Covered Entity Details

DSH100113 SHANDS TEACHING HOSPITAL AND CLINICS, INC. (Active) - information as of 4/23/2025 10:53:55 PM

Main Details

Name

SHANDS TEACHING HOSPITAL AND CLINICS, INC.

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100113

Medicare Provider Number

100113

Additional Details

Current Program Status

Active

Registration Date

9/14/2007

Participating Start Date

7/1/1993

Participating Approval Date

9/14/2007

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Shands Teaching Hospital & Clinics Inc
Traci d'Auguste, Chief Operating Officer
(352) 294-8661

Primary Contact

Shands Teaching Hospital & Clinics, Inc.
Thomas Johns, Associate Vice President, Operations
(352) 594-1321

Addresses

Street Address

1600 SW Archer Road
GAINESVILLE, FL 32610

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
11/3/09 ADDED SHIP TO; 11/3/09 ADDED MEDICAID #	01/14/2010

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	010003000,010003004	1699874248,1588765861
GA	000100724A	1699874248,1588765861

Shipping Addresses

Shipping Address 1

Shands Outpatient Pharmacy
1600 SW Archer Road
Room #1190
Gainesville, FL 32610

Shipping Address 2

Shands Hospital Vault
1600 SW Archer Road
Room #G-539
Gainesville, FL 32610

Shipping Address 3

Shands Main Carousel
1600 SW Archer Road
Room #G-539
Gainesville, FL 32610

Shipping Address 4

Shands Teaching Hospital & Clinics, Inc, D/B/A: UF Health Pharmacy - Springhill
4197 NW 86th Terrace
#1131
Gainesville, FL 32606

Shipping Address 5

Shands HVN Carousel
1505 SW Archer Road
Room #G-640
Gainesville, FL 32608

Shipping Address 6

Shands South Campus Outpatient Pharmacy
1515 SW Archer Road, Room 1010
Gainesville, FL 32608

Shipping Address 7

Shands Medical Plaza Pharmacy
1549 Gale Lemerand Drive, Room #1520
Gainesville, FL 32610

Shipping Address 8

Shands Pharmacy Stores
1600 SW Archer Road
Room #DG-16
Gainesville, FL 32610

Shipping Address 9

Safecor Health, LLC
317 New Boston Street
Suite 100
Woburn, MA 01801

Shipping Address 10

Office of Radiation Safety
1395 Center Drive
Room #DG-11B
Gainesville, FL 32610

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/11/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	CVS ORLANDO FL DISTRIBUTION	8201 CHANCELLOR DR		ORLANDO	FL	32809-7657	01/08/2015	04/01/2015	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00372	101 SOUTHWEST 34TH ST	GAINESVILLE	FL	32607	03/08/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00571	901 N MAIN ST	GAINESVILLE	FL	32601	03/08/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03255	3404 SW ARCHER RD	GAINESVILLE	FL	32608	03/08/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY #5832	1515 NW 13TH STREET	GAINESVILLE	FL	32601	03/08/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY # 7178	1621 SW 13TH ST.	GAINESVILLE	FL	32608	03/08/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01815	4354 NW 23RD AVENUE	GAINESVILLE	FL	32606	01/08/2015	04/01/2015	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01856	7430 SW ARCHER RD.	GAINESVILLE	FL	32608	01/08/2015	04/01/2015	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04139	4145 NW 53RD AVENUE	GAINESVILLE	FL	32653	01/08/2015	04/01/2015	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05181	2303 SW 75TH ST	GAINESVILLE	FL	32607	01/08/2015	04/01/2015	08/01/2015	02/29/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05227	14355 W NEWBERRY RD	JONESVILLE	FL	32669	01/08/2015	04/01/2015	08/01/2015	02/29/2016
Contract Detail	MAGELLAN RX PHARMACY, LLC.	31-75 23RD STREET	SUITE 410	ASTORIA	NY	11106	11/28/2012	01/01/2013	08/01/2015	02/29/2016
Contract Detail	PRIME THERAPEUTICS PHARMACY LLC	6870 SHADOWRIDGE DR STE 111		ORLANDO	FL	32812	11/28/2012	01/01/2013	08/01/2015	02/29/2016
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/14/2016	01/01/2017	07/28/2017	07/31/2017
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #1312	3930 SW ARCHER ROAD	GAINESVILLE	FL	32608	03/19/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0527	5801 S.W. 75TH STREET	GAINESVILLE	FL	32608	03/19/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0690	14130 W NEWBERRY RD	NEWBERRY	FL	32669	03/19/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0795	1302 NORTH MAIN STREET	GAINESVILLE	FL	32601	03/19/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS INC PUBLIX PHARMACY #0735	9200 NW 39th Avenue		Gainesville	FL	32606	03/19/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS INC. PUIBLIX PHARMACY #1038	5200 SW 34th Street		Gainesville	FL	32608	03/19/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1111	2755 S. W. 91ST STREET	GAINESVILLE	FL	32608	03/19/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #0435	5200 NW 43RD STREET SUITE 401	GAINESVILLE	FL	32606	03/19/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE ROAD #5	ORLANDO	FL	32809	01/08/2015	04/01/2015	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPER MARKETS, INC. PUBLIX PHARMACY #1376	4115 NW 16TH BLVD		GAINESVILLE	FL	32605	03/21/2013	04/01/2013	08/01/2015	02/29/2016
Contract Detail	PUBLIX SUPERMARKETS	PUBLIX PHARMACY #0537	3720 N.W. 13TH ST., SUITE 9	GAINESVILLE	FL	32609	03/19/2013	04/01/2013	08/01/2015	02/29/2016

