Covered Entity Details

DSH100093 BAPTIST HOSPITAL (Active) - information as of 4/28/2025 12:44:13 AM

Main Details

Name

BAPTIST HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH100093

Medicare Provider Number

100093

Additional Details

Current Program Status

Active

Registration Date

3/9/2009

Participating Start Date

4/1/2009

Participating Approval Date

3/9/2009

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Baptist Health Care
Valerie Cyd Cadena, Senior Vice President - Operations
(448) 227-8053

Primary Contact

BHC
Frederick Seelmann, Executive Director of Pharmacy
(850) 469-7567

Addresses

Street Address

123 Baptist Way
PENSACOLA, FL 32503

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
6/11/12 reinstated program due to clerical error during recertification, removed termination date as entity listed %SSI days and not allowable DSH%, appropriate documentation received to fix DSH% and allow program to remain in 340B database as eligible entitiy JH 4/1/09 REINSTATED PREV PART FROM 10/1/03 TO 3/31/04 NOT ELIGIBLE FROM 4/1/04 TO 3/31/09 340B ID CHANGE (WAS DSH32501); 2/25/09- DOC RECD TO CONFIRM ELIG DSH ADJ %.11/01/10 ADDED MEDICAID#	06/11/2012
4/1/09 REINSTATED PREV PART FROM 10/1/03 TO 3/31/04 NOT ELIGIBLE FROM 4/1/04 TO 3/31/09 340B ID CHANGE (WAS DSH32501); 2/25/09- DOC RECD TO CONFIRM ELIG DSH ADJ %.11/01/10 ADDED MEDICAID#	11/01/2010

Comment

Last Updated On

6/11/12 reinstated program due to clerical error during recertification, removed termination date as entity listed %SSI days and not allowable DSH%, appropriate documentation received to fix DSH% and allow program to remain in 340B database as eligible entitiy JH 4/1/09 REINSTATED PREV PART FROM 10/1/03 TO 3/31/04 NOT ELIGIBLE FROM 4/1/04 TO 3/31/09 340B ID CHANGE (WAS DSH32501); 2/25/09- DOC RECD TO CONFIRM ELIG DSH ADJ %.11/01/10 ADDED MEDICAID#

06/11/2012

4/1/09 REINSTATED PREV PART FROM 10/1/03 TO 3/31/04 NOT ELIGIBLE FROM 4/1/04 TO 3/31/09 340B ID CHANGE (WAS DSH32501); 2/25/09- DOC RECD TO CONFIRM ELIG DSH ADJ %.11/01/10 ADDED MEDICAID#

11/01/2010

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	010074903,010074900	1700979465,1457448037
AL	HOS0093P	1700979465
AK	1665931	1700979465
AZ	83838	1700979465
AR	121575105	1700979465
CO	23088842	1700979465
CT	HOS0093P	1700979465
GA	000150433AA	1700979465
IL	590657322-002	1700979465
IN	300013901	1700979465
IA	553842	1700979465
KY	1291723	1700979465
LA	1733091	1700979465
MD	217105800	1700979465
MI	HOS0093P	1700979465
MS	97779	1700979465
NJ	250252	1700979465
NC	HOS0093P	1700979465
OH	142769	1700979465
OK	200060650B	1700979465
OR	500773264	1700979465
PA	100777553-0008	1700979465
SC	10172A-inpatient,10867B-outpatient	1700979465
TN	100093	1700979465
VT	100093	1700979465
WI	1700979465	1700979465
VA	1700979465	1700979465

