340B Drug Pricing Program Database


DSH100034 MOUNT SINAI MEDICAL CENTER (Active) - information as of 4/29/2025 12:33:35 AM

Main Details
MOUNT SINAI MEDICAL CENTER
MOUNT SINAI MEDICAL CENTER OF FLORIDA INC.
Disproportionate Share Hospital
No
DSH100034
100034


Additional Details
Active
1/18/2007
4/1/2007
1/18/2007
9/3/2024

Contacts

Mount Sinai Medical Center
ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520

Mount Sinai Medical Center
ANA CAROLINA CALDERA, DIRECTOR OF PHARMACY
(305) 674-2855

Addresses

4300 Alton Road
MIAMI BEACH, FL 33140

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
7/25/11 ADDED SHIP-TO ADD AND NPI#; 7/19/2011- DOC. RECD TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE07/25/2011
7/25/11 ADDED SUBDIV NAME, UPDATED PHYS ADD (WAS 4300 ALTON ROAD); 7/19/2011- DOC. RECD TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE07/25/2011
7/19/2011- DOC. RECD TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE07/20/2011
3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE01/18/2007
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
FL0100463001912964768
Shipping Addresses

Mount Sinai Medical Center
4300 Alton Road
Miami Beach, FL 33140

Mount Sinai Medical Center - Comprehensive Cancer at Aventura
2845 Aventura Blvd
Suite 243
Aventura, FL 33180

Mount Sinai Medical Center - Comprehensive Cancer Center
4306 Alton Road
Miami Beach, FL 33140