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH100113A	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	SHANDS CANCER CENTER, UNIVERSITY OF FLORIDA	2000 SW ARCHER ROAD	GAINESVILLE	FL	Terminated
DSH100113AA	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Endoscopy Suite - ST - Gastroenterology	1515 SW Archer Rd	Gainesville	FL	Active
DSH100113AB	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Radiology - Oaks - Radiology	6201 W Newberry Rd	Gainesville	FL	Active
DSH100113AC	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Diagnostic Imaging-Springhill - RADIOLOGY - DIAGNOSTIC	4037 NW 86th Terrace	Gainesville	FL	Active
DSH100113AD	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Bronchoscopy and Pulmonary Pro - RESPIRATORY THERAPY	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AE	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Radiology - Fixel - RADIOLOGY - DIAGNOSTIC	3009 SW Williston Road	Gainesville	FL	Active
DSH100113AF	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Pediatric Infusion Center - RADIOLOGY - THERAPEUTIC	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AG	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Pediatric Cath Lab - CARDIAC CATHETERIZATION	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AH	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Cardiac Catheterization Lab - CARDIAC CATHETERIZATION	1505 SW Archer Rd	Gainesville	FL	Active
DSH100113AJ	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Burn Outpatient - BURN CLINIC SHANDS@UF	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AK	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	EP Lab - ELECTROCARDIOLOGY	1505 SW Archer Rd	Gainesville	FL	Active
DSH100113AL	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Pulmonary Functions Lab - RESPIRATORY THERAPY	1549 Gale Lemerand Dr	Gainesville	FL	Active
DSH100113AM	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Endoscopy Suite - NT - GI	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AN	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Mobile Stroke Treatment Unit - Ambulance Services	3300 SW Williston Road	Gainesville	FL	Active
DSH100113AP	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Center for Advanced Therapeutics - Radiology Therapeutic	2004 Mowry Road	Gainesville	FL	Active
DSH100113B	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Dialysis Center	2409 SW Archer Road	Gainesville	FL	Active
DSH100113H	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Pain Management	720 SW 2nd Avenue	Gainesville	FL	Active
DSH100113I	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Florida Surgical Center	3480 Hull Road	Gainesville	FL	Active
DSH100113J	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Endoscopy Center	2001 SW 13th Street	Gainesville	FL	Active
DSH100113K	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Psychiatric Hospital	4101 NW 89th Boulevard	Gainesville	FL	Active
DSH100113L	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Emergency Center- Springhill	8475 NW 39th Avenue	Gainesville	FL	Active
DSH100113M	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Shands Radiology at the Orthopedics & Sports Medicine Institute	3450 Hull Road	Gainesville	FL	Active
DSH100113N	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Infusion Center - Medical Plaza	1549 Gale Lemerand Drive	Gainesville	FL	Active
DSH100113P	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Department of Radiation Oncology	1549 Gale Lemerand Drive	Gainesville	FL	Active
DSH100113Q	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Spine & Sports Intervention Center	4101 NW 89TH BLVD	GAINESVILLE	FL	Terminated
