Covered Entity Details

CH04038Y NORTH FLORIDA MEDICAL CENTERS, INC. (Active) - information as of 6/15/2025 6:03:39 AM

Main Details

Name

NORTH FLORIDA MEDICAL CENTERS, INC.

Subdivision Name

Crestview Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013778

340B ID

CH04038Y

Grant Number

H80CS00693

Additional Details

Current Program Status

Active

Registration Date

3/1/2008

Participating Start Date

4/1/2008

Participating Approval Date

3/3/2008

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

North Florida Medical Centers, Inc.
Tori Wiggins, CFO
(850) 298-6040

Primary Contact

North Florida Medical Centers, Inc.
Matthew R Mayo, Privacy Officer
(850) 298-6009

Addresses

Street Address

800 Hospital Dr
Crestview, FL 32539

Billing Address

NORTH FLORIDA MEDICAL CENTERS, INC.
2804 Remington Green Circle
TALLAHASSEE, FL 32308-8707

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	THE PRESCRIPTION SHOPPE	536 E.FIRST AVENUE		CRESTVIEW	FL	32536	04/01/2008	04/01/2008		10/24/2017	02/08/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06811	2350 S FERDON BLVD	CRESTVIEW	FL	32536-8461	05/16/2024	07/01/2024			07/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH040380	Active	BPS-H80-012720	NORTH FLORIDA MEDICAL CENTERS, INC.	North Florida Medical Centers, Inc.	2804 Remington Green Cir	Tallahassee	FL
CH04038AA	Active	BPS-H80-033633	NORTH FLORIDA MEDICAL CENTERS, INC.	North Florida Medical - Perry	1850 South Byron Butler Parkway	PERRY	FL
CH04038AB	Active	BPS-H80-014088	NORTH FLORIDA MEDICAL CENTERS, INC.	Madison Medical Center	235 SW DADE ST	MADISON	FL
CH04038AC	Active	BPS-H80-021632	North Florida Medical Centers, Inc.	North Monroe Medical Center	3721 N Monroe St	Tallahassee	FL
CH04038B	Active	BPS-H80-005556	NORTH FLORIDA MEDICAL CENTERS, INC.	WAKULLA MEDICAL CENTER, INC.	1328 Coastal Hwy	Panacea	FL
CH04038D	Active	BPS-H80-004709	NORTH FLORIDA MEDICAL CENTERS, INC.	Family Medical Practice, Inc.	412 SW HWY 351	CROSS CITY	FL
CH04038E	Active	BPS-H80-008892	NORTH FLORIDA MEDICAL CENTERS, INC.	River Valley Medical Center	710 W Main St	Mayo	FL
CH04038F	Active	BPS-H80-010125	NORTH FLORIDA MEDICAL CENTERS, INC.	Jessie Furlow Medical Center	1249 Strong Rd	Quincy	FL
CH04038G	Active	BPS-H80-003774	NORTH FLORIDA MEDICAL CENTERS, INC.	WEWAHITCH MEDICAL CENTER	255 W River Rd	Wewahitchka	FL
CH04038H	Terminated	BPS-H80-001944	NORTH FLORIDA MEDICAL CENTERS, INC.	TRI-COUNTY FAMILY HLTH CARE CTR	193 NW US 221	Greenville	FL
CH04038S	Active	BPS-H80-014081	NORTH FLORIDA MEDICAL CENTERS, INC.	Eastpoint Medical Center	158 US HIGHWAY 98	EASTPOINT	FL
