Covered Entity Details

CH04413A MIAMI BEACH COMMUNITY HEALTH CENTER INC. (Active) - information as of 5/26/2025 12:52:50 AM

Main Details

Name

MIAMI BEACH COMMUNITY HEALTH CENTER INC.

Subdivision Name

MBCHC North Suite 103 & 104

Type

HRSA-Funded Health Center

Site ID

BPS-H80-009935

340B ID

CH04413A

Grant Number

H80CS00182

Additional Details

Current Program Status

Active

Registration Date

6/4/2008

Participating Start Date

7/1/2008

Participating Approval Date

6/5/2008

Last Recertification Date

2/21/2025

Contacts

Authorizing Official

Miami Beach Community Health Center
Sorangely Menjivar, Chief Operating Officer
(305) 538-8835 Ext: 1409

Primary Contact

Miami Beach Community Health Center, Inc.
Ray Sawaged, VP Pharmacy Services
(305) 538-8835 Ext: 1585

Addresses

Street Address

11645 Biscayne Boulevard Suites 103 and 104
Miami, FL 33181

Billing Address

Miami Beach Community Health Center, Inc.
11645 Biscayne Boulevard,
Suite 207
Miami, FL 33181

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

Comments

Comment	Last Updated On
5/19/11 REMOVED SUB DIV NAME (WAS ADMIN OFFICE); 5/3/11 UPDATED PHYS ADD (WAS SUITE #207)	05/19/2011

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	029544207,004242000,105384100,026581100,029544208	1467606681,1063411874,1790081297,1215002571,1689749269

Shipping Addresses

Shipping Address 1

MIAMI BEACH COMMUNITY HEALTH CENTER PHARMACY #4
11645 BISCAYNE BLVD SUITE # 102
MIAMI, FL 33181

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	FFP, LLC	BIOMATRIX SPECIALTY PHARMACY FL	855 SW 78TH AVE STE C-101	PLANTATION	FL	33324	04/13/2018	07/01/2018		10/14/2019	10/15/2019
Contract Detail	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	04/13/2018	07/01/2018		10/14/2019	10/15/2019