DSH100113R	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Wound Care & Hyperbaric Center	3951 N.W. 48th Terrace	Gainesville	FL	Active
DSH100113S	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Emergency Center - Kanapaha	7405 SW Archer Road	Gainesville	FL	Active
DSH100113T	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health The Oaks - UF Health The Oaks	6201 W Newberry Rd	Gainesville	FL	Active
DSH100113U	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Medical Dermatology - Dermatology	4037 NW 86th Terrace	Gainesville	FL	Active
DSH100113V	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Operating Rooms-ST - Operating Room	1515 SW Archer Rd	Gainesville	FL	Active
DSH100113W	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Operating Rooms-HVN - Operating Room	1505 SW Archer Rd	Gainesville	FL	Active
DSH100113X	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Bone Marrow Transplant Clinic - Radiology	1515 SW Archer Rd	Gainesville	FL	Active
DSH100113Y	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Radiology (MRI) Medical Plaza - Magnetic Resonance Imaging	1549 Gale Lemerand Drive	Gainesville	FL	Active
DSH100113Z	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Adult Emergency - Emergency	1515 SW Archer Rd	Gainesville	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 3:22:01 PM	8/22/2024 11:15:36 AM	8/22/2024 11:15 AM
Addresses	Shipping Address	Insert	Change Request		Office of Radiation Safety 1395 Center Drive Room #DG-11B Gainesville, FL 32610	3/11/2024 8:43 AM
Addresses	Shipping Address	Insert	Change Request		Safecor Health, LLC 317 New Boston Street Suite 100 Woburn, MA 01801	12/28/2023 8:55 AM
Contacts	Primary Contact	Update	Profile Change Request	Johns, Thomas Director, Pharmacy Services Shands Teaching Hospital & Clinics, Inc. 3522650404	Johns, Thomas Associate Vice President, Operations Shands Teaching Hospital & Clinics, Inc. 3525941321	12/21/2023 12:48 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 9:10:54 AM	8/21/2023 3:22:01 PM	8/21/2023 3:22 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 10:23:05 AM	8/25/2022 9:10:54 AM	8/25/2022 9:10 AM
Contacts	Authorizing Official	Update	AO Change Request	Jimenez, Edward CEO Shands Hospital and Teaching Clinics 3522650440	d'Auguste, Traci Chief Operating Officer Shands Teaching Hospital & Clinics Inc 3522948661	7/12/2022 8:26 AM
Details	Last Recertification Date	Update	Recertification	9/1/2020 10:25:18 AM	8/24/2021 10:23:05 AM	8/24/2021 10:23 AM
Addresses	Shipping Address	Update	Change Request	Shands Outpatient Pharmacy 1600 SW Archer Road Room #1147 Gainesville, FL 32610	Shands Outpatient Pharmacy 1600 SW Archer Road Room #1190 Gainesville, FL 32610	7/23/2021 12:50 PM
Addresses	Shipping Address	Delete	Recertification	Shands Medical Plaza Pharmacy 2000 SW Archer Road, Room #1520 Gainesville, FL 32610		9/1/2020 10:25 AM
Addresses	Shipping Address	Delete	Recertification	SHANDS SOUTH CAMPUS OUTPATIENT PHARMACY 1515 SW ARCHER ROAD, ROOM 1010 GAINESVILLE, FL 32608		9/1/2020 10:25 AM
Addresses	Shipping Address	Insert	Recertification		Shands South Campus Outpatient Pharmacy 1515 SW Archer Road, Room 1010 Gainesville, FL 32608	9/1/2020 10:25 AM
Addresses	Shipping Address	Insert	Recertification		Shands Medical Plaza Pharmacy 1549 Gale Lemerand Drive, Room #1520 Gainesville, FL 32610	9/1/2020 10:25 AM