Mount Sinai Pharmacy Express
4302 Alton Road
Suite 110
Miami Beach, FL 33140

RPK SFCR MT SINAI MC; ATTN: SAFECOR HEALTH LLC
317 NEW BOSTON ST- STE 100
WOBURN, MA 01801
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280910/06/201701/01/2018 03/05/201803/05/2018
Contract DetailAETNA SPECIALTY PHARMACY, LLC503 SUNPORT LN
ORLANDOFL32809-787406/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361406/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005606/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621906/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175706/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808306/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700406/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761706/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813306/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/06/201701/01/2018 03/05/201803/05/2018
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237406/10/201906/10/2019 03/06/202006/16/2020
Contract DetailCOMMCARE PHARMACY-FTL, LLC855 SW 78TH AVE STE C100
PLANTATIONFL33324-322310/29/201401/01/2015 06/22/201907/10/2019
Contract DetailCOMMCARE PHARMACY-MIA, LLC  1801 CORAL WAY
SUITE 115 		MIAMIFL33145-278410/29/201401/01/2015 08/08/201708/14/2017
Contract DetailCYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503304/18/201707/01/2017 08/09/201708/14/2017
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503306/29/201707/01/2017  06/29/2017
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 02893 4040 PRAIRIE AVE.
MIAMI BEACHFL3314004/14/201407/01/2014 08/30/201609/06/2016
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 03704 1421 ALTON RD
MIAMI BEACHFL3313904/14/201407/01/2014 08/30/201609/06/2016
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 03706 7400 COLLINS AVE
MIAMI BEACHFL3314104/14/201407/01/2014 08/30/201609/06/2016
Contract DetailHOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04182 9578 HARDING AVE
SURFSIDEFL3315404/14/201407/01/2014 08/30/201609/06/2016
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/10/201910/01/2019 10/01/202208/02/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/06/201701/01/2018 03/05/201803/05/2018
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514606/10/201906/10/2019 03/06/202006/16/2020
Contract DetailPROCARE PHARMACY, L.L.C.NAVARRO SPECIALTY SERVICES # 10727 7205 CORPORATE CENTER DRIVE
SUITE 104 		MIAMIFL3312606/10/201906/10/2019 03/06/202006/16/2020
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022301/17/202404/01/2024  04/01/2024
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104201/17/202404/01/2024  04/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #13851 9310 SW 56TH STREET
MIAMIFL3316503/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04384 400 HIALEAH DRIVE
HIALEAHFL3301003/07/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 04385 770 W 29TH ST
HIALEAHFL3301203/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04386 5999 PEMBROKE ROAD
HOLLYWOODFL3302303/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 01508 2855 STIRLING RD
FT LAUDERDALEFL3331203/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04402 1300 E HALLANDALE BEACH BLVD
HALLANDALE BEACHFL3300903/07/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 04483 6401 W COMMERCIAL BLVD.
TAMARACFL3331903/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04591 509 W HALLANDALE BEACH BLVD.
HALLANDALE BEACHFL3300903/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #01924 2300 COLLINS AVE
MIAMI BEACHFL3313903/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 02128 1845 ALTON ROAD
MIAMI BEACHFL3313903/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 04728 6200 NW 7TH AVE
MIAMIFL3315003/07/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 04770 8625 STIRLING RD
COOPER CITYFL3332803/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04809 3595 CORAL WAY
MIAMIFL3314503/07/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 04915 750 NW 119TH ST.
MIAMIFL3316803/07/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 04917 690 NW 183RD ST
MIAMI GARDENSFL3316903/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04955 18665 BISCAYNE BLVD
AVENTURAFL3318003/07/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 15914 1669 COLLINS AVENUE
MIAMI BEACHFL3313903/07/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 05050 1610 W 49TH ST
HIALEAHFL3301203/07/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 05130 6800 W 28TH AVE
HIALEAHFL3301803/07/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 05198 7340 COLLINS AVE
MIAMI BEACHFL3314103/07/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 05250 1699 NW 7TH ST
MIAMIFL3312503/07/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 05251 1 E FLAGLER ST
MIAMIFL3313103/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05293 4895 PALM AVENUE
HIALEAHFL3301203/07/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 05521 12400 PEMBROKE RD
MIRAMARFL3302703/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05625 1601 SW 107TH AVE
MIAMIFL3316503/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05696 14501 MIRAMAR PARKWAY