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH044130	Active	BPS-H80-000599	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	MIAMI BEACH COMMUNITY HEALTH CENTER, INC.	710 Alton Rd	Miami Beach	FL
CH04413A	Active	BPS-H80-009935	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	MBCHC North Suite 103 & 104	11645 Biscayne Boulevard Suites 103 and 104	Miami	FL
CH04413C	Active	BPS-H80-003523	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	Beverly Press Health Center	1221 71st St	Miami Beach	FL
CH04413J	Terminated	BPS-H80-013563	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	MBCHC North Suite 102	11645 Biscayne Boulevard, Suite 102	Miami	FL
CH04413K	Active	BPS-H80-018282	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	Miami Beach Community Health Center North STE 408	11645 Biscayne Blvd Ste 408,	Miami	FL
CH04413L	Active	BPS-H80-013520	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	MBCHC North Suite 309	11645 Biscayne Blvd Ste 309,	Miami	FL
CH04413M	Active	BPS-H80-013367	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	MBCHC North Suite 301, 305, & 307	11645 Biscayne Boulevard STE 301, 305, and 307,	Miami	FL
CH04413N	Active	BPS-H80-015714	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	MBCHC North 3 Suite 401, 403, & 405	11645 Biscayne Blvd Ste 405,	Miami	FL
CH04413P	Active	BPS-H80-013017	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	MBCHC North Suite 308	11645 Biscayne Blvd STE 308,	Miami	FL
CH04413Q	Active	BPS-H80-019358	Miami Beach Community Health Center Inc.	MBCHC North 4, Suite 302 & 304	11645 Biscayne Boulevard Suite 302 & 304,	Miami	FL
CH04413R	Active	BPS-H80-032503	Miami Beach Community Health Center Inc.	MBCHC North Suite 100	11645 Biscayne Blvd Ste 100	Miami	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH044130	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2025
CH044130	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2025
CH044130	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2025
CH044130	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2025
CH044130	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2025
CH044130	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2025
CH044130	AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM	1409 NE 26TH ST		WILTON MANORS	FL	33305	10/01/2022
CH044130	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	04/01/2019
CH044130	AVITA PHARMACY 1047	AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR	1110 KEVSTIN DR	KISSIMMEE	FL	34744	07/01/2019
CH044130	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2025
CH044130	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2025
CH044130	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2025
CH044130	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2025
CH04413J	FFP, LLC	BIOMATRIX SPECIALTY PHARMACY FL	855 SW 78TH AVE STE C-101	PLANTATION	FL	33324	07/01/2018	10/14/2019
CH04413C	FFP, LLC	BIOMATRIX SPECIALTY PHARMACY FL	855 SW 78TH AVE STE C-101	PLANTATION	FL	33324	07/01/2018	10/14/2019
CH04413K	FFP, LLC	BIOMATRIX SPECIALTY PHARMACY FL	855 SW 78TH AVE STE C-101	PLANTATION	FL	33324	07/01/2018	10/14/2019
CH04413L	FFP, LLC	BIOMATRIX SPECIALTY PHARMACY FL	855 SW 78TH AVE STE C-101	PLANTATION	FL	33324	07/01/2018	10/14/2019
CH04413M	FFP, LLC	BIOMATRIX SPECIALTY PHARMACY FL	855 SW 78TH AVE STE C-101	PLANTATION	FL	33324	07/01/2018	10/14/2019
CH04413A	FFP, LLC	BIOMATRIX SPECIALTY PHARMACY FL	855 SW 78TH AVE STE C-101	PLANTATION	FL	33324	07/01/2018	10/14/2019
CH044130	FFP, LLC	BIOMATRIX SPECIALTY PHARMACY FL	855 SW 78TH AVE STE C-101	PLANTATION	FL	33324	07/01/2018	10/14/2019
CH044130	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04249	11890 BISCAYNE BLVD	MIAMI	FL	33181	07/01/2016	04/06/2017
CH04413K	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2018	10/14/2019
CH04413M	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2018	10/14/2019
CH04413L	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2018	10/14/2019
CH04413J	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2018	10/14/2019
CH044130	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2018	10/14/2019
CH04413C	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2018	10/14/2019
CH04413A	K & K RX SERVICES, LP	BIOMATRIX SPECIALTY PHARMACY PA	3070 MCCANN FARM DR STE 101	GARNET VALLEY	PA	19060	07/01/2018	10/14/2019
CH044130	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	04/01/2019	10/01/2019
CH044130	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	07/01/2021
CH044130	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0073	9400 HARDING AVE	SURFSIDE	FL	33154	04/01/2019	11/08/2019
CH044130	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #1017	14641 BISCAYNE BOULEVARD	NORTH MIAMI BEACH	FL	33181	04/01/2019	11/08/2019
CH044130	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0794	9050 BISCAYNE BLVD.	MIAMI SHORES	FL	33138	04/01/2019	11/08/2019
CH044130	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	04/01/2019	11/08/2019
CH044130	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY 1382	6876 COLLINS AVE	MIAMI BEACH	FL	33141-3244	04/01/2019	11/08/2019
CH044130	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1397	1776 BISCAYNE BLVD.	MIAMI	FL	33132	04/01/2019	11/08/2019