Addresses	Shipping Address	Insert	Recertification		Shands Pharmacy Stores 1600 SW Archer Road Room #DG-16 Gainesville, FL 32610	9/1/2020 10:25 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2020 10:25 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000100724A	9/1/2020 10:25 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/1/2020 10:25 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2020 10:25 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		010003004	9/1/2020 10:25 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/1/2020 10:25 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	010003002 (FL)		9/1/2020 10:25 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	010003003 (FL)		9/1/2020 10:25 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	010003001 (FL)		9/1/2020 10:25 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	000100724 (GA)		9/1/2020 10:25 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699874248	9/1/2020 10:25 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 10:25 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1588765861	9/1/2020 10:25 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/1/2020 10:25 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699874248	9/1/2020 10:25 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 10:25 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1588765861	9/1/2020 10:25 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/1/2020 10:25 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1699874248 ( )		9/1/2020 10:25 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1134308489 ( )		9/1/2020 10:25 AM
Details	Last Recertification Date	Update	Recertification	9/10/2019 8:15:31 AM	9/1/2020 10:25:18 AM	9/1/2020 10:25 AM
Details	Last Recertification Date	Update	Recertification	8/23/2018 11:50:38 AM	9/10/2019 8:15:31 AM	9/10/2019 8:15 AM
Addresses	Shipping Address	Insert	Recertification		Shands HVN Carousel 1505 SW Archer Road Room #G-640 Gainesville, FL 32608	8/23/2018 11:50 AM
Addresses	Shipping Address	Delete	Recertification	Shands South Tower Carousel 1515 SW Archer Road Room #G-102 Gainesville, FL 32608		8/23/2018 11:50 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 2:19:25 PM	8/23/2018 11:50:38 AM	8/23/2018 11:50 AM
Addresses	Shipping Address	Insert	Change Request		Shands Teaching Hospital & Clinics, Inc, D/B/A: UF Health Pharmacy - Springhill 4197 NW 86th Terrace #1131 Gainesville, FL 32606	8/20/2018 9:39 AM
Addresses	Shipping Address	Delete	Change Request	Shands Teaching Hospital & Clinics, Inc, D/B/A: Ayers Pharmacy 720 SW 2nd Ave., Suite #180 Gainesville, FL 32601		8/20/2018 9:39 AM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	11/29/2017 2:19:25 PM	11/29/2017 2:19 PM
Contacts	Authorizing Official	Update		Jimenez, Edward CEO 3522650440	Jimenez, Edward CEO Shands Hospital and Teaching Clinics 3522650440	11/2/2017 11:56 AM
Contacts	Primary Contact	Update		Johns, Thomas Director, Pharmacy Services 3522650404	Johns, Thomas Director, Pharmacy Services Shands Teaching Hospital & Clinics, Inc. 3522650404	10/26/2017 8:28 AM
Contacts	Authorizing Official	Update		KOVAL, CHARLES B. DEPUTY GENERAL COUNSEL AND ASSISTANT SECRETARY 3527330030	Jimenez, Edward CEO 3522650440	7/31/2017 1:38 PM
Contacts	Primary Contact	Update		HARBILAS, BILL ASSISTANT DIRECTOR, PHARMACY SERVICE 3522650404	Johns, Thomas Director, Pharmacy Services 3522650404	8/23/2016 8:13 AM
Addresses	Main Address	Insert			1600 SW ARCHER ROAD GAINESVILLE, FL 32610	8/22/2016 3:38 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/22/2016 12:00:00 AM	8/22/2016 3:38 PM
Addresses	Shipping Address	Insert			Shands Medical Plaza Pharmacy 2000 SW Archer Road, Room #1520 Gainesville, FL 32610	4/22/2016 10:51 AM
Addresses	Shipping Address	Insert			Shands Teaching Hospital & Clinics, Inc, D/B/A: Ayers Pharmacy 720 SW 2nd Ave., Suite #180 Gainesville, FL 32601	4/22/2016 10:51 AM
Addresses	Shipping Address	Insert			Shands Outpatient Pharmacy 1600 SW Archer Road Room #1147 Gainesville, FL 32610	4/22/2016 10:51 AM
Addresses	Shipping Address	Insert			SHANDS SOUTH CAMPUS OUTPATIENT PHARMACY 1515 SW ARCHER ROAD, ROOM 1010 GAINESVILLE, FL 32608	4/22/2016 10:51 AM
