022IChildDSHJACKSON HEALTH SYSTEMMETRO WEST DETENTION CENTER13850 NW 41ST STREETMIAMIFLActive
DSH100022JChildDSHJACKSON HEALTH SYSTEMPRE-TRIAL DETENTION CENTER OF DADE COUNTY1321 NW 13TH STREETMIAMIFLActive
DSH100022LChildDSHJACKSON HEALTH SYSTEMJACKSON SOUTH COMMUNITY HOSPITAL9333 SW 152ND STREETMIAMIFLActive
DSH100022MChildDSHJACKSON HEALTH SYSTEMJACKSON NORTH MEDICAL CENTER160 NW 170 STREETNORTH MIAMI BEACHFLActive
DSH100022NChildDSHJACKSON HEALTH SYSTEMPUBLIC HEALTH TRUST OF DADEPETS HEALTH CENTERMIAMI BEACHFLActive
DSH100022PChildDSHJACKSON HEALTH SYSTEMROSIE LEE WESLEY HEALTH CENTER6601 SW 62ND AVEMIAMIFLActive
DSH100022QChildDSHJACKSON HEALTH SYSTEMPUBLIC HEALTH TRUST OF DADE COUNTYPHT/ RAFAEL A PENALVER CLINICMIAMIFLActive
DSH100022RChildDSHJACKSON HEALTH SYSTEMPUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY SOUTH DADE HOMELESS ASSISTANCE CENTER CLINIC28205 SW 124th Ct.HOMESTEADFLActive
DSH100022SChildDSHJACKSON MEMORIALPHT DR RAFAEL A PENALVER CLINIC971 NW 2ND AVENUEMIAMIFLTerminated
DSH100022TChildDSHJACKSON HEALTH SYSTEMJACKSON SOUTH EMERGENCY DEPARTMENT9333 SW 152ND STREETMIAMIFLActive
DSH100022UChildDSHJACKSON HEALTH SYSTEMJBHH ED EMERGENCY SERVICES1695 NW 9TH AVEMIAMIFLActive
DSH100022VChildDSHJACKSON HEALTH SYSTEMJBHH ADULT OUTPATIENT CENTER (AOC)1695 NW 9TH AVEMIAMIFLActive
DSH100022WChildDSHJACKSON HEALTH SYSTEMJBHH CHILD AND ADOLESCENT CENTER (CAC)1695 NW 9TH AVEMIAMIFLActive
DSH100022XChildDSHJACKSON HEALTH SYSTEMJACKSON SOUTH WOUND CARE CENTER9333 SW 152ND STREETMIAMIFLTerminated
DSH100022YChildDSHJACKSON HEALTH SYSTEMJNMC NURSING SERVICES160 NW 170 STREETNORTH MIAMI BEACHFLTerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertRecertification Public Health Trust of Miami-Dade County Jackson Health System Infusion Services 1611 NW 12TH AVE Suite T-277 Miami, FL 331369/9/2024 10:06 AM
DetailsLast Recertification DateUpdateRecertification9/18/2023 7:23:52 AM9/9/2024 10:06:46 AM9/9/2024 10:06 AM
Medicaid BillingMedicaid: NumberDeleteChange Request0034192000 (FL) 4/1/2024 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/1/2024 11:33 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0034192004/1/2024 11:33 AM
Medicaid BillingMedicaid: StateInsertChange Request FL4/1/2024 11:33 AM
ContactsPrimary ContactUpdateProfile Change RequestPRICE, VENESSA DIRECTOR OF PHARMACY Jackson Health System 3055857411GOODNOW, VENESSA AVP & CHIEF PHARMACY OFFICER Jackson Health System 30558574112/7/2024 1:01 PM
AddressesShipping AddressInsertRecertification Metro West Detention Center Pharmacy 13850 NW 41st Street Miami, FL 331789/18/2023 7:23 AM
AddressesShipping AddressInsertRecertification PUBLIC HEALTH TRUST OF DADE COUNTY JACKSON MEM HOSP-HIGHLAND PARK PHARMACY 1695 N. W. 9TH AVENUE Miami, FL 33136-14209/18/2023 7:23 AM
AddressesShipping AddressInsertRecertification PUBLIC HEALTH TRUST Jackson North Medical Center Pharmacy 160 NW 170th Street N. MIAMI BEACH, FL 331699/18/2023 7:23 AM
AddressesShipping AddressInsertRecertification PUBLIC HEALTH TRUST OF MIAMI: DADE COUNTY Jackson South Medical Center Pharmacy 9333 S.W. 152ND STREET MIAMI, FL 331579/18/2023 7:23 AM
AddressesShipping AddressDeleteRecertificationMetro West Detention Center 13850 NW 41st Street Miami, FL 33178 9/18/2023 7:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/18/2023 7:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 00341920009/18/2023 7:23 AM
Medicaid BillingMedicaid: StateInsertRecertification FL9/18/2023 7:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/18/2023 7:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 1047027009/18/2023 7:23 AM
Medicaid BillingMedicaid: StateInsertRecertification FL9/18/2023 7:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/18/2023 7:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 0034206029/18/2023 7:23 AM