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/12/2016	10/01/2016		07/12/2016
Contract Detail	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	07/12/2016	10/01/2016	04/10/2018	04/16/2018
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/12/2016	10/01/2016		07/12/2016
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/15/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/12/2016	10/01/2016	05/31/2023	12/29/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/12/2016	10/01/2016		07/12/2016
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/12/2016	10/01/2016		07/12/2016
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/15/2024	04/01/2024		04/01/2024
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04938	208 MCMEANS AVE.	BAY MINETTE	AL	36507	01/22/2021	04/01/2021		04/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01806	1300 SOUTH MCKENZIE ST	FOLEY	AL	36535	07/26/2021	10/01/2021		10/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10208	333 S COLLEGE STREET	AUBURN	AL	36830	04/12/2022	07/01/2022		07/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04953	879 FORT DALE RD.	GREENVILLE	AL	36037	04/12/2022	07/01/2022		07/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02899	25761 PERDIDO BEACH BLVD.	ORANGE BEACH	AL	36561	04/12/2022	07/01/2022		07/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04915	2 N. BROADWAY AVE.	SYLACAUGA	AL	35150	04/12/2022	07/01/2022		07/01/2022
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01822	21975 HWY 59	ROBERTSDALE	AL	36567	04/12/2022	07/01/2022		07/01/2022
Contract Detail	BAPTIST HOSPITAL INC	1110 GULF BREEZE PARKWAY		GULF BREEZE	FL	32561	08/09/2011	08/09/2011		03/28/2013
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/26/2020	01/01/2021		01/01/2021
Contract Detail	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	01/27/2022	04/01/2022		04/01/2022
Contract Detail	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	01/27/2022	04/01/2022		04/01/2022
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	9143 PHILLIPS HIGHWAY SUITE 300	JACKSONVILLE	FL	32256	07/17/2017	10/01/2017	01/17/2025	02/21/2025
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	3439 NORTH 12TH AVENUE SUITE A AND B	PENSACOLA	FL	32503-4008	07/17/2017	10/01/2017	01/17/2025	02/21/2025
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	CORAM CVS/SPECIALTY INFUSION SERVICES	2140 NEWMARKET PARKWAY SUITE 106	MARIETTA	GA	30067-8767	07/17/2017	10/01/2017	01/17/2025	02/21/2025
Contract Detail	CORAM HEALTHCARE CORPORATION OF ALABAMA	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	300 RIVERHILLS BUS PARK SUITE 390	BIRMINGHAM	AL	35242-8101	07/17/2017	10/01/2017	03/06/2024	02/21/2025
Contract Detail	CORAM HEALTHCARE CORPORATION OF FLORIDA	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	8508 BENJAMIN RD SUITE C	TAMPA	FL	33634-1241	07/26/2021	10/01/2021	01/17/2025	02/21/2025
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY #11186	1806 PINE AVE.	NIAGARA FALLS	NY	14301	04/27/2021	07/01/2021	08/29/2022	12/04/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/26/2020	01/01/2021		01/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/26/2020	01/01/2021		01/01/2021
Contract Detail	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00620	1 KENNEDY MEMORIAL DR.	WATERVILLE	ME	04901	04/12/2022	07/01/2022		07/01/2022
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/26/2020	01/01/2021		01/01/2021
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/17/2017	10/01/2017		10/01/2017
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/13/2016	10/01/2016		07/13/2016
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/13/2016	10/01/2016		07/13/2016
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/13/2016	10/01/2016		07/13/2016
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/13/2016	10/01/2016		07/13/2016
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	255 PHILLIPI ROAD	COLUMBUS	OH	43228	07/13/2016	10/01/2016	06/29/2018	07/09/2018
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5523	5900 WATSON BLVD.	WARNER ROBINS	GA	31093	04/12/2022	07/01/2022		07/01/2022
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01055	2090 S HIGHWAY 29	CANTONMENT	FL	32533	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03283	6888 N 9TH AVE	PENSACOLA	FL	32504	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03675	1 E NINE MILE RD	PENSACOLA	FL	32534	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04177	2100 WEST CERVANTES	PENSACOLA	FL	32505	07/14/2016	10/01/2016	11/12/2024	12/10/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04430	44 GULF BEACH HWY	PENSACOLA	FL	32507	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04449	6501 CAROLINE ST	MILTON	FL	32570	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04461	811 N FAIRFIELD DR	PENSACOLA	FL	32506	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05158	5301 N PALAFOX ST	PENSACOLA	FL	32505	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05176	225 GULF BREEZE PKWY	GULF BREEZE	FL	32561	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05180	6025 MOBILE HWY.	PENSACOLA	FL	32526	07/14/2016	10/01/2016		07/14/2016
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16620	1749 E NINE MILE RD	PENSACOLA	FL	32514	07/16/2019	10/01/2019		10/01/2019
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16207	4711 BAYOU BLVD	PENSACOLA	FL	32503	07/16/2019	10/01/2019		10/01/2019
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17353	4727 HWY 90	PACE	FL	32571	07/16/2019	10/01/2019		10/01/2019