MIRAMARFL3302703/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05742 14190 SW 26TH STREET
MIAMIFL3317503/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05845 14901 NE 6TH AVE
MIAMIFL3316103/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06011 8001 MIRAMAR PKWY
MIRAMARFL33025-300403/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06012 655 NW 57TH AVE
MIAMIFL3312603/07/201304/01/2013 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 06013 13698 SW 8TH STREET
MIAMIFL3318403/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06402 501 E SHERIDAN ST
DANIAFL3300403/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06404 11204 W STATE ROAD 84
DAVIEFL3332503/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 00456 1723 E YOUNG CIRCLE
HOLLYWOODFL3302003/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 00621 5731 BIRD ROAD
MIAMIFL3315503/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06442 15195 SW 42ND STREET
MIAMIFL3318503/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 00622 3715 N.W. 7TH ST
MIAMIFL3312603/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06873 1201 SW 1ST STREET
MIAMIFL33135-240103/07/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 00748 12295 BISCAYNE BLVD
NORTH MIAMIFL3318103/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 07844 7605 W 33RD CT
HIALEAHFL3301803/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #09018 1155 W. 68TH ST
HIALEAHFL33014-515203/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09206 8650 SW 132ND ST
MIAMIFL33156-650703/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 01532 6700 COLLINS AVE
MIAMI BEACHFL3314103/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 09572 11211 S DIXIE HWY
PINECRESTFL33156-444103/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02129 17534 COLLINS AVE
SUNNY ISLES BEACHFL3316003/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS #10648 6700 DYKES RD.
SOUTHWEST RANCHESFL3333103/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02184 8327 W FLAGLER ST
MIAMIFL3314403/06/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS #10830 201 N. HIATUS ROAD
PEMBROKE PINESFL3302603/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02416 10609 SW 40TH ST
MIAMIFL3316503/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 10900 3490 BIRD RD
MIAMIFL3313303/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02443 3705 HOLLYWOOD BLVD
HOLLYWOODFL3302103/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02489 3007 AVENTURA BLVD., #4
AVENTURAFL3318003/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS #11304 15043 S. DIXIE HWY.
PALMETTO BAYFL3317603/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #15994 801 SW 8TH ST
MIAMIFL3313003/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02545 1480 NE MIAMI GARDENS DR
NORTH MIAMI BEACHFL3317903/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS #11638 15050 BISCAYNE BLVD
NORTH MIAMIFL3318103/07/201304/01/2013 03/15/201603/15/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 02719 791 NE 167TH ST
NORTH MIAMI BEACHFL3316203/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS #11657 2000 NORMANDY DR.
MIAMI BEACHFL3314103/07/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS #11938 10700 W FLAGLER ST
MIAMIFL3317403/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02743 998 SW 67TH AVE
MIAMIFL3314403/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 11939 8450 CORAL WAY
MIAMIFL3315503/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #12260 11700 SW 104TH ST
MIAMIFL3318603/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 12285 780 EAST 9TH STREET
HIALEAHFL3301003/07/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS #12463 501 COLLINS AVE.
MIAMI BEACHFL3313903/07/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #13849 2540 NE 15TH AVE
WILTON MANORSFL3330503/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 02790 3103 BISCAYNE BLVD
MIAMIFL3313703/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 02832 4010 S W 137TH AVE
MIAMIFL3317503/06/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 03105 11920 NW 27TH AVENUE
MIAMIFL3316703/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03162 524 JEFFERSON AVE.
MIAMI BEACHFL3313903/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 03173 9020 BISCAYNE BLVD
MIAMI SHORESFL3313803/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 03211 9675 NW 41ST STREET
DORALFL33178-297403/06/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 03239 1 SE 3RD AVE STE 100
MIAMIFL3313103/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03250 18300 NW 37TH AVE.
MIAMI GARDENSFL33056-510103/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03301 1695 NW 20TH STREET
MIAMIFL3314203/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 03302 9701 SW 24TH STREET
MIAMIFL3316503/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03316 2700 W. FLAGLER STREET
MIAMIFL3313503/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03317 4200 SW 8TH STREET
CORAL GABLESFL3313403/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03318 11690 SW 72ND ST
MIAMIFL3317303/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03371 7910 NW 27TH AVENUE