Medicaid BillingMedicaid: StateInsertRecertification FL9/18/2023 7:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/18/2023 7:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 1112507009/18/2023 7:23 AM
Medicaid BillingMedicaid: StateInsertRecertification FL9/18/2023 7:23 AM
Medicaid BillingNPI: NumberInsertRecertification 12958060169/18/2023 7:23 AM
Medicaid BillingNPI: StateInsertRecertification FL9/18/2023 7:23 AM
Medicaid BillingNPI: NumberInsertRecertification 19524346319/18/2023 7:23 AM
Medicaid BillingNPI: StateInsertRecertification FL9/18/2023 7:23 AM
DetailsLast Recertification DateUpdateRecertification9/15/2022 7:23:26 AM9/18/2023 7:23:52 AM9/18/2023 7:23 AM
DetailsLast Recertification DateUpdateRecertification9/2/2021 11:00:12 AM9/15/2022 7:23:26 AM9/15/2022 7:23 AM
AddressesShipping AddressUpdateChange RequestPublic Health Trust of Dade County DBA Jackson Pharmacy Solutions 901 NW 17th Street Unit D Miami, FL 33136Public Health Trust of Dade County DBA Jackson Pharmacy Solutions 901 NW 17th Street UNIT O Miami, FL 331363/15/2022 4:10 PM
Medicaid BillingNPI: NumberInsertChange Request 173076797112/2/2021 2:25 PM
Medicaid BillingNPI: StateInsertChange Request FL12/2/2021 2:25 PM
DetailsLast Recertification DateUpdateRecertification8/28/2020 7:47:40 AM9/2/2021 11:00:12 AM9/2/2021 11:00 AM
ContactsAuthorizing OfficialUpdate Migoya, Carlos A. CEO Jackson Health System 3055856754Migoya, Carlos A. CEO Jackson Health System 30558567547/13/2021 3:16 PM
AddressesShipping AddressInsertChange Request PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY Jackson West Retail Pharmacy 2801 NW 79TH AVENUE DORAL, FL 331225/24/2021 7:00 PM
Medicaid BillingNPI: NumberDeleteRecertification1568578367 ( ) 8/28/2020 7:47 AM
Medicaid BillingNPI: NumberInsertRecertification 10635865438/28/2020 7:47 AM
Medicaid BillingNPI: StateInsertRecertification FL8/28/2020 7:47 AM
Medicaid BillingNPI: NumberInsertRecertification 12250330208/28/2020 7:47 AM
Medicaid BillingNPI: StateInsertRecertification FL8/28/2020 7:47 AM
Medicaid BillingNPI: NumberInsertRecertification 15685783678/28/2020 7:47 AM
Medicaid BillingNPI: StateInsertRecertification FL8/28/2020 7:47 AM
Medicaid BillingNPI: NumberInsertRecertification 17201498188/28/2020 7:47 AM
Medicaid BillingNPI: StateInsertRecertification FL8/28/2020 7:47 AM
Medicaid BillingNPI: NumberInsertRecertification 17908564588/28/2020 7:47 AM
Medicaid BillingNPI: StateInsertRecertification FL8/28/2020 7:47 AM
Medicaid BillingNPI: NumberDeleteRecertification1720149818 ( ) 8/28/2020 7:47 AM
Medicaid BillingNPI: NumberDeleteRecertification1790856458 ( ) 8/28/2020 7:47 AM
Medicaid BillingNPI: NumberDeleteRecertification1063586543 ( ) 8/28/2020 7:47 AM
Medicaid BillingNPI: NumberDeleteRecertification1225033020 ( ) 8/28/2020 7:47 AM
DetailsLast Recertification DateUpdateRecertification9/5/2019 8:28:39 AM8/28/2020 7:47:40 AM8/28/2020 7:47 AM
DetailsLast Recertification DateUpdateRecertification9/10/2018 2:36:12 PM9/5/2019 8:28:39 AM9/5/2019 8:28 AM
DetailsLast Recertification DateUpdateRecertification12/5/2017 10:09:56 AM9/10/2018 2:36:12 PM9/10/2018 2:36 PM
AddressesShipping AddressInsertChange Request JACKSON MEMORIAL HOSPITAL CO HOSP PHARMACY (ACC BLDG) DBA Jackson Memorial Pharmacy 901 NW 17th St Suite N Miami, FL 331366/18/2018 8:28 AM
AddressesShipping AddressDeleteChange RequestJackson Health System Central Fill Pharmacy 1660 NW 7th Court Room 126 Miami, FL 33136 6/18/2018 8:28 AM
Medicaid BillingNPI: NumberInsertChange Request 17908564583/15/2018 4:19 PM
Medicaid BillingNPI: NumberInsertChange Request 10635865433/15/2018 4:19 PM
DetailsLast Recertification DateUpdateRecertification9/2/2016 12:00:00 AM12/5/2017 10:09:56 AM12/5/2017 10:09 AM