CH044130	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	04/01/2019	11/08/2019
CH044130	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1236	12800 BISCAYNE BOULEVARD	NORTH MIAMI	FL	33181	04/01/2019	11/08/2019
CH044130	RELIABLE SUPER DRUGS OF MIAMI LLC	2168 NE 123RD ST		NORTH MIAMI	FL	33181-2902	01/01/2015	09/26/2016
CH044130	SKYEMED PHARMACY & INFUSION SERVICE	SKYEMED PHARMACY & INFUSION SVCS	1332 NORTH FEDERAL HWY	POMPANO BEACH	FL	33062	10/01/2015	04/01/2017
CH044130	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019	09/30/2022
CH044130	WAL-MART PHARMACY 10-1996	2551 E. HALLANDALE BCH. BLVD.		HALLANDALE	FL	33009	07/01/2015	09/26/2016
CH044130	WAL-MART PHARMACY 10-3235	1425 NORTHEAST 163RD STREET		NORTH MIAMI BEACH	FL	33162	07/01/2015	09/26/2016
CH044130	WAL-MART PHARMACY 10-3235	1425 NORTHEAST 163RD STREET		NORTH MIAMI BEACH	FL	33162	04/01/2019	09/30/2022
CH044130	WAL-MART PHARMACY 10-3397	17650 NW 2ND AVE.		MIAMI GARDENS	FL	33169	07/01/2015	09/26/2016
CH044130	WAL-MART PHARMACY 10-3397	17650 NW 2ND AVE.		MIAMI GARDENS	FL	33169	07/01/2020	09/30/2022
CH044130	WAL-MART PHARMACY 10-5945	400 W. 49TH		HIALEAH	FL	33012	07/01/2020	09/30/2022
CH044130	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019	09/30/2022
CH044130	WALGREEN CO.	DBA: WALGREENS # 00748	12295 BISCAYNE BLVD	NORTH MIAMI	FL	33181	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 01532	6700 COLLINS AVE	MIAMI BEACH	FL	33141	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 02128	1845 ALTON ROAD	MIAMI BEACH	FL	33139	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 02545	1480 NE MIAMI GARDENS DR	NORTH MIAMI BEACH	FL	33179	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 02719	791 NE 167TH ST	NORTH MIAMI BEACH	FL	33162	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 02790	3103 BISCAYNE BLVD	MIAMI	FL	33137	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03162	524 JEFFERSON AVE.	MIAMI BEACH	FL	33139	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03173	9020 BISCAYNE BLVD	MIAMI SHORES	FL	33138	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03301	1695 NW 20TH STREET	MIAMI	FL	33142	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03527	567 NE 125TH STREET	NORTH MIAMI	FL	33161	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03678	1501 NE 163RD STREET	NORTH MIAMI BEACH	FL	33162	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03679	161 NE 54TH STREET	MIAMI	FL	33137	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03835	19935 NW 2ND AVE	MIAMI	FL	33169	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03942	4049 PINE TREE DR	MIAMI BEACH	FL	33140	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 04915	750 NW 119TH ST.	MIAMI	FL	33168	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 04955	18665 BISCAYNE BLVD	AVENTURA	FL	33180	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 05198	7340 COLLINS AVE	MIAMI BEACH	FL	33141	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 06873	1201 SW 1ST STREET	MIAMI	FL	33135-2401	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS #10983	1011 ALTON RD.	MIAMI BEACH	FL	33139	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS #11657	2000 NORMANDY DR.	MIAMI BEACH	FL	33141	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS #12463	501 COLLINS AVE.	MIAMI BEACH	FL	33139	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 03493	9498 NW 7TH AVE	MIAMI	FL	33150	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 04728	6200 NW 7TH AVE	MIAMI	FL	33150	04/01/2016	08/22/2016
CH044130	WALGREEN CO.	DBA: WALGREENS # 05845	14901 NE 6TH AVE	MIAMI	FL	33161	04/01/2016	08/22/2016
CH044130	WALMART PHARMACY #10-4303	3200 NW 79TH STREET		MIAMI	FL	33147	04/01/2019	09/30/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		105384100	2/21/2025 12:16 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/21/2025 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		026581100	2/21/2025 12:16 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/21/2025 12:16 PM
Details	Last Recertification Date	Update	Recertification	2/8/2024 10:29:26 AM	2/21/2025 12:16:45 PM	2/21/2025 12:16 PM
Details	Last Recertification Date	Update	Recertification	2/17/2023 10:19:13 AM	2/8/2024 10:29:26 AM	2/8/2024 10:29 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1215002571	11/14/2023 12:03 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	11/14/2023 12:03 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1689749269	11/14/2023 12:03 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	11/14/2023 12:03 PM
Details	Last Recertification Date	Update	Recertification	2/7/2022 3:28:32 PM	2/17/2023 10:19:13 AM	2/17/2023 10:19 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2022 3:28 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		004242000	2/7/2022 3:28 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/7/2022 3:28 PM
Details	Last Recertification Date	Update	Recertification	2/5/2021 5:20:47 PM	2/7/2022 3:28:32 PM	2/7/2022 3:28 PM
Contacts	Authorizing Official	Update	AO Change Request	Rabinowitz, Mark CEO Miami Beach Community Health Center 3055388835-1600	Menjivar, Sorangely Chief Operating Officer Miami Beach Community Health Center 3055388835-1409	1/28/2022 8:59 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1063411874	10/28/2021 12:06 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	10/28/2021 12:06 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1790081297	10/28/2021 12:06 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	10/28/2021 12:06 PM
