340B Drug Pricing Program Database


CH04413A MIAMI BEACH COMMUNITY HEALTH CENTER INC. (Active) - information as of 5/4/2025 10:22:44 PM

Main Details
MIAMI BEACH COMMUNITY HEALTH CENTER INC.
MBCHC North Suite 103 & 104
HRSA-Funded Health Center
BPS-H80-009935
CH04413A
H80CS00182


Additional Details
Active
6/4/2008
7/1/2008
6/5/2008
2/21/2025

Contacts

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

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

Addresses

11645 Biscayne Boulevard Suites 103 and 104
Miami, FL 33181

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
CommentLast 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

Yes
StateMedicaid NumberNPI Number
FL029544207,004242000,105384100,026581100,0295442081467606681,1063411874,1790081297,1215002571,1689749269
Shipping Addresses

MIAMI BEACH COMMUNITY HEALTH CENTER PHARMACY #4
11645 BISCAYNE BLVD SUITE # 102
MIAMI, FL 33181
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailFFP, LLCBIOMATRIX SPECIALTY PHARMACY FL 855 SW 78TH AVE STE C-101
PLANTATIONFL3332404/13/201807/01/2018 10/14/201910/15/2019
Contract DetailK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906004/13/201807/01/2018 10/14/201910/15/2019
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH044130ActiveBPS-H80-000599MIAMI BEACH COMMUNITY HEALTH CENTER INC.MIAMI BEACH COMMUNITY HEALTH CENTER, INC.710 Alton Rd Miami BeachFL
CH04413AActiveBPS-H80-009935MIAMI BEACH COMMUNITY HEALTH CENTER INC.MBCHC North Suite 103 & 104 11645 Biscayne Boulevard Suites 103 and 104 MiamiFL
CH04413CActiveBPS-H80-003523MIAMI BEACH COMMUNITY HEALTH CENTER INC.Beverly Press Health Center1221 71st St Miami BeachFL
CH04413JTerminatedBPS-H80-013563MIAMI BEACH COMMUNITY HEALTH CENTER INC.MBCHC North Suite 10211645 Biscayne Boulevard, Suite 102 MiamiFL
CH04413KActiveBPS-H80-018282MIAMI BEACH COMMUNITY HEALTH CENTER INC.Miami Beach Community Health Center North STE 40811645 Biscayne Blvd Ste 408, MiamiFL
CH04413LActiveBPS-H80-013520MIAMI BEACH COMMUNITY HEALTH CENTER INC.MBCHC North Suite 30911645 Biscayne Blvd Ste 309, MiamiFL
CH04413MActiveBPS-H80-013367MIAMI BEACH COMMUNITY HEALTH CENTER INC.MBCHC North Suite 301, 305, & 30711645 Biscayne Boulevard STE 301, 305, and 307, MiamiFL
CH04413NActiveBPS-H80-015714MIAMI BEACH COMMUNITY HEALTH CENTER INC.MBCHC North 3 Suite 401, 403, & 40511645 Biscayne Blvd Ste 405, MiamiFL
CH04413PActiveBPS-H80-013017MIAMI BEACH COMMUNITY HEALTH CENTER INC.MBCHC North Suite 30811645 Biscayne Blvd STE 308, MiamiFL
CH04413QActiveBPS-H80-019358Miami Beach Community Health Center Inc.MBCHC North 4, Suite 302 & 30411645 Biscayne Boulevard Suite 302 & 304, MiamiFL
CH04413RActiveBPS-H80-032503Miami Beach Community Health Center Inc.MBCHC North Suite 10011645 Biscayne Blvd Ste 100 MiamiFL
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH044130ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/01/2025  
CH044130ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2025  
CH044130ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2025  
CH044130ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/01/2025  
CH044130ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/01/2025  
CH044130ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/01/2025  
CH044130AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM1409 NE 26TH ST
WILTON MANORSFL3330510/01/2022  