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17500	2950 S BLUE ANGEL PKWY	PENSACOLA	FL	32506	10/14/2019	01/01/2020		01/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04171	1101 SCENIC HWY	PENSACOLA	FL	32503	10/21/2019	01/01/2020		01/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05249	3888 HWY 90	PACE	FL	32571	10/21/2019	01/01/2020		01/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05248	8422 NAVARRE PKWY	NAVARRE	FL	32566	10/21/2019	01/01/2020		01/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04155	3359 GULF BREEZE PARKWAY	GULF BREEZE	FL	32563	10/21/2019	01/01/2020		01/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05175	13430 INNERARITY POINT RD	PENSACOLA	FL	32507	10/21/2019	01/01/2020		01/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04458	8100 N DAVIS HWY	PENSACOLA	FL	32514	10/21/2019	01/01/2020		01/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05179	3880 N 9TH AVE	PENSACOLA	FL	32503	01/15/2020	04/01/2020	06/02/2022	12/04/2023
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04015	302 E. JAMES LEE BLVD.	CRESTVIEW	FL	32539	01/15/2020	04/01/2020		04/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04027	8361 N CENTURY BLVD	CENTURY	FL	32535	10/26/2020	01/01/2021		01/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03003	71 MARY ESTHER BLVD	MARY ESTHER	FL	32569	01/22/2021	04/01/2021		04/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05194	1081 BEAL PKWY NW	FORT WALTON BEACH	FL	32547	07/26/2021	10/01/2021		10/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16224	250 E MIRACLE STRIP PKWY	MARY ESTHER	FL	32569	04/12/2022	07/01/2022		07/01/2022
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04440	434 RACETRACK RD NE	FORT WALTON BEACH	FL	32547	04/12/2022	07/01/2022		07/01/2022
Contract Detail	OMNICARE PHARMACY OF FL, LP	OMNICARE OF TAMPA	8603 FLORIDA MINING BLVD	TAMPA	FL	33634-1261	07/26/2021	10/01/2021		10/01/2021
Contract Detail	OMNICARE PHARMACY OF FLORIDA, LP	OMNICARE OF PANAMA CITY	2605 W 23RD ST	PANAMA CITY	FL	32405	07/26/2021	10/01/2021	06/18/2024	08/28/2024
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	07/15/2016	10/01/2016	04/10/2018	04/16/2018
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/12/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/12/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/15/2024	07/01/2024		07/01/2024
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/12/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/12/2021	07/01/2021		07/01/2021
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/22/2021	04/01/2021	01/09/2023	01/10/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/17/2017	10/01/2017		10/01/2017
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/26/2020	01/01/2021		01/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/26/2020	01/01/2021		01/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	NAVARRO SPECIALTY SERVICES # 10727	7205 CORPORATE CENTER DRIVE SUITE 104	MIAMI	FL	33126	04/27/2021	07/01/2021		07/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY# 11235	9555 KINGS CHARTER DR., SUITE D	ASHLAND	VA	23005	07/26/2021	10/01/2021	11/15/2023	08/28/2024
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0896	8244 NAVARRE PKWY	NAVARRE	FL	32566	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0801	2250 SOUTH FERDON BOULEVARD	CRESTVIEW	FL	32536	04/17/2019	07/01/2019	06/20/2022	06/27/2022
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1317	9251 UNIVERSITY PARKWAY	PENSACOLA	FL	32514	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1316	5055 NORTH 9TH AVE.	PENSACOLA	FL	32504	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1225	4739 HIGHWAY 90	PACE	FL	32571	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1189	852 GULF BREEZE PARKWAY	GULF BREEZE	FL	32561	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1296	13390 PERDIDO KEY DR.	PENSACOLA	FL	32507	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1522	1100 E CERVANTES ST	PENSACOLA	FL	32501	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1343	2180 WEST NINE MILE ROAD	PENSACOLA	FL	32534	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1537	1430 TIGER PARK LANE	GULF BREEZE	FL	32563	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1318	5998 MOBILE HWY	PENSACOLA	FL	32526	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1572	5580 WOODBINE RD	PACE	FL	32571	04/17/2019	07/01/2019		07/01/2019
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1746	8684 BEULAH ROAD	PENSACOLA	FL	32526	04/14/2023	07/01/2023		07/01/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1807	5854 DOGWOOD DR	MILTON	FL	32570	04/14/2023	07/01/2023		07/01/2023
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	07/15/2016	10/01/2016		07/15/2016
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	07/15/2016	10/01/2016		07/15/2016
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	05/05/2017	07/01/2017		05/05/2017
Contract Detail	THE TOWERS PHARMACY	125 BAPTIST WAY STE 1F		PENSACOLA	FL	32503	04/01/2009	04/01/2009		03/28/2013
Contract Detail	The Towers Specialty Pharmacy	1717 North E Street	Suite 302B	Pensacola	FL	32501	10/21/2022	01/01/2023	12/23/2024	01/06/2025
Contract Detail	TOWERS PHARMACY INC	TOWERS SPECIALTY PHARMACY	125 BAPTIST WAY STE 1H	PENSACOLA	FL	32503	01/15/2024	01/15/2024		01/29/2024
Contract Detail	TWIN TOWERS PHARMACY	9400 UNIVERSITY PKWY STE 118	DBA BAPTIST MEDICAL PARK PHARM	PENSACOLA	FL	32514-5752	03/14/2012	03/14/2012		03/28/2013