Addresses	Billing Address	Update	Recertification	Miami Beach Community Health Center, Inc. 11645 Biscayne Boulevard, Suite 207 Miami, FL 33181-3138	Miami Beach Community Health Center, Inc. 11645 Biscayne Boulevard, Suite 207 Miami, FL 33181	2/5/2021 5:20 PM
Addresses	Shipping Address	Insert	Recertification		MIAMI BEACH COMMUNITY HEALTH CENTER PHARMACY #4 11645 BISCAYNE BLVD SUITE # 102 MIAMI, FL 33181	2/5/2021 5:20 PM
Addresses	Main Address	Update	Recertification	11645 Biscayne Boulevard Suites 103 and 104 Miami, FL 33181-3138	11645 Biscayne Boulevard Suites 103 and 104 Miami, FL 33181	2/5/2021 5:20 PM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/5/2021 5:20 PM
Details	Last Recertification Date	Update	Recertification	1/31/2020 4:16:28 PM	2/5/2021 5:20:47 PM	2/5/2021 5:20 PM
Contacts	Primary Contact	Update	Profile Change Request	Sawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-1602	Sawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-1585	2/3/2021 12:51 PM
Details	Last Recertification Date	Update	Recertification	2/4/2019 11:59:20 AM	1/31/2020 4:16:28 PM	1/31/2020 4:16 PM
Addresses	Billing Address	Insert	Recertification		Miami Beach Community Health Center, Inc. 11645 Biscayne Boulevard, Suite 207 Miami, FL 33181-3138	2/4/2019 11:59 AM
Details	Last Recertification Date	Update	Recertification	2/9/2018 11:34:47 AM	2/4/2019 11:59:20 AM	2/4/2019 11:59 AM
Contacts	Primary Contact	Update	Profile Change Request	Sawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-1332	Sawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-1602	2/4/2019 10:31 AM
Details	Last Recertification Date	Update	Recertification	2/7/2017 12:00:00 AM	2/9/2018 11:34:47 AM	2/9/2018 11:34 AM
Contacts	Authorizing Official	Update		Rabinowitz, Mark CEO 3055388835-1600	Rabinowitz, Mark CEO Miami Beach Community Health Center 3055388835-1600	1/8/2018 5:16 PM
Contacts	Primary Contact	Update		Sawaged, Ray VP Pharmacy Services 3055388835-1332	Sawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-1332	10/2/2017 11:31 AM
Contacts	Primary Contact	Insert			Sawaged, Ray VP Pharmacy Services 3055388835-1332	6/29/2017 7:39 PM
Addresses	Main Address	Insert			11645 Biscayne Boulevard Suites 103 and 104 Miami, FL 33181-3138	6/29/2017 7:36 PM
Contacts	Authorizing Official	Insert			Rabinowitz, Mark CEO 3055388835-1600	6/29/2017 7:36 PM
Medicaid Billing	Medicaid: Number	Update		004242000	029544207	4/10/2017 10:02 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/10/2017 10:02 AM
Medicaid Billing	Medicaid: Number	Insert			029544208	4/10/2017 10:02 AM
Medicaid Billing	Medicaid: State	Insert			FL	4/10/2017 10:02 AM
Medicaid Billing	NPI: Number	Update		1790081297	1467606681	4/10/2017 10:02 AM
Details	Entity Subname	Update		Miami Beach Community Health Center North	MBCHC North Suite 103 & 104	4/10/2017 10:02 AM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	2/7/2017 12:00:00 AM	2/7/2017 10:04 AM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	2/12/2016 12:00:00 AM	2/12/2016 4:40 PM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	2/3/2015 12:00:00 AM	2/3/2015 12:52 PM
Details	Entity Name	Update		MIAMI BEACH COMMUNITY HEALTH CENTER, INC.	MIAMI BEACH COMMUNITY HEALTH CENTER INC.	3/31/2014 4:25 PM
Details	Entity Subname	Update			Miami Beach Community Health Center North	3/31/2014 4:25 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/10/2014 12:00:00 AM	2/10/2014 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	3/19/2013 2:46 PM
Medicaid Billing	Medicaid: Number	Insert			004242000	3/19/2013 2:46 PM
Medicaid Billing	Medicaid: State	Insert			FL	3/19/2013 2:46 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/25/2013 10:10 AM
Details	Last Recertification Date	Insert				5/19/2011 1:09 PM
Details	Grant Number	Insert			H80CS00182	5/19/2011 1:09 PM
Details	340B ID	Insert			CH04413A	5/19/2011 1:09 PM
Details	Is Authorizing Official EHB Data	Insert				5/19/2011 1:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/19/2011 1:09 PM
Details	Medicare Provider Number	Insert				5/19/2011 1:09 PM
Details	Entity Name	Insert			MIAMI BEACH COMMUNITY HEALTH CENTER, INC.	5/19/2011 1:09 PM
Details	Program Code	Insert			CH	5/19/2011 1:09 PM
Details	Entity Subname	Insert				5/19/2011 1:09 PM
Dates	Participating Approval Date	Insert			6/5/2008 12:00:00 AM	5/19/2011 1:09 PM
Details	State	Insert			Active	5/19/2011 1:09 PM
Dates	Registration Date	Insert			6/4/2008 12:00:00 AM	5/19/2011 1:09 PM
Dates	Signed By Date	Insert			4/21/2008 12:00:00 AM	5/19/2011 1:09 PM
Dates	Start Date	Insert			7/1/2008 12:00:00 AM	5/19/2011 1:09 PM
Terminations	Termination Comments	Insert				5/19/2011 1:09 PM
Terminations	Termination Date	Insert				5/19/2011 1:09 PM
Terminations	Termination Effective Date	Insert				5/19/2011 1:09 PM
Terminations	Termination Reason	Insert				5/19/2011 1:09 PM
Details	Comments Public	Insert			5/19/11 REMOVED SUB DIV NAME (WAS ADMIN OFFICE); 5/3/11 UPDATED PHYS ADD (WAS SUITE #207)	5/19/2011 1:09 PM
Medicaid Billing	NPI: Number	Insert			1790081297	6/4/2008 1:54 PM

340B Drug Pricing Program Database