CH044130AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080804/01/2019  
CH044130AVITA PHARMACY 1047AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR 801 N MAGNOLIA AVE STE 406
ORLANDOFL32803-384307/01/2019  
CH044130ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/01/2025  
CH044130EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/01/2025  
CH044130EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/01/2025  
CH044130EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/01/2025  
CH04413JFFP, LLCBIOMATRIX SPECIALTY PHARMACY FL 855 SW 78TH AVE STE C-101
PLANTATIONFL3332407/01/2018 10/14/2019
CH04413CFFP, LLCBIOMATRIX SPECIALTY PHARMACY FL 855 SW 78TH AVE STE C-101
PLANTATIONFL3332407/01/2018 10/14/2019
CH04413KFFP, LLCBIOMATRIX SPECIALTY PHARMACY FL 855 SW 78TH AVE STE C-101
PLANTATIONFL3332407/01/2018 10/14/2019
CH04413LFFP, LLCBIOMATRIX SPECIALTY PHARMACY FL 855 SW 78TH AVE STE C-101
PLANTATIONFL3332407/01/2018 10/14/2019
CH04413MFFP, LLCBIOMATRIX SPECIALTY PHARMACY FL 855 SW 78TH AVE STE C-101
PLANTATIONFL3332407/01/2018 10/14/2019
CH04413AFFP, LLCBIOMATRIX SPECIALTY PHARMACY FL 855 SW 78TH AVE STE C-101
PLANTATIONFL3332407/01/2018 10/14/2019
CH044130FFP, LLCBIOMATRIX SPECIALTY PHARMACY FL 855 SW 78TH AVE STE C-101
PLANTATIONFL3332407/01/2018 10/14/2019
CH044130HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04249 11890 BISCAYNE BLVD
MIAMIFL3318107/01/2016 04/06/2017
CH04413KK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906007/01/2018 10/14/2019
CH04413MK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906007/01/2018 10/14/2019
CH04413LK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906007/01/2018 10/14/2019
CH04413JK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906007/01/2018 10/14/2019
CH044130K & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906007/01/2018 10/14/2019
CH04413CK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906007/01/2018 10/14/2019
CH04413AK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906007/01/2018 10/14/2019
CH044130LONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D
LEXINGTONSC29072-245304/01/2019 10/01/2019
CH044130LONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D
LEXINGTONSC29072-245307/01/2021  
CH044130PUBLIX SUPER MARKETSPUBLIX PHARMACY #0073 9400 HARDING AVE
SURFSIDEFL3315404/01/2019 11/08/2019
CH044130PUBLIX SUPER MARKETSPUBLIX PHARMACY #1017 14641 BISCAYNE BOULEVARD
NORTH MIAMI BEACHFL3318104/01/2019 11/08/2019
CH044130PUBLIX SUPER MARKETS INCPUBLIX PHARMACY #0794 9050 BISCAYNE BLVD.
MIAMI SHORESFL3313804/01/2019 11/08/2019
CH044130PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #3213 1950 SAND LAKE RD, BLDG #5
ORLANDOFL3280904/01/2019 11/08/2019
CH044130PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY 1382 6876 COLLINS AVE
MIAMI BEACHFL33141-324404/01/2019 11/08/2019
CH044130PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #1397 1776 BISCAYNE BLVD.
MIAMIFL3313204/01/2019 11/08/2019
CH044130PUBLIX SUPER MARKETS, INC.PUBLIX CENTRAL PHARMACY #3201 2424 ORLANDO CENTRAL PARKWAY
ORLANDOFL3280904/01/2019 11/08/2019
CH044130PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #1236 12800 BISCAYNE BOULEVARD
NORTH MIAMIFL3318104/01/2019 11/08/2019
CH044130RELIABLE SUPER DRUGS OF MIAMI LLC2168 NE 123RD ST
NORTH MIAMIFL33181-290201/01/2015 09/26/2016