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-0904	2200 S MCKENZIE ST		FOLEY	AL	36535	01/22/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART PHARMACY 10-0919	748 BEAL PKWY NW		FT WALTON BEACH	FL	32547	01/22/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART PHARMACY 10-0944	3351 S. FERDON BLVD		CRESTVIEW	FL	32539	01/22/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART PHARMACY 10-0990	4965 HIGHWAY 90		PACE (MILTON)	FL	32571	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-1222	8970 PENSACOLA BLVD		PENSACOLA	FL	32534	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-1224	2650 CREIGHTON ROAD		PENSACOLA	FL	32504	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-1605	4600 MOBILE HWY-STE. 122		PENSACOLA W	FL	32506	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-1620	2578 DOUGLAS AVENUE		BREWTON	AL	36426	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-2533	3767 GULF BREEZE PARKWAY		GULF BREEZE	FL	32563	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-3439	9360 NAVARRE PARKWAY		NAVARRE	FL	32566	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-3484	2951 SOUTH BLUE ANGEL PARKWAY		PENSACOLA (SW)	FL	32506	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-3785	501 NORTH NAVY BLVD.		PENSACOLA	FL	32507	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-4568	1882 HOLLY ST.		BLAIR	NE	68008	01/22/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/22/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART PHARMACY 10-5623	334 GULF BREEZE PARKWAY		GULF BREEZE	FL	32561	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WAL-MART PHARMACY 10-5653	25241 PERDIDO BEACH BLVD.		ORANGE BEACH	AL	36561	07/15/2019	10/01/2019		10/01/2019
Contract Detail	WAL-MART PHARMACY 10-5845	1300 JOHN SIMS PKWY E		NICEVILLE	FL	32578	01/22/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WALGREEN CO	DBA: WALGREENS #10312	85 BEVERLY PKWY	PENSACOLA	FL	32505-2813	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05581	6314 N 9TH AVE	PENSACOLA	FL	32504	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #01042	4497 MOBILE HWY	PENSACOLA	FL	32506	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12300	6506 CAROLINE STREET	MILTON	FL	32570	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05757	3909 HIGHWAY 90	PACE	FL	32571	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06210	1459 TIGER PARK LANE	GULF BREEZE	FL	32563-5720	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10181	2237 WEST NINE MILE ROAD	PENSACOLA	FL	32534-9416	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07344	700 N PACE BLVD	PENSACOLA	FL	32505-7500	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01222	20 W NINE MILE ROAD	PENSACOLA	FL	32534-1263	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09917	5995 MOBILE HIGHWAY	PENSACOLA	FL	32526	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05659	870 E CERVANTES	PENSACOLA	FL	32501	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09916	1841 E OLIVE RD	PENSACOLA	FL	32514	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09535	8220 NAVARRE PKWY	NAVARRE	FL	32566-6943	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15616	5149 N 9TH AVE STE 1137	PENSACOLA	FL	32504	07/17/2017	10/01/2017	10/01/2024	10/15/2024
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13072	8333 N DAVIS HWY STE 50	PENSACOLA	FL	32514	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21392	1731 SPRING HILL AVE STE B	MOBILE	AL	36604	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #12146	1200 KUHL AVE	ORLANDO	FL	32806	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04848	414 C MARY ESTHER CUTOFF NW	FT WALTON BEACH	FL	32548	01/10/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05582	825 BEAL PKWY N	FORT WALTON BEACH	FL	32547	01/10/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01318	698 S MCKENZIE ST	FOLEY	AL	36535	10/11/2023	01/01/2024		01/01/2024
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02980	4747 S SHERWOOD FOREST	BATON ROUGE	LA	70816	10/11/2023	01/01/2024		01/01/2024
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/10/2023	04/01/2023		04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/17/2017	10/01/2017	03/28/2022	03/30/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/17/2017	10/01/2017		10/01/2017
Contract Detail	WALMART PHARMACY #10-4357	6670 MOBILE HIGHWAY		PENSACOLA	FL	32526	07/12/2016	10/01/2016		07/12/2016
Contract Detail	WALMART PHARMACY #10-4582	7360 NAVARRE PARKWAY		NAVARRE	FL	32566	07/15/2019	10/01/2019		10/01/2019
Contract Detail	WALMART PHARMACY #10-5771	1525 E NINE MILE ROAD		PENSACOLA	FL	32514	07/15/2019	10/01/2019		10/01/2019
Contract Detail	WALMART PHARMACY #10-7247	911 N. MAIN STREET		ATMORE	AL	36502	07/15/2019	10/01/2019		10/01/2019
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/15/2024	01/01/2025		01/01/2025
Contract Detail	WALMART PHARMACY 10-6531	9301 PINE FOREST ROAD		PENSACOLA	FL	32534	07/15/2019	10/01/2019		10/01/2019
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/17/2023	01/01/2024		01/01/2024
Contract Detail	WINN DIXIE #556	4751 BAYOU BLVD		PENSACOLA	FL	32503	10/14/2019	01/01/2020	10/19/2023	11/13/2023
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN-DIXIE PHARMACY #506	312 E NINE MILE ROAD	PENSACOLA	FL	32514	10/14/2019	01/01/2020	10/29/2023	11/13/2023
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN-DIXIE PHARMACY #495	5975 MOBILE HWY	PENSACOLA	FL	32526	10/14/2019	01/01/2020	03/28/2022	03/30/2022
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN-DIXIE PHARMACY #535	50 S BLUE ANGEL PARKWAY	PENSACOLA	FL	32506	10/14/2019	01/01/2020	10/30/2023	11/13/2023
Contract Detail	WINN DIXIE PHARMACY #498	1550 SO HWY 29		CANTONMENT	FL	32533	10/14/2019	01/01/2020	11/08/2023	11/13/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH100093AA	Child	DSH	BAPTIST HOSPITAL	BH AI PMR BMPA 102 - BH AI PMR BMPA 102	5100 North 12th Avenue	Pensacola	FL	Active