MIAMIFL3314703/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 03493 9498 NW 7TH AVE
MIAMIFL3315003/06/201304/01/2013 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 03527 567 NE 125TH STREET
NORTH MIAMIFL3316103/06/201304/01/2013 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03566 4451 W. 12TH AVE.
HIALEAHFL3301203/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03678 1501 NE 163RD STREET
NORTH MIAMI BEACHFL3316203/06/201304/01/2013 08/19/202108/31/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 03679 161 NE 54TH STREET
MIAMIFL3313703/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 03782 5701 NW 183RD ST
HIALEAHFL3301503/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03784 3655 S DIXIE HWY
MIAMIFL3313303/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03835 19935 NW 2ND AVE
MIAMIFL3316903/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 03854 15900 NW 27TH AVE
OPA LOCKAFL3305403/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03905 1751 BONAVENTURE BLVD
WESTONFL3332603/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03942 4049 PINE TREE DR
MIAMI BEACHFL3314003/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 03943 200 SW 13TH ST
MIAMIFL3313003/06/201304/01/2013  03/28/2013
Contract DetailWALGREEN CO.DBA: WALGREENS # 04003 3015 S. UNIVERSITY DR.
DAVIEFL3332803/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04143 13800 PINES BLVD.
PEMBROKE PINESFL3302703/06/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04324 15911 PINES BLVD.
PEMBROKE PINESFL3302703/07/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #15912 7100 W 20TH AVENUE, STE G177
HIALEAHFL3301604/05/201304/01/2013 07/13/201601/25/2017
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21359 275 NE 35TH ST
MIAMIFL3313704/18/201707/01/2017 08/31/201801/21/2019
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21155 5966 S DIXIE HWY STE 103B
SOUTH MIAMIFL3314307/15/201910/01/2019  10/01/2019
Contract DetailWALGREEN CO.WALGREENS SPECIALTY PHARMACY #15106 1250 NW 7TH STREET SUITE 205
MIAMIFL3312507/15/201910/01/2019  10/01/2019
Contract DetailWALGREEN CO.WALGREENS #16542 1475 NW 12TH AVE STE 2307B
MIAMIFL3313607/15/201910/01/2019  10/01/2019
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15299 1201 NE 26TH ST STE 110
WILTON MANORSFL3330507/15/201910/01/2019  10/01/2019
Contract DetailWALGREEN CO.DBA: WALGREENS # 05050 1610 W 49TH ST
HIALEAHFL3301204/15/202107/01/2021  07/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 07844 7605 W 33RD CT
HIALEAHFL3301804/15/202107/01/2021  07/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS #09018 1155 W. 68TH ST
HIALEAHFL33014-515204/15/202107/01/2021  07/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 05130 6800 W 28TH AVE
HIALEAHFL3301804/15/202107/01/2021  07/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 03318 11690 SW 72ND ST
MIAMIFL3317301/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 03854 15900 NW 27TH AVE
OPA LOCKAFL3305401/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 06013 13698 SW 8TH STREET
MIAMIFL3318401/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 02443 3705 HOLLYWOOD BLVD
HOLLYWOODFL3302101/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03566 4451 W. 12TH AVE.
HIALEAHFL3301201/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 04324 15911 PINES BLVD.
PEMBROKE PINESFL3302701/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #15994 801 SW 8TH ST
MIAMIFL3313001/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04591 509 W HALLANDALE BEACH BLVD.
HALLANDALE BEACHFL3300901/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 03721 15255 SW 137TH AVENUE
MIAMIFL3317701/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 03784 3655 S DIXIE HWY
MIAMIFL3313301/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04803 11105 STIRLING RD
COOPER CITYFL3332801/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04385 770 W 29TH ST
HIALEAHFL3301201/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #10983 1011 ALTON RD.
MIAMI BEACHFL3313901/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 04143 13800 PINES BLVD.
PEMBROKE PINESFL3302701/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04766 9005 PINES BLVD
PEMBROKE PINESFL3302401/14/202204/01/2022 05/21/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 04386 5999 PEMBROKE ROAD
HOLLYWOODFL3302301/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 03782 5701 NW 183RD ST
HIALEAHFL3301501/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 03105 11920 NW 27TH AVENUE
MIAMIFL3316701/14/202204/01/2022 02/28/202405/30/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #15912 7100 W 20TH AVENUE, STE G177
HIALEAHFL3301604/20/202207/01/2022 03/22/202308/02/2023
Contract DetailWalgreens #21395Walgreens Central Fill #21395 5710 Young Pine Rd
OrlandoFL3282910/14/202201/01/2023  01/01/2023
Contract DetailWALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904903/06/201304/01/2013 07/01/201507/06/2015
Contract DetailWALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528404/25/201307/01/2013 07/01/201507/06/2015