CH044130SKYEMED PHARMACY & INFUSION SERVICESKYEMED PHARMACY & INFUSION SVCS 1332 NORTH FEDERAL HWY
POMPANO BEACHFL3306210/01/2015 04/01/2017
CH044130WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2019 09/30/2022
CH044130WAL-MART PHARMACY 10-19962551 E. HALLANDALE BCH. BLVD.
HALLANDALEFL3300907/01/2015 09/26/2016
CH044130WAL-MART PHARMACY 10-32351425 NORTHEAST 163RD STREET
NORTH MIAMI BEACHFL3316207/01/2015 09/26/2016
CH044130WAL-MART PHARMACY 10-32351425 NORTHEAST 163RD STREET
NORTH MIAMI BEACHFL3316204/01/2019 09/30/2022
CH044130WAL-MART PHARMACY 10-339717650 NW 2ND AVE.
MIAMI GARDENSFL3316907/01/2015 09/26/2016
CH044130WAL-MART PHARMACY 10-339717650 NW 2ND AVE.
MIAMI GARDENSFL3316907/01/2020 09/30/2022
CH044130WAL-MART PHARMACY 10-5945400 W. 49TH
HIALEAHFL3301207/01/2020 09/30/2022
CH044130WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2019 09/30/2022
CH044130WALGREEN CO.DBA: WALGREENS # 00748 12295 BISCAYNE BLVD
NORTH MIAMIFL3318104/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 01532 6700 COLLINS AVE
MIAMI BEACHFL3314104/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 02128 1845 ALTON ROAD
MIAMI BEACHFL3313904/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 02545 1480 NE MIAMI GARDENS DR
NORTH MIAMI BEACHFL3317904/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 02719 791 NE 167TH ST
NORTH MIAMI BEACHFL3316204/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 02790 3103 BISCAYNE BLVD
MIAMIFL3313704/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03162 524 JEFFERSON AVE.
MIAMI BEACHFL3313904/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03173 9020 BISCAYNE BLVD
MIAMI SHORESFL3313804/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03301 1695 NW 20TH STREET
MIAMIFL3314204/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03527 567 NE 125TH STREET
NORTH MIAMIFL3316104/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03678 1501 NE 163RD STREET
NORTH MIAMI BEACHFL3316204/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03679 161 NE 54TH STREET
MIAMIFL3313704/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03835 19935 NW 2ND AVE
MIAMIFL3316904/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03942 4049 PINE TREE DR
MIAMI BEACHFL3314004/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 04915 750 NW 119TH ST.
MIAMIFL3316804/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 04955 18665 BISCAYNE BLVD
AVENTURAFL3318004/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 05198 7340 COLLINS AVE
MIAMI BEACHFL3314104/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 06873 1201 SW 1ST STREET
MIAMIFL33135-240104/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS #10983 1011 ALTON RD.
MIAMI BEACHFL3313904/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS #11657 2000 NORMANDY DR.
MIAMI BEACHFL3314104/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS #12463 501 COLLINS AVE.
MIAMI BEACHFL3313904/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 03493 9498 NW 7TH AVE
MIAMIFL3315004/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 04728 6200 NW 7TH AVE
MIAMIFL3315004/01/2016 08/22/2016
CH044130WALGREEN CO.DBA: WALGREENS # 05845 14901 NE 6TH AVE
MIAMIFL3316104/01/2016 08/22/2016
CH044130WALMART PHARMACY #10-43033200 NW 79TH STREET
MIAMIFL3314704/01/2019 09/30/2022