DSH100093AB	Child	DSH	BAPTIST HOSPITAL	BH AI PMR HWC 4A	125 Baptist Way	Pensacola	FL	Active
DSH100093AC	Child	DSH	BAPTIST HOSPITAL	BH AI PMR SM AI 208 - BH AI PMR SM AI 208	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093AD	Child	DSH	BAPTIST HOSPITAL	BH Card Con BMP9 103 - BH Card Con BMP9 103	9400 University Parkway	Pensacola	FL	Active
DSH100093AE	Child	DSH	BAPTIST HOSPITAL	BH Card Con BMPA 202 - BH Card Con BMPA 202	5100 North 12th Avenue	Pensacola	FL	Active
DSH100093AF	Child	DSH	BAPTIST HOSPITAL	BH Card Con BMPN 101 - BH Card Con BMPN 101	8880 Navarre Parkway	Navarre	FL	Active
DSH100093AG	Child	DSH	BAPTIST HOSPITAL	BH Card Con HWC 3	125 Baptist Way	Pensacola	FL	Active
DSH100093AH	Child	DSH	BAPTIST HOSPITAL	BH Card Con GB 102 - BH Card Con GB 102	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093AJ	Child	DSH	BAPTIST HOSPITAL	BH Card Con HRC HWC 3	125 Baptist Way	Pensacola	FL	Terminated
DSH100093AK	Child	DSH	BAPTIST HOSPITAL	BH Card Con Milton 200 - BH Card Con Milton 200	5907 Berryhill Road	Milton	FL	Active
DSH100093AL	Child	DSH	BAPTIST HOSPITAL	BH Convenient Care Southtowne - BH Convenient Care Southtowne	190 East Intendencia Street	Pensacola	FL	Active
DSH100093AM	Child	DSH	BAPTIST HOSPITAL	BH Endocrinology HWC 5B	125 Baptist Way	Pensacola	FL	Active
DSH100093AN	Child	DSH	BAPTIST HOSPITAL	BH ENT BMP9 200 - BH ENT BMP9 200	9400 University Parkway	Pensacola	FL	Active
DSH100093AP	Child	DSH	BAPTIST HOSPITAL	BH General Surgery Westside - BH General Surgery Westside	6715 Highway 98 West	Pensacola	FL	Active
DSH100093AQ	Child	DSH	BAPTIST HOSPITAL	BH Neurosurgery Milton 200 - BH Neurosurgery Milton 200	5907 Berryhill Road	Milton	FL	Active
DSH100093AR	Child	DSH	BAPTIST HOSPITAL	BH OBGYN HWC 5A	125 Baptist Way	Pensacola	FL	Active
DSH100093AS	Child	DSH	BAPTIST HOSPITAL	BH Wellness BMPN 206 - BH Wellness BMPN 206	8880 Navarre Parkway	Navarre	FL	Terminated
DSH100093AT	Child	DSH	BAPTIST HOSPITAL	BH Radiation Onc HWC 1E	125 Baptist Way	Pensacola	FL	Active
DSH100093AU	Child	DSH	BAPTIST HOSPITAL	BH General Surgery BMPN 101 - BH General Surgery BMPN 101	8880 Navarre Parkway	Navarre	FL	Active
DSH100093AV	Child	DSH	BAPTIST HOSPITAL	BH Gastroenterology HWC 4C	125 Baptist Way	Pensacola	FL	Active
DSH100093AW	Child	DSH	BAPTIST HOSPITAL	BH Family Medicine GB 100 - BH Family Medicine GB 100	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Terminated
DSH100093AX	Child	DSH	BAPTIST HOSPITAL	BH Primary Care East Hill	3417 North 12th Avenue	Pensacola	FL	Active
DSH100093AY	Child	DSH	BAPTIST HOSPITAL	BH General Surgery Pace-Hwy 90 - BH General Surgery Pace-Hwy 90	4498 US Highway 90	Pace	FL	Active
DSH100093AZ	Child	DSH	BAPTIST HOSPITAL	BH Urology Milton 200 - BH Urology Milton 200	5907 Berryhill Road	Milton	FL	Terminated
DSH100093B	Child	DSH	BAPTIST HOSPITAL	Baptist Hospital Outpatient Infusion at Ciano Cancer Center	1114 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093BA	Child	DSH	BAPTIST HOSPITAL	BH Family Medicine BMP9 409 - BH Family Medicine BMP9 409	9400 University Parkway	Pensacola	FL	Active
DSH100093BB	Child	DSH	BAPTIST HOSPITAL	BH General Surgery GB 203 - BH General Surgery GB 203	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093BC	Child	DSH	BAPTIST HOSPITAL	BH Urology HWC 4B	125 Baptist Way	Pensacola	FL	Active
DSH100093BD	Child	DSH	BAPTIST HOSPITAL	BH ENT HWC 5C	125 Baptist Way	Pensacola	FL	Active
DSH100093BE	Child	DSH	BAPTIST HOSPITAL	BH Primary Care BMP9 210 - BH Primary Care BMP9 210	9400 University Parkway	Pensacola	FL	Active
DSH100093BF	Child	DSH	BAPTIST HOSPITAL	BH Hematology Onc BMP9 408 - BH Hematology Onc BMP9 408	9400 University Parkway	Pensacola	FL	Active
DSH100093BG	Child	DSH	BAPTIST HOSPITAL	BH Urology GB 200 - BH Urology GB 200	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093BH	Child	DSH	BAPTIST HOSPITAL	BH Family Medicine Tiger Point - BH Family Medicine Tiger Point	1337 Country Club Rd	Gulf Breeze	FL	Terminated
DSH100093BJ	Child	DSH	BAPTIST HOSPITAL	BH Primary Care Live Oak - BH Primary Care Live Oak	2896 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093BK	Child	DSH	BAPTIST HOSPITAL	BH OBGYN GB 101 - BH OBGYN GB 101	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Terminated
DSH100093BL	Child	DSH	BAPTIST HOSPITAL	BH Rheumatology HWC 4A	125 Baptist Way	Pensacola	FL	Active
DSH100093BM	Child	DSH	BAPTIST HOSPITAL	BH Gastroenterology BMPN 101 - BH Gastroenterology BMPN 101	8880 Navarre Parkway	Navarre	FL	Active
DSH100093BN	Child	DSH	BAPTIST HOSPITAL	BH Radiation Onc GB Ciano - BH Radiation Onc GB Ciano	1114 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093BP	Child	DSH	BAPTIST HOSPITAL	BH Wellness BMT 533 - BH Wellness BMT 533	1717 North E Street	Pensacola	FL	Terminated
DSH100093BQ	Child	DSH	BAPTIST HOSPITAL	BH OBGYN BMPP - BH OBGYN BMPP	3874 Highway 90	Pace	FL	Active
DSH100093BR	Child	DSH	BAPTIST HOSPITAL	BH Hematology Onc BMPA 201 - BH Hematology Onc BMPA 201	5100 North 12th Avenue	Pensacola	FL	Terminated
DSH100093BS	Child	DSH	BAPTIST HOSPITAL	BH Primary Care BMPN 206 - BH Primary Care BMPN 206	8880 Navarre Parkway	Navarre	FL	Active
DSH100093BT	Child	DSH	BAPTIST HOSPITAL	BH Neurosurgery BMPN 101 - BH Neurosurgery BMPN 101	8880 Navarre Parkway	Navarre	FL	Terminated
DSH100093BU	Child	DSH	BAPTIST HOSPITAL	BH Gastroenterology BMP9 200 - BH Gastroenterology BMP9 200	9400 University Parkway	Pensacola	FL	Active
DSH100093BV	Child	DSH	BAPTIST HOSPITAL	BH Wellness Westside - BH Wellness Westside	6715 Highway 98 West	Pensacola	FL	Terminated