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/18/201707/01/2017  04/18/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/18/201707/01/2017 10/01/202108/02/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/18/201707/01/2017  04/18/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/18/201707/01/2017  04/18/2017
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH100034AChildDSHMOUNT SINAI MEDICAL CENTERCOMPREHENSIVE CANCER CENTER4306 ALTON ROADMIAMI BEACHFLActive
DSH100034BChildDSHMOUNT SINAI MEDICAL CENTERCOMPREHENSIVE CANCER AT AVENTURA2845 AVENTURA BLVDAVENTURAFLActive
DSH100034CChildDSHMOUNT SINAI MEDICAL CENTERMOUNT SINAI MEDICAL CENTER OF FLORIDA, INC.2845 AVENTURA BLVDAVENTURAFLActive
DSH100034DChildDSHMOUNT SINAI MEDICAL CENTERMount Sinai Medical Center - Hialeah Emergency Dept.6050 W 20TH AVEHIALEAHFLActive
DSH100034EChildDSHMOUNT SINAI MEDICAL CENTERMount Sinai Medical Center - Outpatient Behavioral Health Center4302 Alton RoadMiami BeachFLActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressDeleteRecertificationRPK SFCR MT SINAI MC; ATTN: SAFECOR HEALTH LLC 317 NEW BOSTON ST- STE 10 WOBURN, MA 01801 9/3/2024 10:18 AM
AddressesShipping AddressInsertRecertification RPK SFCR MT SINAI MC; ATTN: SAFECOR HEALTH LLC 317 NEW BOSTON ST- STE 100 WOBURN, MA 018019/3/2024 10:18 AM
Medicaid BillingMedicaid: NumberDeleteRecertification002968600 (FL) 9/3/2024 10:18 AM
Medicaid BillingNPI: NumberDeleteRecertification1780987412 (FL) 9/3/2024 10:18 AM
DetailsLast Recertification DateUpdateRecertification9/5/2023 10:17:38 AM9/3/2024 10:18:56 AM9/3/2024 10:18 AM
DetailsLast Recertification DateUpdateRecertification9/13/2022 7:17:50 AM9/5/2023 10:17:38 AM9/5/2023 10:17 AM
AddressesShipping AddressInsertChange Request Mount Sinai Pharmacy Express 4302 Alton Road Suite 110 Miami Beach, FL 331407/13/2023 7:15 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/13/2023 7:15 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0029686007/13/2023 7:15 AM
Medicaid BillingMedicaid: StateInsertChange Request FL7/13/2023 7:15 AM
Medicaid BillingNPI: NumberInsertChange Request 17809874127/13/2023 7:15 AM
Medicaid BillingNPI: StateInsertChange Request FL7/13/2023 7:15 AM
AddressesShipping AddressInsertRecertification RPK SFCR MT SINAI MC; ATTN: SAFECOR HEALTH LLC 317 NEW BOSTON ST- STE 10 WOBURN, MA 018019/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertificationMOU003RN (AL) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification315772 (AZ) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1912964768 (CA) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification9000166797 (CO) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification822523928A (GA) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1912964768 (IA) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification590624424001 (IL) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1291087 (KY) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification43248200 (MN) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1912964768 (NC) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification350481 (OH) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification16118740001 (PA) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification10472B (SC) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification100034 (VT) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1912964768 (WI) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification350454 (NY) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification008002667 (CT) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification008014269 (CT) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification300031438 (IN) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1912964768 (ME) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification80036571 (NM) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification100507524 (NV) 9/13/2022 7:17 AM
Medicaid BillingMedicaid: NumberDeleteRecertification071769601 (TX) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (AL) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (AZ) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (CA) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (CO) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (GA) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (IA) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (IL) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (KY) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (MN) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (NC) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (OH) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (PA) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (SC) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (VT) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (WI) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (NY) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (CT) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (IN) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (ME) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (NM) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (NV) 9/13/2022 7:17 AM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 (TX) 9/13/2022 7:17 AM