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/21/2025 12:16 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1053841002/21/2025 12:16 PM
Medicaid BillingMedicaid: StateInsertRecertification FL2/21/2025 12:16 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/21/2025 12:16 PM
Medicaid BillingMedicaid: NumberInsertRecertification 0265811002/21/2025 12:16 PM
Medicaid BillingMedicaid: StateInsertRecertification FL2/21/2025 12:16 PM
DetailsLast Recertification DateUpdateRecertification2/8/2024 10:29:26 AM2/21/2025 12:16:45 PM2/21/2025 12:16 PM
DetailsLast Recertification DateUpdateRecertification2/17/2023 10:19:13 AM2/8/2024 10:29:26 AM2/8/2024 10:29 AM
Medicaid BillingNPI: NumberInsertChange Request 121500257111/14/2023 12:03 PM
Medicaid BillingNPI: StateInsertChange Request FL11/14/2023 12:03 PM
Medicaid BillingNPI: NumberInsertChange Request 168974926911/14/2023 12:03 PM
Medicaid BillingNPI: StateInsertChange Request FL11/14/2023 12:03 PM
DetailsLast Recertification DateUpdateRecertification2/7/2022 3:28:32 PM2/17/2023 10:19:13 AM2/17/2023 10:19 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/7/2022 3:28 PM
Medicaid BillingMedicaid: NumberInsertRecertification 0042420002/7/2022 3:28 PM
Medicaid BillingMedicaid: StateInsertRecertification FL2/7/2022 3:28 PM
DetailsLast Recertification DateUpdateRecertification2/5/2021 5:20:47 PM2/7/2022 3:28:32 PM2/7/2022 3:28 PM
ContactsAuthorizing OfficialUpdateAO Change RequestRabinowitz, Mark CEO Miami Beach Community Health Center 3055388835-1600Menjivar, Sorangely Chief Operating Officer Miami Beach Community Health Center 3055388835-14091/28/2022 8:59 AM
Medicaid BillingNPI: NumberInsertChange Request 106341187410/28/2021 12:06 PM
Medicaid BillingNPI: StateInsertChange Request FL10/28/2021 12:06 PM
Medicaid BillingNPI: NumberInsertChange Request 179008129710/28/2021 12:06 PM
Medicaid BillingNPI: StateInsertChange Request FL10/28/2021 12:06 PM
AddressesBilling AddressUpdateRecertificationMiami Beach Community Health Center, Inc. 11645 Biscayne Boulevard, Suite 207 Miami, FL 33181-3138Miami Beach Community Health Center, Inc. 11645 Biscayne Boulevard, Suite 207 Miami, FL 331812/5/2021 5:20 PM
AddressesShipping AddressInsertRecertification MIAMI BEACH COMMUNITY HEALTH CENTER PHARMACY #4 11645 BISCAYNE BLVD SUITE # 102 MIAMI, FL 331812/5/2021 5:20 PM
AddressesMain AddressUpdateRecertification 11645 Biscayne Boulevard Suites 103 and 104 Miami, FL 33181-3138 11645 Biscayne Boulevard Suites 103 and 104 Miami, FL 331812/5/2021 5:20 PM
Medicaid BillingNPI: StateUpdateRecertification FL2/5/2021 5:20 PM
DetailsLast Recertification DateUpdateRecertification1/31/2020 4:16:28 PM2/5/2021 5:20:47 PM2/5/2021 5:20 PM
ContactsPrimary ContactUpdateProfile Change RequestSawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-1602Sawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-15852/3/2021 12:51 PM
DetailsLast Recertification DateUpdateRecertification2/4/2019 11:59:20 AM1/31/2020 4:16:28 PM1/31/2020 4:16 PM
AddressesBilling AddressInsertRecertification Miami Beach Community Health Center, Inc. 11645 Biscayne Boulevard, Suite 207 Miami, FL 33181-31382/4/2019 11:59 AM
DetailsLast Recertification DateUpdateRecertification2/9/2018 11:34:47 AM2/4/2019 11:59:20 AM2/4/2019 11:59 AM
ContactsPrimary ContactUpdateProfile Change RequestSawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-1332Sawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-16022/4/2019 10:31 AM