DSH100093BW	Child	DSH	BAPTIST HOSPITAL	BH Gastroenterology BMPP 202 - BH Gastroenterology BMPP 202	3874 Highway 90	Pace	FL	Active
DSH100093BX	Child	DSH	BAPTIST HOSPITAL	BH General Surgery BMP9 200 - BH General Surgery BMP9 200	9400 University Parkway	Pensacola	FL	Active
DSH100093BY	Child	DSH	BAPTIST HOSPITAL	BH Wellness GB 200 - BH Wellness GB 200	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Terminated
DSH100093BZ	Child	DSH	BAPTIST HOSPITAL	BH Family Medicine WIC BMPP101 - BH Family Medicine WIC BMPP101	3874 Highway 90	Pace	FL	Active
DSH100093C	Child	DSH	BAPTIST HOSPITAL	Baptist Medical Park - Cardiology	9400 University Parkway	Pensacola	FL	Active
DSH100093CA	Child	DSH	BAPTIST HOSPITAL	BH Primary Care BMPA 201 - BH Primary Care BMPA 201	5100 North 12th Avenue	Pensacola	FL	Active
DSH100093CB	Child	DSH	BAPTIST HOSPITAL	BH Primary Care GB	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093CC	Child	DSH	BAPTIST HOSPITAL	BH General Surgery HWC 5C	125 Baptist Way	Pensacola	FL	Active
DSH100093CD	Child	DSH	BAPTIST HOSPITAL	BH Urology BMPN 101 - BH Urology BMPN 101	8880 Navarre Parkway	Navarre	FL	Terminated
DSH100093CE	Child	DSH	BAPTIST HOSPITAL	BH Hematology Onc HWC 1C	125 Baptist Way	Pensacola	FL	Active
DSH100093CF	Child	DSH	BAPTIST HOSPITAL	BH General Surgery BMPP 202 - BH General Surgery BMPP 202	3874 Highway 90	Pace	FL	Terminated
DSH100093CG	Child	DSH	BAPTIST HOSPITAL	BH Family Medicine WIC BMPN - BH Family Medicine WIC BMPN	8880 Navarre Parkway, Suite 106	Navarre	FL	Active
DSH100093CH	Child	DSH	BAPTIST HOSPITAL	BH Primary Care Perdido - BH Primary Care Perdido	12601 Sorrento Road	Pensacola	FL	Active
DSH100093CJ	Child	DSH	BAPTIST HOSPITAL	BH Neurosurgery AI 205 - BH Neurosurgery AI 205	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093CK	Child	DSH	BAPTIST HOSPITAL	BH General Surgery BMPA 203 - BH General Surgery BMPA 203	5100 North 12th Avenue	Pensacola	FL	Terminated
DSH100093CL	Child	DSH	BAPTIST HOSPITAL	BH Urology BMPA 201 - BH Urology BMPA 201	5100 North 12th Avenue	Pensacola	FL	Terminated
DSH100093CM	Child	DSH	BAPTIST HOSPITAL	BH Wellness BMP9 200 - BH Wellness BMP9 200	9400 University Parkway	Pensacola	FL	Terminated
DSH100093CN	Child	DSH	BAPTIST HOSPITAL	BH Family Medicine Westside - BH Family Medicine Westside	6715 Highway 98 West	Pensacola	FL	Active
DSH100093CP	Child	DSH	BAPTIST HOSPITAL	BH Family Medicine BMPP 201 - BH Family Medicine BMPP 201	3874 Highway 90	Pace	FL	Active
DSH100093CQ	Child	DSH	BAPTIST HOSPITAL	BH Urology BMP9 408 - BH Urology BMP9 408	9400 University Parkway	Pensacola	FL	Active
DSH100093CR	Child	DSH	BAPTIST HOSPITAL	BH Primary Care GB B - BH Primary Care GB B	1200 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093CS	Child	DSH	BAPTIST HOSPITAL	BH Gastroenterology GB 101 - BH Gastroenterology GB 101	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093CT	Child	DSH	BAPTIST HOSPITAL	BH Neurosurgery HWC 4C	125 Baptist Way	Pensacola	FL	Active
DSH100093CU	Child	DSH	BAPTIST HOSPITAL	BH Hematology Onc GB Ciano - BH Hematology Onc GB Ciano	1114 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093CV	Child	DSH	BAPTIST HOSPITAL	BH Neurosurgery BMPA 201 - BH Neurosurgery BMPA 201	5100 North 12th Avenue	Pensacola	FL	Terminated
DSH100093CW	Child	DSH	BAPTIST HOSPITAL	Navarre FSED - Navarre FSED	8888 Navarre Pkwy	Pensacola	FL	Active
DSH100093CX	Child	DSH	BAPTIST HOSPITAL	BH Card Con Perdido - BH Card Con Perdido	12601 Sorrento Road	Pensacola	FL	Active
DSH100093CY	Child	DSH	BAPTIST HOSPITAL	BH ENT GB 100B - BH ENT GB 100B	1118 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093CZ	Child	DSH	BAPTIST HOSPITAL	Pharmacotherapy Clinic	125 Baptist Way	Pensacola	FL	Active
DSH100093D	Child	DSH	BAPTIST HOSPITAL	Baptist Medical Park - Radiology	9400 University Parkway	Pensacola	FL	Active
DSH100093DA	Child	DSH	BAPTIST HOSPITAL	BH Neurosurgery BMP9 200 - BH Neurosurgery BMP9 200	9400 University Parkway	Pensacola	FL	Active
DSH100093DB	Child	DSH	BAPTIST HOSPITAL	BH AI PMR GB 203 - BH AI PMR GB 203	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Terminated
DSH100093DC	Child	DSH	BAPTIST HOSPITAL	BH AI PMR BMPP 202 - BH AI PMR BMPP 202	3874 US-90	Pace	FL	Terminated
DSH100093DD	Child	DSH	BAPTIST HOSPITAL	BH Primary Care Pine Forest - BH Primary Care Pine Forest	2115 W 9 Mile Road	Pensacola	FL	Active
DSH100093DE	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho SM Westside - BH AI Ortho SM Westside	12601 Sorrento Road	Pensacola	FL	Terminated
DSH100093DF	Child	DSH	BAPTIST HOSPITAL	BH Card Con BMP9 306 - BH Card Con BMP9 306	9400 University Parkway	Pensacola	FL	Active
DSH100093DG	Child	DSH	BAPTIST HOSPITAL	BH Card Con BMPP 202 - BH Card Con BMPP 202	3874 Highway 90	Pace	FL	Active
DSH100093DH	Child	DSH	BAPTIST HOSPITAL	BH Radiology - Navarre - BH Radiology - Navarre	8888 Navarre Parkway	Navarre	FL	Active
DSH100093DJ	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho SM BMP9 200 - BH AI Ortho SM BMP9 200	9400 University Parkway	Pensacola	FL	Active
DSH100093DK	Child	DSH	BAPTIST HOSPITAL	BH Primary Care HWC - BH Primary Care HWC	125 Baptist Way	Pensacola	FL	Active
DSH100093DL	Child	DSH	BAPTIST HOSPITAL	9 Mile FSED - 9 Mile FSED	9400 University Parkway	Pensacola	FL	Active
DSH100093DM	Child	DSH	BAPTIST HOSPITAL	BH AIPMR AI 206 - BH AIPMR AI 206	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093DN	Child	DSH	BAPTIST HOSPITAL	Wound Care Center - Wound Care Center	121 Baptist Way	Pensacola	FL	Approved
DSH100093E	Child	DSH	BAPTIST HOSPITAL	Baptist Medical Park - Women Services - Womens Services	9400 University Parkway	Pensacola	FL	Active