DetailsLast Recertification DateUpdateRecertification9/7/2021 2:44:56 PM9/13/2022 7:17:50 AM9/13/2022 7:17 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/7/2021 2:44 PM
Medicaid BillingMedicaid: NumberInsertRecertification 0080026679/7/2021 2:44 PM
Medicaid BillingMedicaid: StateInsertRecertification CT9/7/2021 2:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/7/2021 2:44 PM
Medicaid BillingMedicaid: NumberInsertRecertification 0080142699/7/2021 2:44 PM
Medicaid BillingMedicaid: StateInsertRecertification CT9/7/2021 2:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/7/2021 2:44 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3000314389/7/2021 2:44 PM
Medicaid BillingMedicaid: StateInsertRecertification IN9/7/2021 2:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/7/2021 2:44 PM
Medicaid BillingMedicaid: NumberInsertRecertification 19129647689/7/2021 2:44 PM
Medicaid BillingMedicaid: StateInsertRecertification ME9/7/2021 2:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/7/2021 2:44 PM
Medicaid BillingMedicaid: NumberInsertRecertification 800365719/7/2021 2:44 PM
Medicaid BillingMedicaid: StateInsertRecertification NM9/7/2021 2:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/7/2021 2:44 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1005075249/7/2021 2:44 PM
Medicaid BillingMedicaid: StateInsertRecertification NV9/7/2021 2:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/7/2021 2:44 PM
Medicaid BillingMedicaid: NumberInsertRecertification 0717696019/7/2021 2:44 PM
Medicaid BillingMedicaid: StateInsertRecertification TX9/7/2021 2:44 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/7/2021 2:44 PM
Medicaid BillingNPI: StateInsertRecertification CT9/7/2021 2:44 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/7/2021 2:44 PM
Medicaid BillingNPI: StateInsertRecertification IN9/7/2021 2:44 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/7/2021 2:44 PM
Medicaid BillingNPI: StateInsertRecertification ME9/7/2021 2:44 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/7/2021 2:44 PM
Medicaid BillingNPI: StateInsertRecertification NM9/7/2021 2:44 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/7/2021 2:44 PM
Medicaid BillingNPI: StateInsertRecertification NV9/7/2021 2:44 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/7/2021 2:44 PM
Medicaid BillingNPI: StateInsertRecertification TX9/7/2021 2:44 PM
DetailsLast Recertification DateUpdateRecertification9/9/2020 12:29:17 PM9/7/2021 2:44:56 PM9/7/2021 2:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification MOU003RN9/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification AL9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3157729/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification AZ9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification CA9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 90001667979/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification CO9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 822523928A9/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification GA9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification IA9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 5906244240019/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification IL9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 12910879/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification KY9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 432482009/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification MN9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification NC9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3504819/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification OH9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 161187400019/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification PA9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10472B9/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification SC9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1000349/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification VT9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification WI9/9/2020 12:29 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/9/2020 12:29 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3504549/9/2020 12:29 PM
Medicaid BillingMedicaid: StateInsertRecertification NY9/9/2020 12:29 PM
Medicaid BillingNPI: NumberDeleteRecertification1912964768 ( ) 9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification FL9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification AL9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification CA9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification CO9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification GA9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification IA9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification IL9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification KY9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification MN9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification NC9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification OH9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification PA9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification SC9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification WI9/9/2020 12:29 PM