CH04038Y	Active	BPS-H80-013778	NORTH FLORIDA MEDICAL CENTERS, INC.	Crestview Health Center	800 Hospital Dr	Crestview	FL
CH04038Z	Terminated	BPS-H80-008103	NORTH FLORIDA MEDICAL CENTERS, INC.	Baker Family Medical Center	1321 Georgia Ave	Baker	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH040380	CHEEK REXALL PHARMACY INC	EVANS SQUARE SHOPPING CENTER	16734 SE HWY 19	CROSS CITY	FL	32628	10/01/2018
CH04038D	CHEEK REXALL PHARMACY INC	EVANS SQUARE SHOPPING CENTER	16734 SE HWY 19	CROSS CITY	FL	32628	07/01/2024
CH040380	CRAWFORDVILLE PHARMACY, INC	2650 CRAWFORDVILLE HWY STE 1		CRAWFORDVILLE	FL	32327-2369	10/01/2017
CH04038B	CRAWFORDVILLE PHARMACY, INC	2650 CRAWFORDVILLE HWY STE 1		CRAWFORDVILLE	FL	32327-2369	07/01/2024
CH040380	GARRETT'S PHARMACY SERVICES, INC	THE PRESCRIPTION SHOPPE	536 E 1ST AVE	CRESTVIEW	FL	32536-2505	10/01/2015	10/24/2017
CH040380	HEALTHSMART DISCOUNT PHARMACY	HEALTH SMART PHARMACY, INC.	5809 HIGHWAY 189 N	BAKER	FL	32531-2501	10/01/2015	06/19/2017
CH04038Z	HEALTHSMART DISCOUNT PHARMACY	HEALTH SMART PHARMACY, INC.	5809 HIGHWAY 189 N	BAKER	FL	32531-2501	04/01/2009	04/01/2017
CH040380	JIGNESH LLC	JAY'S PHARMACY	828 S JEFFERSON ST	PERRY	FL	32347-4119	01/01/2017
CH04038AA	JIGNESH LLC	JAY'S PHARMACY	828 S JEFFERSON ST	PERRY	FL	32347-4119	07/01/2024
CH04038E	JIGNESH LLC	JAY'S PHARMACY	828 S JEFFERSON ST	PERRY	FL	32347-4119	07/01/2024
CH04038D	JIGNESH LLC	JAY'S PHARMACY	828 S JEFFERSON ST	PERRY	FL	32347-4119	07/01/2024
CH04038F	MASSEY DRUGS	105 W JEFFERSON ST		QUINCY	FL	32351	02/23/2006	07/12/2017
CH040380	MASSEY DRUGS	105 W JEFFERSON ST		QUINCY	FL	32351	10/01/2015	07/12/2017
CH04038E	NORTH FL PHARMACY OF MAYO	PO BOX 1510	229 WEST MAIN STREET	MAYO	FL	32066-1510	03/21/2006
CH040380	NORTH FL PHARMACY OF MAYO	PO BOX 1510	229 WEST MAIN STREET	MAYO	FL	32066-1510	10/01/2015
CH04038AB	NORTH FL PHARMACY OF MAYO	PO BOX 1510	229 WEST MAIN STREET	MAYO	FL	32066-1510	07/01/2024
CH04038H	NORTH FLORIDA PHARMACY OF MADISON INC.	139 SW MACON ST		MADISON	FL	32340	07/12/2011	04/01/2017
CH040380	NORTH FLORIDA PHARMACY OF MADISON INC.	139 SW MACON ST		MADISON	FL	32340	10/01/2015
CH04038AB	NORTH FLORIDA PHARMACY OF MADISON INC.	139 SW MACON ST		MADISON	FL	32340	07/01/2024
CH04038G	PHARMACY INVESTMENT COORDINATORS, INC	BUY RITE DRUGS #11	218 S HIGHWAY 71	WEWAHITCHKA	FL	32465-4305	09/17/2007
CH040380	PHARMACY INVESTMENT COORDINATORS, INC	D/B/A BUY RITE DRUGS #8	117 US HIGHWAY 98 PIC INC	APALACHICOLA	FL	32320-2035	10/01/2015
CH040380	PHARMACY INVESTMENT COORDINATORS, INC	BUY RITE DRUGS #11	218 S HIGHWAY 71	WEWAHITCHKA	FL	32465-4305	10/01/2015
