340B Drug Pricing Program Database


CH04271F TRENTON MEDICAL CENTER (Active) - information as of 4/29/2025 1:38:04 AM

Main Details
TRENTON MEDICAL CENTER
Palms Medical Group - Branford
HRSA-Funded Health Center
BPS-H80-007812
CH04271F
H80CS00691


Additional Details
Active
11/12/2009
1/1/2010
12/3/2009
2/14/2025

Contacts

Trenton Medical Center, Inc.
Anita Rembert, CEO
(352) 463-4501

Trenton Medical Center Inc.
Charles Turley, Pharmacy Director
(352) 463-4511 Ext: 1000

Addresses

103 US Hwy 27 SW
Branford, FL 32008-3048

TRENTON MEDICAL CENTER, INC.
23476 NW 186th Ave
TRENTON, FL 32643-3239


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
11/23/10 UPDATED SUB-DIV NAME (WAS DBA BRANFORD HEALTH AND WELLNESS)11/23/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
FL029506007,0158914001508048596,1942676168
Shipping Addresses

Palms Pharmacy of Branford
103 US Hwy 27 SW
Branford, FL 32008
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282401/16/202404/01/2024  04/01/2024
Contract DetailWAL-MART PHARMACY 10-07672767 WEST US HIGHWAY 90
LAKE CITYFL3205501/16/202404/01/2024  04/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH042710ActiveBPS-H80-007810TRENTON MEDICAL CENTERPalms Medical Group - Trenton911 South Main street TrentonFL
CH04271BActiveBPS-H80-004965TRENTON MEDICAL CENTERPalms Medical Group - Bell1830 N Main St BellFL
CH04271CActiveBPS-H80-012666TRENTON MEDICAL CENTERPalms Medical Group - Chiefland410 N Main St STE 1 & 2 ChieflandFL
CH04271DActiveBPS-H80-008563TRENTON MEDICAL CENTERPalms Medical Group - Williston630 N Main St WillistonFL
CH04271EActiveBPS-H80-032577TRENTON MEDICAL CENTERPalms Medical Group - Gainesville200 SW 62nd Blvd GainesvilleFL
CH04271FActiveBPS-H80-007812TRENTON MEDICAL CENTERPalms Medical Group - Branford103 US Hwy 27 SW BranfordFL
CH04271GActiveBPS-H80-009999TRENTON MEDICAL CENTERPalms Medical Group - Starke550 Georgia St StarkeFL
CH04271HActiveBPS-H80-035558TRENTON MEDICAL CENTERPalms Medical Group - High Springs16916 NW US Highway 441 High SpringsFL
CH04271JActiveBPS-H80-018273TRENTON MEDICAL CENTERPalms Medical Group - Live Oak211 Ranchera ST NW LIVE OAKFL
CH04271KTerminatedBPS-H80-013781TRENTON MEDICAL CENTERPalms Dentistry - Lake City171 NW ALBRITTON LN LAKE CITYFL
CH04271LActiveBPS-H80-004578TRENTON MEDICAL CENTER INCPalms Pediatrics - Trenton911 S. Main St TRENTONFL
CH04271MTerminatedBPS-H80-007812TRENTON MEDICAL CENTER INCPalms Medical Group - Branford103 SW US 27 BranfordFL
CH04271NTerminatedBPS-H80-015173TRENTON MEDICAL CENTER INCPalms Medical Group - Orange Park2021 PROFESSIONAL CENTER DR ORANGE PARKFL
CH04271PActiveBPS-H80-030094TRENTON MEDICAL CENTER INCPalms Medical Group - Lake City West4784 W US Highway 90 Lake CityFL
CH04271QActiveBPS-H80-035535TRENTON MEDICAL CENTERPalms Medical Group - Live Oak SCSB300 Pinewood Dr. Live OakFL
CH04271RActiveBPS-H80-035767TRENTON MEDICAL CENTERPalms Medical Group - Orange Park2233 Park Ave. Suite 403 & 405 Orange ParkFL
CH04271SActiveBPS-H80-036827TRENTON MEDICAL CENTERPalms Medical Group - Fleming Island2349 Village Square Pkwy STE 110-111 Fleming IslandFL
CH048970ActiveBPS-H80-013780TRENTON MEDICAL CENTERPalms Medical Group - Lake City173 NW Albritton Ln Lake CityFL
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH042710ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/01/2025  
CH042710ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/01/2025  
CH042710ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/01/2025  
CH042710ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/01/2025  
CH042710ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/01/2025  
CH042710ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349201/01/2025  
CH042710CENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282401/01/2024  
CH042710CENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506901/01/2024  
CH04271QCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271SCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271KCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024 04/01/2025
CH04271BCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271ECENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271GCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271FCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271DCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271PCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271JCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271LCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH048970CENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271CCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271HCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH04271RCENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2024  