ContactsAuthorizing OfficialUpdate Migoya, Carlos A. CEO 3055856754Migoya, Carlos A. CEO Jackson Health System 305585675410/11/2017 2:17 PM
ContactsPrimary ContactUpdate PRICE, VENESSA DIRECTOR OF PHARMACY 3055857411PRICE, VENESSA DIRECTOR OF PHARMACY Jackson Health System 305585741110/11/2017 12:49 PM
ContactsPrimary ContactInsert  PRICE, VENESSA DIRECTOR OF PHARMACY 30558574117/13/2017 2:20 PM
ContactsAuthorizing OfficialUpdate ROLDAN, ENEIDA PRESIDENT/CEO 3055856754Migoya, Carlos A. CEO 30558567547/13/2017 2:20 PM
AddressesMain AddressInsert   1611 NW 12 AVE. MIAMI, FL 331365/11/2017 1:17 PM
AddressesShipping AddressInsert  Public Health Trust of Dade County DBA Jackson Pharmacy Solutions 901 NW 17th Street Unit D Miami, FL 331365/11/2017 1:17 PM
AddressesShipping AddressInsert  Jackson Health System Central Fill Pharmacy 1660 NW 7th Court Room 126 Miami, FL 331365/11/2017 1:17 PM
AddressesShipping AddressInsert  Metro West Detention Center 13850 NW 41st Street Miami, FL 331785/11/2017 1:17 PM
DetailsLast Recertification DateUpdate 9/9/2015 12:00:00 AM9/2/2016 12:00:00 AM9/2/2016 11:11 AM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse9/9/2015 2:32 PM
DetailsLast Recertification DateUpdate 9/3/2014 12:00:00 AM9/9/2015 12:00:00 AM9/9/2015 2:32 PM
DetailsLast Recertification DateUpdate 9/6/2013 12:00:00 AM9/3/2014 12:00:00 AM9/3/2014 12:35 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/6/2013 12:00:00 AM9/6/2013 3:51 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False9/17/2012 9:59 AM
Medicaid BillingMedicaid: NumberInsert  0034206009/17/2012 9:59 AM
Medicaid BillingMedicaid: StateInsert  FL9/17/2012 9:59 AM
Medicaid BillingNPI: NumberInsert  12250330209/17/2012 9:59 AM
Medicaid BillingNPI: NumberInsert  17201498185/25/2012 10:36 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/25/2012 10:36 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/26/2012 11:57 AM
Medicaid BillingMedicaid: NumberInsert  00100421003/26/2012 11:57 AM
Medicaid BillingMedicaid: StateInsert  FL3/26/2012 11:57 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/26/2012 11:57 AM
Medicaid BillingMedicaid: NumberInsert  00100421013/26/2012 11:57 AM
Medicaid BillingMedicaid: StateInsert  FL3/26/2012 11:57 AM
ContactsAuthorizing OfficialInsert  ROLDAN, ENEIDA PRESIDENT/CEO 305585675412/19/2011 5:13 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True12/5/2006 10:02 AM
Medicaid BillingMedicaid: NumberInsert  10949800012/5/2006 10:02 AM
Medicaid BillingMedicaid: StateInsert  FL12/5/2006 10:02 AM
Medicaid BillingNPI: NumberInsert  156857836712/5/2006 10:02 AM
DetailsLast Recertification DateInsert   12/5/2006 10:02 AM
DetailsGrant NumberInsert   12/5/2006 10:02 AM
Details340B IDInsert  DSH10002212/5/2006 10:02 AM
DetailsIs Authorizing Official EHB DataInsert   12/5/2006 10:02 AM
DatesLast Date That 340B Drugs PurchasedInsert   12/5/2006 10:02 AM
DetailsMedicare Provider NumberInsert  10002212/5/2006 10:02 AM
DetailsEntity NameInsert  JACKSON HEALTH SYSTEM12/5/2006 10:02 AM
DetailsProgram CodeInsert  DSH12/5/2006 10:02 AM
DetailsEntity SubnameInsert  JACKSON MEMORIAL HOSPITAL12/5/2006 10:02 AM
DatesParticipating Approval DateInsert  12/5/2006 12:00:00 AM12/5/2006 10:02 AM
DetailsStateInsert  Active12/5/2006 10:02 AM
DatesRegistration DateInsert  12/5/2006 12:00:00 AM12/5/2006 10:02 AM
DatesSigned By DateInsert   12/5/2006 10:02 AM
DatesStart DateInsert  12/1/1992 12:00:00 AM12/5/2006 10:02 AM
TerminationsTermination CommentsInsert   12/5/2006 10:02 AM
TerminationsTermination DateInsert   12/5/2006 10:02 AM
TerminationsTermination Effective DateInsert   12/5/2006 10:02 AM
TerminationsTermination ReasonInsert   12/5/2006 10:02 AM
DetailsComments PublicInsert  9/17/08-REVISED NAME (WAS JACKSON MEMORIAL HOSPITAL); 7/1/08-ADDED NPI 156857836712/5/2006 10:02 AM