CH04038G	PHARMACY INVESTMENT COORDINATORS, INC	D/B/A BUY RITE DRUGS #8	117 US HIGHWAY 98 PIC INC	APALACHICOLA	FL	32320-2035	07/01/2024
CH04038S	PHARMACY INVESTMENT COORDINATORS, INC	BUY RITE DRUGS #11	218 S HIGHWAY 71	WEWAHITCHKA	FL	32465-4305	07/01/2024
CH04038S	PHARMACY INVESTMENT COORDINATORS, INC.	DBA BUY RITE DRUGS #8	117 AVE E (HWY 98)	APALACHICOLA	FL	32320	03/08/2006
CH040380	SUBHAM HEALTHCARE LLC	STEINHATCHEE DRUGS	105 15TH ST SE	STEINHATCHEE	FL	32359	10/01/2017
CH04038Y	THE PRESCRIPTION SHOPPE	536 E.FIRST AVENUE		CRESTVIEW	FL	32536	04/01/2008	10/24/2017
CH040380	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CH040380	WAL-MART PHARMACY 10-0488	1940 PAT THOMAS PARKWAY		QUINCY	FL	32351	10/01/2015
CH04038AC	WAL-MART PHARMACY 10-0488	1940 PAT THOMAS PARKWAY		QUINCY	FL	32351	07/01/2024
CH04038F	WAL-MART PHARMACY 10-0488	1940 PAT THOMAS PARKWAY		QUINCY	FL	32351	07/01/2024
CH040380	WAL-MART PHARMACY 10-3307	35 MIKE STEWART DRIVE		CRAWFORDVILLE	FL	32327	01/01/2020
CH04038B	WAL-MART PHARMACY 10-3307	35 MIKE STEWART DRIVE		CRAWFORDVILLE	FL	32327	07/01/2024
CH040380	WAL-MART PHARMACY 10-5172	1900 SOUTH JEFFERSON ST		PERRY	FL	32348	01/01/2020
CH04038AA	WAL-MART PHARMACY 10-5172	1900 SOUTH JEFFERSON ST		PERRY	FL	32348	07/01/2024
CH040380	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CH040380	WALGREEN CO.	DBA: WALGREENS # 07583	3820 N MONROE ST	TALLAHASSEE	FL	32303-2136	10/01/2018
CH040380	WALGREEN CO.	DBA: WALGREENS # 06811	2350 S FERDON BLVD	CRESTVIEW	FL	32536-8461	10/01/2018
CH040380	WALGREEN CO.	DBA: WALGREENS # 10147	1217 W JEFFERSON ST	QUINCY	FL	32351-2125	10/01/2018
CH040380	WALGREEN CO.	DBA: WALGREENS # 09578	2580 CRAWFORDVILLE HWY	CRAWFORDVILLE	FL	32327-2174	01/01/2022
CH04038AC	WALGREEN CO.	DBA: WALGREENS # 07583	3820 N MONROE ST	TALLAHASSEE	FL	32303-2136	07/01/2024
CH04038Y	WALGREEN CO.	DBA: WALGREENS # 06811	2350 S FERDON BLVD	CRESTVIEW	FL	32536-8461	07/01/2024
CH04038F	WALGREEN CO.	DBA: WALGREENS # 10147	1217 W JEFFERSON ST	QUINCY	FL	32351-2125	07/01/2024
CH040380	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	01/01/2024
CH040380	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2018
CH040380	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2018
CH040380	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH040380	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH04038B	WINN DIXIE STORE #186	2629 CRAWFORDVILLE HWY		CRAWFORDVILLE	FL	32327	06/30/2007	07/12/2017
CH040380	WINN DIXIE STORE #186	2629 CRAWFORDVILLE HWY		CRAWFORDVILLE	FL	32327	10/01/2015	07/12/2017
CH040380	WINN DIXIE STORES, INC.	WINN DIXIE PHARMACY #28	729 WEST BASE STREET	MADISON	FL	32340	07/01/2016	07/12/2017