Medicaid BillingNPI: NumberInsertRecertification 19129647689/9/2020 12:29 PM
Medicaid BillingNPI: StateInsertRecertification NY9/9/2020 12:29 PM
DetailsLast Recertification DateUpdateRecertification9/9/2019 3:12:51 PM9/9/2020 12:29:17 PM9/9/2020 12:29 PM
DetailsLast Recertification DateUpdateRecertification9/10/2018 10:55:55 AM9/9/2019 3:12:51 PM9/9/2019 3:12 PM
AddressesShipping AddressInsertChange Request Mount Sinai Medical Center 4300 Alton Road Miami Beach, FL 331407/11/2019 8:35 AM
AddressesShipping AddressInsertChange Request Mount Sinai Medical Center - Comprehensive Cancer at Aventura 2845 Aventura Blvd Suite 243 Aventura, FL 331807/11/2019 8:35 AM
AddressesShipping AddressInsertChange Request Mount Sinai Medical Center - Comprehensive Cancer Center 4306 Alton Road Miami Beach, FL 331407/11/2019 8:35 AM
DetailsLast Recertification DateUpdateRecertification12/5/2017 7:21:35 PM9/10/2018 10:55:55 AM9/10/2018 10:55 AM
AddressesShipping AddressDeleteChange RequestMount Sinai Medical Center of Florida Inc 4302 Alton Road Suite 110, ATTN: Pharmacy Express Miami Beach, FL 33140 3/7/2018 8:36 AM
DetailsLast Recertification DateUpdateRecertification9/6/2016 12:00:00 AM12/5/2017 7:21:35 PM12/5/2017 7:21 PM
ContactsAuthorizing OfficialUpdate PALLIN, ANGEL SVP OF OPERATIONS 3056742520PALLIN, ANGEL SVP OF OPERATIONS Mount Sinai Medical Center 305674252010/6/2017 12:03 PM
ContactsPrimary ContactUpdateProfile Change RequestCALDERA, ANA CAROLINA DIRECTOR OF PHARMACY Mount Sinai Medical Center 3056742512CALDERA, ANA CAROLINA DIRECTOR OF PHARMACY Mount Sinai Medical Center 305674285510/4/2017 12:24 PM
ContactsPrimary ContactUpdate CALDERA, ANA DIRECTOR OF PHARMACY 3056742512CALDERA, ANA CAROLINA DIRECTOR OF PHARMACY Mount Sinai Medical Center 305674251210/4/2017 12:22 PM
ContactsAuthorizing OfficialInsert  PALLIN, ANGEL SVP OF OPERATIONS 30567425208/14/2017 3:19 PM
AddressesMain AddressUpdate  4302 ALTON ROAD MIAMI BEACH, FL 33140 4300 ALTON ROAD MIAMI BEACH, FL 331401/25/2017 5:19 PM
AddressesMain AddressInsert   4302 ALTON ROAD MIAMI BEACH, FL 331401/25/2017 5:19 PM
AddressesShipping AddressInsert  Mount Sinai Medical Center of Florida Inc 4302 Alton Road Suite 110, ATTN: Pharmacy Express Miami Beach, FL 331401/25/2017 5:19 PM
ContactsPrimary ContactUpdate Shah, Mukesh Director Of Pharmacy 3055352512CALDERA, ANA DIRECTOR OF PHARMACY 30567425121/25/2017 5:19 PM
ContactsPrimary ContactInsert  Shah, Mukesh Director Of Pharmacy 30553525129/6/2016 4:15 PM
DetailsLast Recertification DateUpdate 8/25/2015 12:00:00 AM9/6/2016 12:00:00 AM9/6/2016 4:15 PM
DetailsLast Recertification DateUpdate 8/18/2014 12:00:00 AM8/25/2015 12:00:00 AM8/25/2015 11:44 AM
DetailsLast Recertification DateUpdate 9/6/2013 12:00:00 AM8/18/2014 12:00:00 AM8/18/2014 2:20 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False9/6/2013 3:48 PM
Medicaid BillingMedicaid: NumberInsert  0100463009/6/2013 3:48 PM
Medicaid BillingMedicaid: StateInsert  FL9/6/2013 3:48 PM
Medicaid BillingNPI: NumberInsert  19129647689/6/2013 3:48 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/6/2013 12:00:00 AM9/6/2013 3:48 PM
DetailsEntity SubnameUpdate MOUNT SINAI PHARMACY EXPRESSMOUNT SINAI MEDICAL CENTER OF FLORIDA INC.2/22/2013 6:32 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/15/2012 7:20 AM
DetailsComments PublicInsert  7/25/11 ADDED SHIP-TO ADD AND NPI#; 7/19/2011- DOC. RECD TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE7/25/2011 4:33 PM
DetailsEntity SubnameUpdate  MOUNT SINAI PHARMACY EXPRESS7/25/2011 3:50 PM
DetailsComments PublicInsert  7/25/11 ADDED SUBDIV NAME, UPDATED PHYS ADD (WAS 4300 ALTON ROAD); 7/19/2011- DOC. RECD TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE7/25/2011 3:50 PM
DetailsComments PublicInsert  7/19/2011- DOC. RECD TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE7/20/2011 11:39 AM
DetailsLast Recertification DateInsert   1/18/2007 2:22 PM
DetailsGrant NumberInsert   1/18/2007 2:22 PM
Details340B IDInsert  DSH1000341/18/2007 2:22 PM
DetailsIs Authorizing Official EHB DataInsert   1/18/2007 2:22 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/18/2007 2:22 PM
DetailsMedicare Provider NumberInsert  1000341/18/2007 2:22 PM
DetailsEntity NameInsert  MOUNT SINAI MEDICAL CENTER1/18/2007 2:22 PM
DetailsProgram CodeInsert  DSH1/18/2007 2:22 PM
DetailsEntity SubnameInsert   1/18/2007 2:22 PM
DatesParticipating Approval DateInsert  1/18/2007 12:00:00 AM1/18/2007 2:22 PM
DetailsStateInsert  Active1/18/2007 2:22 PM
DatesRegistration DateInsert  1/18/2007 12:00:00 AM1/18/2007 2:22 PM
DatesSigned By DateInsert  9/1/2006 12:00:00 AM1/18/2007 2:22 PM
DatesStart DateInsert  4/1/2007 12:00:00 AM1/18/2007 2:22 PM
TerminationsTermination CommentsInsert   1/18/2007 2:22 PM
TerminationsTermination DateInsert   1/18/2007 2:22 PM
TerminationsTermination Effective DateInsert   1/18/2007 2:22 PM
TerminationsTermination ReasonInsert   1/18/2007 2:22 PM
DetailsComments PublicInsert  3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE1/18/2007 2:22 PM