DSH100093F	Child	DSH	BAPTIST HOSPITAL	Baptist Medical Park - Ultrasound - Ultrasound	9400 University Parkway	Pensacola	FL	Active
DSH100093G	Child	DSH	BAPTIST HOSPITAL	Baptist Medical Park - CT - CT	9400 University Parkway	Pensacola	FL	Active
DSH100093H	Child	DSH	BAPTIST HOSPITAL	Baptist Medical Park - Nuclear Medicine - Nuclear Medicine	9400 University Parkway	Pensacola	FL	Active
DSH100093J	Child	DSH	BAPTIST HOSPITAL	Baptist Medical Park - MRI - MRI	9400 University Parkway	Pensacola	FL	Active
DSH100093K	Child	DSH	BAPTIST HOSPITAL	BH AI Non-Surg SM AI 204 - BH AI Non-Surg SM AI 204	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Terminated
DSH100093L	Child	DSH	BAPTIST HOSPITAL	BH AI Non-Surg SM BMP9 101B - BH AI Non-Surg SM BMP9 101B	9400 University Parkway	Pensacola	FL	Terminated
DSH100093M	Child	DSH	BAPTIST HOSPITAL	BH AI Non-Surg SM BMPA 102 - BH AI Non-Surg SM BMPA 102	5100 North 12th Avenue	Pensacola	FL	Active
DSH100093N	Child	DSH	BAPTIST HOSPITAL	BH AI Non-Surg SM BMPN 201 - BH AI Non-Surg SM BMPN 201	8880 Navarre Parkway	Navarre	FL	Active
DSH100093P	Child	DSH	BAPTIST HOSPITAL	BH AI Non-Surg SM HWC	125 Baptist Way	Pensacola	FL	Terminated
DSH100093Q	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho SM AI 203 - BH AI Ortho SM AI 203	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093R	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho SM AI 204 - BH AI Ortho SM AI 204	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093S	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho SM AI 206 - BH AI Ortho SM AI 206	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093T	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho SM AI 208 - BH AI Ortho SM AI 208	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093U	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho SM BMP9 101B - BH AI Ortho SM BMP9 101B	9400 University Parkway	Pensacola	FL	Active
DSH100093V	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho SM BMPA 102 - BH AI Ortho SM BMPA 102	5100 North 12th Avenue	Pensacola	FL	Active
DSH100093W	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho Trauma AI 205 - BH AI Ortho Trauma AI 205	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093X	Child	DSH	BAPTIST HOSPITAL	BH AI Ortho Trauma HWC 4A	125 Baptist Way	Pensacola	FL	Active
DSH100093Y	Child	DSH	BAPTIST HOSPITAL	BH AI PMR AI 210 - BH AI PMR AI 210	1040 Gulf Breeze Parkway	Gulf Breeze	FL	Active
DSH100093Z	Child	DSH	BAPTIST HOSPITAL	BH AI PMR BMP9 101B - BH AI PMR BMP9 101B	9400 University Parkway	Pensacola	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Terry, Andrew L. Vice President Revenue Management Baptist Health Care 8504697643	Cadena, Valerie Cyd Senior Vice President - Operations Baptist Health Care 4482278053	4/14/2025 11:17 AM
Contacts	Primary Contact	Update	Profile Change Request	Seelmann, Frederick Director of Pharmacy BHC 8504697567	Seelmann, Frederick Executive Director of Pharmacy BHC 8504697567	2/20/2025 12:19 PM
Details	Last Recertification Date	Update	Recertification	8/17/2023 1:47:15 PM	8/28/2024 11:13:47 AM	8/28/2024 11:13 AM
Addresses	Main Address	Update	Change Request	1000 WEST MORENO STREET PENSACOLA, FL 32501	123 Baptist Way PENSACOLA, FL 32503	9/27/2023 3:49 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 6:24:13 AM	8/17/2023 1:47:15 PM	8/17/2023 1:47 PM
Details	Last Recertification Date	Update	Recertification	9/9/2021 5:58:00 PM	9/14/2022 6:24:13 AM	9/14/2022 6:24 AM
Details	Last Recertification Date	Update	Recertification	9/11/2020 10:43:56 AM	9/9/2021 5:58:00 PM	9/9/2021 5:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1665931	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AK	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		83838	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		121575105	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AR	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		23088842	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CO	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HOS0093P	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000150433AA	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		590657322-002	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		300013901	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IN	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		553842	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IA	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1291723	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		KY	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1733091	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		217105800	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HOS0093P	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MI	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		97779	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MS	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		250252	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NJ	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HOS0093P	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		142769	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		200060650B	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OK	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500773264	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100777553-0008	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		10172A-inpatient	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		10867B-outpatient	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100093	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		TN	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100093	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VT	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		WI	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1457448037	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1700979465	9/11/2020 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1700979465 ( )		9/11/2020 10:43 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1457448037 ( )		9/11/2020 10:43 AM
