| Addresses | Main Address | Update | Change Request |
2814 14th Ave SE
Ruskin, FL 33570-5471 |
820 15th ST SE
Ruskin, FL 33570 | 3/20/2025 1:55 PM |
| Addresses | Shipping Address | Delete | Change Request | Ruskin Health Center Pharmacy
2814 14th Ave. SE
Ruskin, FL 33570 | | 3/20/2025 1:55 PM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2024 3:02:52 PM | 2/14/2025 10:21:47 AM | 2/14/2025 10:21 AM |
| Contacts | Primary Contact | Update | Group Change Request | Leone, Natalie Kaye
Clinic Administrator
Suncoast Community Health Centers, Inc.
8133314921 | Peguero, Miosotis
Analyst – Finance & Pharmacy Compliance
Suncoast Community Health Centers, Inc.
8133497998 | 3/28/2024 10:03 AM |
| Contacts | Primary Contact | Update | Recertification | Leone, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Leone, Natalie Kaye
Clinic Administrator
Suncoast Community Health Centers, Inc.
8133314921 | 2/2/2024 3:02 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 9:53:11 AM | 2/2/2024 3:02:52 PM | 2/2/2024 3:02 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Wrightson, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Leone, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 5/23/2023 12:41 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 3:23:59 PM | 1/30/2023 9:53:11 AM | 1/30/2023 9:53 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Wrightson, Natalie Kaye
Pharmacy Compliance and Financial Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Wrightson, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 6/23/2022 9:54 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 9:24:16 AM | 2/1/2022 3:23:59 PM | 2/1/2022 3:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/3/2021 9:24 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/3/2021 9:24 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 2:38:49 PM | 2/3/2021 9:24:16 AM | 2/3/2021 9:24 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 3:51:23 PM | 1/28/2020 2:38:49 PM | 1/28/2020 2:38 PM |
| Contacts | Primary Contact | Update | Change Request | Hunt, Jeff
Pharmacy Director
Suncoast Community Health Centers, Inc
8133497959 | Wrightson, Natalie Kaye
Pharmacy Compliance and Financial Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 9/25/2019 11:53 AM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2018 2:24:53 PM | 1/30/2019 3:51:23 PM | 1/30/2019 3:51 PM |
| Details | Last Recertification Date | Update | Recertification | 2/10/2017 12:00:00 AM | 2/19/2018 2:24:53 PM | 2/19/2018 2:24 PM |
| Contacts | Authorizing Official | Update | | Herremans, Bradley
CEO
8136536268 | Herremans, Bradley
CEO
Suncoast Community Health Centers, Inc.
8136536268 | 1/9/2018 11:45 AM |
| Contacts | Primary Contact | Update | | Hunt, Jeff
Pharmacy Director
8133497959 | Hunt, Jeff
Pharmacy Director
Suncoast Community Health Centers, Inc
8133497959 | 1/9/2018 9:54 AM |
| Contacts | Primary Contact | Insert | | | Hunt, Jeff
Pharmacy Director
8133497959 | 8/9/2017 11:03 AM |
| Contacts | Authorizing Official | Update | | ROSZEL, BRANTZ
CEO
8133497568 | Herremans, Bradley
CEO
8136536268 | 8/9/2017 11:03 AM |
| Addresses | Main Address | Insert | | |
2814 14th Ave SE
Ruskin, FL 33570-5471 | 2/10/2017 11:25 AM |
| Details | Last Recertification Date | Update | | 2/12/2016 12:00:00 AM | 2/10/2017 12:00:00 AM | 2/10/2017 11:25 AM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 2/12/2016 11:48 AM |
| Details | Last Recertification Date | Update | | 2/3/2015 12:00:00 AM | 2/12/2016 12:00:00 AM | 2/12/2016 11:48 AM |
| Addresses | Billing Address | Insert | | | Suncoast Community Health Centers, Inc.
P.O. Box 1349
Ruskin, FL 33575 | 7/13/2015 3:39 PM |
| Addresses | Shipping Address | Insert | | | Ruskin Health Center Pharmacy
2814 14th Ave. SE
Ruskin, FL 33570 | 7/13/2015 3:39 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/13/2015 3:38 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 029557400 | 7/13/2015 3:38 PM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 7/13/2015 3:38 PM |
| Details | Last Recertification Date | Update | | 3/21/2014 12:00:00 AM | 2/3/2015 12:00:00 AM | 2/3/2015 12:32 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/21/2014 12:00:00 AM | 3/21/2014 10:20 PM |
| Details | Entity Subname | Update | | Ruskin Health Center | SUNCOAST COMMUNITY HEALTH CENTERS, INC. | 3/21/2014 10:20 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/19/2013 10:48 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1770596058 | 5/15/2012 8:55 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1285644799 | 5/15/2012 8:55 AM |
| Details | Entity Subname | Update | | | Ruskin Health Center | 5/15/2012 8:55 AM |
| Contacts | Authorizing Official | Insert | | | ROSZEL, BRANTZ
CEO
8133497568 | 1/21/2010 11:13 AM |
| Details | Last Recertification Date | Insert | | | | 12/21/2005 3:22 PM |
| Details | Grant Number | Insert | | | H80CS00541 | 12/21/2005 3:22 PM |
| Details | 340B ID | Insert | | | CH041750 | 12/21/2005 3:22 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 12/21/2005 3:22 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/21/2005 3:22 PM |
| Details | Medicare Provider Number | Insert | | | | 12/21/2005 3:22 PM |
| Details | Entity Name | Insert | | | SUNCOAST COMMUNITY HEALTH CENTERS, INC. | 12/21/2005 3:22 PM |
| Details | Program Code | Insert | | | CH | 12/21/2005 3:22 PM |
| Details | Entity Subname | Insert | | | | 12/21/2005 3:22 PM |
| Dates | Participating Approval Date | Insert | | | 12/1/1992 12:00:00 AM | 12/21/2005 3:22 PM |
| Details | State | Insert | | | Active | 12/21/2005 3:22 PM |
| Dates | Registration Date | Insert | | | 12/1/1992 12:00:00 AM | 12/21/2005 3:22 PM |
| Dates | Signed By Date | Insert | | | | 12/21/2005 3:22 PM |
| Dates | Start Date | Insert | | | 12/1/1992 12:00:00 AM | 12/21/2005 3:22 PM |
| Terminations | Termination Comments | Insert | | | | 12/21/2005 3:22 PM |
| Terminations | Termination Date | Insert | | | | 12/21/2005 3:22 PM |
| Terminations | Termination Effective Date | Insert | | | | 12/21/2005 3:22 PM |
| Terminations | Termination Reason | Insert | | | | 12/21/2005 3:22 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 12/1/1992 12:00 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 104053700 | 12/1/1992 12:00 AM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 12/1/1992 12:00 AM |