DetailsLast Recertification DateUpdateRecertification2/7/2017 12:00:00 AM2/9/2018 11:34:47 AM2/9/2018 11:34 AM
ContactsAuthorizing OfficialUpdate Rabinowitz, Mark CEO 3055388835-1600Rabinowitz, Mark CEO Miami Beach Community Health Center 3055388835-16001/8/2018 5:16 PM
ContactsPrimary ContactUpdate Sawaged, Ray VP Pharmacy Services 3055388835-1332Sawaged, Ray VP Pharmacy Services Miami Beach Community Health Center, Inc. 3055388835-133210/2/2017 11:31 AM
ContactsPrimary ContactInsert  Sawaged, Ray VP Pharmacy Services 3055388835-13326/29/2017 7:39 PM
AddressesMain AddressInsert   11645 Biscayne Boulevard Suites 103 and 104 Miami, FL 33181-31386/29/2017 7:36 PM
ContactsAuthorizing OfficialInsert  Rabinowitz, Mark CEO 3055388835-16006/29/2017 7:36 PM
Medicaid BillingMedicaid: NumberUpdate 0042420000295442074/10/2017 10:02 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/10/2017 10:02 AM
Medicaid BillingMedicaid: NumberInsert  0295442084/10/2017 10:02 AM
Medicaid BillingMedicaid: StateInsert  FL4/10/2017 10:02 AM
Medicaid BillingNPI: NumberUpdate 179008129714676066814/10/2017 10:02 AM
DetailsEntity SubnameUpdate Miami Beach Community Health Center NorthMBCHC North Suite 103 & 104 4/10/2017 10:02 AM
DetailsLast Recertification DateUpdate 2/12/2016 12:00:00 AM2/7/2017 12:00:00 AM2/7/2017 10:04 AM
DetailsLast Recertification DateUpdate 2/3/2015 12:00:00 AM2/12/2016 12:00:00 AM2/12/2016 4:40 PM
DetailsLast Recertification DateUpdate 2/10/2014 12:00:00 AM2/3/2015 12:00:00 AM2/3/2015 12:52 PM
DetailsEntity NameUpdate MIAMI BEACH COMMUNITY HEALTH CENTER, INC.MIAMI BEACH COMMUNITY HEALTH CENTER INC.3/31/2014 4:25 PM
DetailsEntity SubnameUpdate  Miami Beach Community Health Center North3/31/2014 4:25 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM2/10/2014 12:00:00 AM2/10/2014 4:43 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/19/2013 2:46 PM
Medicaid BillingMedicaid: NumberInsert  0042420003/19/2013 2:46 PM
Medicaid BillingMedicaid: StateInsert  FL3/19/2013 2:46 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/25/2013 10:10 AM
DetailsLast Recertification DateInsert   5/19/2011 1:09 PM
DetailsGrant NumberInsert  H80CS001825/19/2011 1:09 PM
Details340B IDInsert  CH04413A5/19/2011 1:09 PM
DetailsIs Authorizing Official EHB DataInsert   5/19/2011 1:09 PM
DatesLast Date That 340B Drugs PurchasedInsert   5/19/2011 1:09 PM
DetailsMedicare Provider NumberInsert   5/19/2011 1:09 PM
DetailsEntity NameInsert  MIAMI BEACH COMMUNITY HEALTH CENTER, INC.5/19/2011 1:09 PM
DetailsProgram CodeInsert  CH5/19/2011 1:09 PM
DetailsEntity SubnameInsert   5/19/2011 1:09 PM
DatesParticipating Approval DateInsert  6/5/2008 12:00:00 AM5/19/2011 1:09 PM
DetailsStateInsert  Active5/19/2011 1:09 PM
DatesRegistration DateInsert  6/4/2008 12:00:00 AM5/19/2011 1:09 PM
DatesSigned By DateInsert  4/21/2008 12:00:00 AM5/19/2011 1:09 PM
DatesStart DateInsert  7/1/2008 12:00:00 AM5/19/2011 1:09 PM
TerminationsTermination CommentsInsert   5/19/2011 1:09 PM
TerminationsTermination DateInsert   5/19/2011 1:09 PM
TerminationsTermination Effective DateInsert   5/19/2011 1:09 PM
TerminationsTermination ReasonInsert   5/19/2011 1:09 PM
DetailsComments PublicInsert  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 BillingNPI: NumberInsert  17900812976/4/2008 1:54 PM