Details	Last Recertification Date	Update	Recertification	9/5/2019 8:29:12 AM	9/11/2020 10:43:56 AM	9/11/2020 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/13/2020 1:04 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		HOS0093P	1/13/2020 1:04 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	1/13/2020 1:04 PM
Details	Last Recertification Date	Update	Recertification	8/29/2018 4:16:51 PM	9/5/2019 8:29:12 AM	9/5/2019 8:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2018 10:28 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010074903	12/14/2018 10:28 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	12/14/2018 10:28 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1457448037	12/14/2018 10:28 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 8:18:15 PM	8/29/2018 4:16:51 PM	8/29/2018 4:16 PM
Details	Last Recertification Date	Update	Recertification	9/6/2016 12:00:00 AM	11/15/2017 8:18:15 PM	11/15/2017 8:18 PM
Contacts	Primary Contact	Update		Seelmann, Frederick Director of Pharmacy 8504697567	Seelmann, Frederick Director of Pharmacy BHC 8504697567	10/5/2017 2:50 PM
Contacts	Authorizing Official	Update		Terry, Andrew L. Vice President Revenue Management 8504697643	Terry, Andrew L. Vice President Revenue Management Baptist Health Care 8504697643	10/4/2017 9:14 AM
Contacts	Authorizing Official	Update		Nobles, Sharon CFO 8504692315	Terry, Andrew L. Vice President Revenue Management 8504697643	7/17/2017 4:42 PM
Addresses	Main Address	Insert			1000 WEST MORENO STREET PENSACOLA, FL 32501	3/8/2017 1:53 PM
Contacts	Primary Contact	Update		Cummings, Chris Pharmacy Director 8502086100-4	Seelmann, Frederick Director of Pharmacy 8504697567	3/8/2017 1:53 PM
Contacts	Authorizing Official	Insert			Nobles, Sharon CFO 8504692315	9/28/2016 3:32 PM
Medicaid Billing	NPI: Number	Insert			1700979465	9/6/2016 5:49 PM
Details	Last Recertification Date	Update		8/27/2015 12:00:00 AM	9/6/2016 12:00:00 AM	9/6/2016 5:49 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/27/2015 4:35 PM
Details	Last Recertification Date	Update		9/10/2014 12:00:00 AM	8/27/2015 12:00:00 AM	8/27/2015 4:35 PM
Details	Last Recertification Date	Update		9/13/2013 12:00:00 AM	9/10/2014 12:00:00 AM	9/10/2014 6:57 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/13/2013 12:00:00 AM	9/13/2013 11:12 AM
Contacts	Primary Contact	Insert			Cummings, Chris Pharmacy Director 8502086100-4	6/18/2012 11:32 AM
Details	State	Update		Terminated	Active	6/11/2012 4:14 PM
Terminations	Termination Date	Update		7/1/2012 12:00:00 AM		6/11/2012 4:14 PM
Terminations	Termination Reason	Update		DSH percentage below statutory minimum		6/11/2012 4:14 PM
Details	Comments Public	Insert			6/11/12 reinstated program due to clerical error during recertification, removed termination date as entity listed %SSI days and not allowable DSH%, appropriate documentation received to fix DSH% and allow program to remain in 340B database as eligible entitiy JH 4/1/09 REINSTATED PREV PART FROM 10/1/03 TO 3/31/04 NOT ELIGIBLE FROM 4/1/04 TO 3/31/09 340B ID CHANGE (WAS DSH32501); 2/25/09- DOC RECD TO CONFIRM ELIG DSH ADJ %.11/01/10 ADDED MEDICAID#	6/11/2012 4:14 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/25/2012 10:43 AM
Details	State	Update		Active	Terminated	5/25/2012 10:43 AM
Terminations	Termination Date	Update			7/1/2012 12:00:00 AM	5/25/2012 10:43 AM
Terminations	Termination Reason	Update			DSH percentage below statutory minimum	5/25/2012 10:43 AM
Details	Last Recertification Date	Insert				11/1/2010 1:04 PM
Details	Grant Number	Insert				11/1/2010 1:04 PM
Details	340B ID	Insert			DSH100093	11/1/2010 1:04 PM
Details	Is Authorizing Official EHB Data	Insert				11/1/2010 1:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert				11/1/2010 1:04 PM
Details	Medicare Provider Number	Insert			100093	11/1/2010 1:04 PM
Details	Entity Name	Insert			BAPTIST HOSPITAL	11/1/2010 1:04 PM
Details	Program Code	Insert			DSH	11/1/2010 1:04 PM
Details	Entity Subname	Insert				11/1/2010 1:04 PM
Dates	Participating Approval Date	Insert			3/9/2009 12:00:00 AM	11/1/2010 1:04 PM
Details	State	Insert			Active	11/1/2010 1:04 PM
Dates	Registration Date	Insert			3/9/2009 12:00:00 AM	11/1/2010 1:04 PM
Dates	Signed By Date	Insert			11/25/2008 12:00:00 AM	11/1/2010 1:04 PM
Dates	Start Date	Insert			4/1/2009 12:00:00 AM	11/1/2010 1:04 PM
Terminations	Termination Comments	Insert				11/1/2010 1:04 PM
Terminations	Termination Date	Insert				11/1/2010 1:04 PM
Terminations	Termination Effective Date	Insert				11/1/2010 1:04 PM
Terminations	Termination Reason	Insert				11/1/2010 1:04 PM
Details	Comments Public	Insert			4/1/09 REINSTATED PREV PART FROM 10/1/03 TO 3/31/04 NOT ELIGIBLE FROM 4/1/04 TO 3/31/09 340B ID CHANGE (WAS DSH32501); 2/25/09- DOC RECD TO CONFIRM ELIG DSH ADJ %.11/01/10 ADDED MEDICAID#	11/1/2010 1:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	3/9/2009 2:23 PM
Medicaid Billing	Medicaid: Number	Insert			010074900	3/9/2009 2:23 PM
Medicaid Billing	Medicaid: State	Insert			FL	3/9/2009 2:23 PM