Addresses	Shipping Address	Insert			Shands Main Carousel 1600 SW Archer Road Room #G-539 Gainesville, FL 32610	4/22/2016 10:51 AM
Addresses	Shipping Address	Insert			Shands South Tower Carousel 1515 SW Archer Road Room #G-102 Gainesville, FL 32608	4/22/2016 10:51 AM
Addresses	Shipping Address	Insert			Shands Hospital Vault 1600 SW Archer Road Room #G-539 Gainesville, FL 32610	4/22/2016 10:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/9/2015 8:07 AM
Medicaid Billing	Medicaid: Number	Insert			000100724	10/9/2015 8:07 AM
Medicaid Billing	Medicaid: State	Insert			GA	10/9/2015 8:07 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/19/2015 10:01 AM
Medicaid Billing	Medicaid: Number	Insert			010003002	8/19/2015 10:01 AM
Medicaid Billing	Medicaid: State	Insert			FL	8/19/2015 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/19/2015 10:01 AM
Medicaid Billing	Medicaid: Number	Insert			010003003	8/19/2015 10:01 AM
Medicaid Billing	Medicaid: State	Insert			FL	8/19/2015 10:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/19/2015 10:01 AM
Medicaid Billing	Medicaid: Number	Insert			010003001	8/19/2015 10:01 AM
Medicaid Billing	Medicaid: State	Insert			FL	8/19/2015 10:01 AM
Medicaid Billing	NPI: Number	Insert			1134308489	8/19/2015 10:01 AM
Details	Last Recertification Date	Update		9/8/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 10:01 AM
Contacts	Primary Contact	Update		Knudsen, Alan K. Director, Pharmacy 3522650404	HARBILAS, BILL ASSISTANT DIRECTOR, PHARMACY SERVICE 3522650404	9/8/2014 5:02 PM
Details	Last Recertification Date	Update		9/9/2013 12:00:00 AM	9/8/2014 12:00:00 AM	9/8/2014 5:02 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/9/2013 12:00:00 AM	9/9/2013 11:01 AM
Contacts	Primary Contact	Insert			Knudsen, Alan K. Director, Pharmacy 3522650404	12/20/2012 4:12 PM
Contacts	Authorizing Official	Insert			KOVAL, CHARLES B. DEPUTY GENERAL COUNSEL AND ASSISTANT SECRETARY 3527330030	8/16/2012 8:37 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/25/2012 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	5/25/2012 10:47 AM
Medicaid Billing	Medicaid: Number	Update		101454400	010003000	5/25/2012 10:47 AM
Medicaid Billing	NPI: Number	Update		1700112000	1699874248	5/25/2012 10:47 AM
Details	Last Recertification Date	Insert				1/14/2010 2:03 PM
Details	Grant Number	Insert				1/14/2010 2:03 PM
Details	340B ID	Insert			DSH100113	1/14/2010 2:03 PM
Details	Is Authorizing Official EHB Data	Insert				1/14/2010 2:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2010 2:03 PM
Details	Medicare Provider Number	Insert			100113	1/14/2010 2:03 PM
Details	Entity Name	Insert			SHANDS TEACHING HOSPITAL AND CLINICS, INC.	1/14/2010 2:03 PM
Details	Program Code	Insert			DSH	1/14/2010 2:03 PM
Details	Entity Subname	Insert				1/14/2010 2:03 PM
Dates	Participating Approval Date	Insert			9/14/2007 12:00:00 AM	1/14/2010 2:03 PM
Details	State	Insert			Active	1/14/2010 2:03 PM
Dates	Registration Date	Insert			9/14/2007 12:00:00 AM	1/14/2010 2:03 PM
Dates	Signed By Date	Insert				1/14/2010 2:03 PM
Dates	Start Date	Insert			7/1/1993 12:00:00 AM	1/14/2010 2:03 PM
Terminations	Termination Comments	Insert				1/14/2010 2:03 PM
Terminations	Termination Date	Insert				1/14/2010 2:03 PM
Terminations	Termination Effective Date	Insert				1/14/2010 2:03 PM
Terminations	Termination Reason	Insert				1/14/2010 2:03 PM
Details	Comments Public	Insert			11/3/09 ADDED SHIP TO; 11/3/09 ADDED MEDICAID #	1/14/2010 2:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	9/14/2007 8:27 AM
Medicaid Billing	Medicaid: Number	Insert			101454400	9/14/2007 8:27 AM
Medicaid Billing	Medicaid: State	Insert			FL	9/14/2007 8:27 AM
Medicaid Billing	NPI: Number	Insert			1700112000	9/14/2007 8:27 AM