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 2:19:07 PM	2/10/2025 1:53:46 PM	2/10/2025 1:53 PM
Details	Last Recertification Date	Update	Recertification	1/31/2023 8:52:22 AM	2/1/2024 2:19:07 PM	2/1/2024 2:19 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 9:18:21 AM	1/31/2023 8:52:22 AM	1/31/2023 8:52 AM
Details	Last Recertification Date	Update	Recertification	2/9/2021 11:18:26 AM	2/1/2022 9:18:21 AM	2/1/2022 9:18 AM
Details	Last Recertification Date	Update	Recertification	1/30/2020 10:24:21 AM	2/9/2021 11:18:26 AM	2/9/2021 11:18 AM
Details	Last Recertification Date	Update	Recertification	2/7/2019 8:28:58 AM	1/30/2020 10:24:21 AM	1/30/2020 10:24 AM
Details	Last Recertification Date	Update	Recertification	2/8/2018 9:55:29 AM	2/7/2019 8:28:58 AM	2/7/2019 8:28 AM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/8/2018 9:55:29 AM	2/8/2018 9:55 AM
Contacts	Primary Contact	Update	Change Request	Lunn, Lane Chief Executive Officer North Florida Medical Centers,Inc 8502986001	Mayo, Matthew R Privacy Officer North Florida Medical Centers, Inc. 8502986009	1/9/2018 1:46 PM
Contacts	Authorizing Official	Update		Wiggins, Tori CFO 8502986040	Wiggins, Tori CFO North Florida Medical Centers, Inc. 8502986040	1/8/2018 3:56 PM
Contacts	Primary Contact	Update	Profile Change Request	Lunn, Lane Compliance Officer North Florida Medical Centers,Inc 8502986007	Lunn, Lane Chief Executive Officer North Florida Medical Centers,Inc 8502986001	1/8/2018 3:32 PM
Contacts	Primary Contact	Update		Lunn, Lane Compliance Officer 8502986007	Lunn, Lane Compliance Officer North Florida Medical Centers,Inc 8502986007	1/8/2018 3:27 PM
Contacts	Authorizing Official	Insert			Wiggins, Tori CFO 8502986040	7/20/2017 10:44 AM
Addresses	Main Address	Insert			800 Hospital Dr Crestview, FL 32539	2/13/2017 11:50 AM
Contacts	Primary Contact	Insert			Lunn, Lane Compliance Officer 8502986007	2/13/2017 11:50 AM
Details	Last Recertification Date	Update		2/16/2016 12:00:00 AM	2/13/2017 12:00:00 AM	2/13/2017 11:50 AM
Details	Last Recertification Date	Update		3/3/2015 12:00:00 AM	2/16/2016 12:00:00 AM	3/1/2016 9:50 AM
Details	Last Recertification Date	Update		3/16/2014 12:00:00 AM	3/3/2015 12:00:00 AM	3/3/2015 10:03 AM
Addresses	Billing Address	Insert			NORTH FLORIDA MEDICAL CENTERS, INC. 2804 Remington Green Circle TALLAHASSEE, FL 32308-8707	1/13/2015 6:02 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/16/2014 12:00:00 AM	3/16/2014 2:33 PM
Details	Entity Subname	Update		CRESTVIEW HEALTH CENTER	Crestview Health Center	3/16/2014 2:33 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/20/2013 10:27 AM
Details	Last Recertification Date	Insert				3/3/2008 11:28 AM
Details	Grant Number	Insert			H80CS00693	3/3/2008 11:28 AM
Details	340B ID	Insert			CH04038Y	3/3/2008 11:28 AM
Details	Is Authorizing Official EHB Data	Insert				3/3/2008 11:28 AM
Dates	Last Date That 340B Drugs Purchased	Insert				3/3/2008 11:28 AM
Details	Medicare Provider Number	Insert				3/3/2008 11:28 AM
Details	Entity Name	Insert			NORTH FLORIDA MEDICAL CENTERS, INC.	3/3/2008 11:28 AM
Details	Program Code	Insert			CH	3/3/2008 11:28 AM
Details	Entity Subname	Insert			CRESTVIEW HEALTH CENTER	3/3/2008 11:28 AM
Dates	Participating Approval Date	Insert			3/3/2008 12:00:00 AM	3/3/2008 11:28 AM
Details	State	Insert			Active	3/3/2008 11:28 AM
Dates	Registration Date	Insert			3/1/2008 12:00:00 AM	3/3/2008 11:28 AM
Dates	Signed By Date	Insert			10/31/2007 12:00:00 AM	3/3/2008 11:28 AM
Dates	Start Date	Insert			4/1/2008 12:00:00 AM	3/3/2008 11:28 AM
Terminations	Termination Comments	Insert				3/3/2008 11:28 AM
Terminations	Termination Date	Insert				3/3/2008 11:28 AM
Terminations	Termination Effective Date	Insert				3/3/2008 11:28 AM
Terminations	Termination Reason	Insert				3/3/2008 11:28 AM

340B Drug Pricing Program Database