CH042710CHEEK & SCOTT DRUGS1520 OHIO AVE S
LIVE OAKFL32064-451401/01/2016 11/07/2017
CH042710CHEEK & SCOTT DRUGS1520 OHIO AVE S
LIVE OAKFL32064-451410/01/2023  
CH04271QCHEEK & SCOTT DRUGS1520 OHIO AVE S
LIVE OAKFL32064-451404/01/2024  
CH042710CHEEK AND SCOTT DRUGS INCCHEEK & SCOTT PHARMACY 4785 W US HIGHWAY 90
LAKE CITYFL3205501/01/2016 11/07/2017
CH042710CHEEK AND SCOTT DRUGS INCCHEEK & SCOTT PHARMACY 4785 W US HIGHWAY 90
LAKE CITYFL3205510/01/2023  
CH04271KCHEEK AND SCOTT DRUGS INCCHEEK & SCOTT PHARMACY 4785 W US HIGHWAY 90
LAKE CITYFL3205504/01/2024 04/01/2025
CH042710CHEEK AND SCOTT DRUGS INC.1150 US HIGHWAY 41 NW STE 13
JASPERFL32052-588910/01/2023  
CH042710CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2022  
CH042710ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/01/2025  
CH042710EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/01/2025  
CH042710EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/01/2025  
CH042710EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/01/2025  
CH042710NORTH FLORIDA PHARMACY3718 W US HIGHWAY 90
LAKE CITYFL32055-489707/01/2020  
CH042710NORTH FLORIDA PHARMACY 0F FORT WHITE INC7729 SW US HIGHWAY 27
FORT WHITEFL32038-350807/01/2014  
CH04271BNORTH FLORIDA PHARMACY 0F FORT WHITE INC7729 SW US HIGHWAY 27
FORT WHITEFL32038-350804/01/2024  
CH042710NORTH FLORIDA PHARMACY OFNORTH FLORIDA PHARMACY CHIEFLAND INC
1100 N YOUNG BLVD 		CHIEFLANDFL3262607/01/2014  
CH042710NORTH FLORIDA PHARMACY OF BRANFORD305 US HIGHWAY 27 SW
BRANFORDFL3200810/01/2018  
CH042710NORTH FLORIDA PHARMACY, INCNORTH FLORIDA PHARMACY 347 SW MAIN BLVD STE 102
LAKE CITYFL32025-526207/01/2014  
CH048970NORTH FLORIDA PHARMACY, INCNORTH FLORIDA PHARMACY 347 SW MAIN BLVD STE 102
LAKE CITYFL32025-526207/01/2005  
CH042710OLD TOWN PHARMACY INCNORTH FLORIDA PHARMACY 26064 SE HIGHWAY 19
OLD TOWNFL3268007/01/2020  
CH042710PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #3213 1950 SAND LAKE RD, BLDG #5
ORLANDOFL3280907/01/2022  
CH042710PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #1192 255 N. W. COMMONS LOOP
LAKE CITYFL3205507/01/2022  
CH042710PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #1505 16193 NW US HWY 441
ALACHUAFL3261507/01/2022  
CH042710PUBLIX SUPER MARKETS, INC.PUBLIX CENTRAL PHARMACY #3201 2424 ORLANDO CENTRAL PARKWAY
ORLANDOFL3280907/01/2022  
CH042710PUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #1709 2215 OHIO AVE N
LIVE OAKFL3206410/01/2023  
CH042710SHAMBHU INC.19214 NW US HIGHWAY 441 SUITE 10
HIGH SPRINGSFL32643-878301/01/2016 04/30/2019
CH042710SOUTHCARE PHARMACY, INC.D/B/A BEST DRUGS OF TRENTON 405 SE 1ST AVE
TRENTONFL3269310/01/2020 06/21/2024
CH042710WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2018  
CH042710WAL-MART PHARMACY #10-58202570 COUNTY ROAD 220
MIDDLEBURGFL3206807/01/2017  
CH042710WAL-MART PHARMACY 10-07672767 WEST US HIGHWAY 90
LAKE CITYFL3205507/01/2017  
CH04271FWAL-MART PHARMACY 10-07672767 WEST US HIGHWAY 90
LAKE CITYFL3205504/01/2024  
CH042710WAL-MART PHARMACY 10-128314500 US HWY SO. 301
STARKEFL3209107/01/2017  
CH042710WAL-MART PHARMACY 10-12972201 N. YOUNG BLVD
CHIEFLANDFL3262607/01/2017  
CH04271CWAL-MART PHARMACY 10-12972201 N. YOUNG BLVD
CHIEFLANDFL3262604/01/2024  
CH042710WAL-MART PHARMACY 10-26266868 US HWY 129
LIVE OAKFL3206007/01/2017  
CH042710WAL-MART PHARMACY 10-38771800 NE 12TH AVE
GAINESVILLEFL3264107/01/2017  
CH042710WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2018  
CH042710WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2018 07/12/2018
CH042710WALGREEN CODBA: WALGREENS #11306 8 NW MAIN ST
WILLISTONFL3269607/01/2014  
CH042710WALGREEN CODBA: WALGREENS #11245 14040 W NEWBERRY RD
NEWBERRYFL3266907/01/2015  
CH042710WALGREEN CODBA: WALGREENS #10792 5171 NW 43RD STREET
GAINESVILLEFL3260607/01/2019  
CH04271DWALGREEN CODBA: WALGREENS #11306 8 NW MAIN ST
WILLISTONFL3269604/01/2024  
CH04271LWALGREEN CODBA: WALGREENS #11245 14040 W NEWBERRY RD
NEWBERRYFL3266904/01/2024  
CH042710WALGREEN CO.DBA: WALGREENS # 04272 1120 E. UNIVERSITY AVE.
GAINESVILLEFL3264107/01/2014  
CH042710WALGREEN CO.DBA: WALGREENS # 05994 7520 W NEWBERRY ROAD
GAINESVILLEFL3260607/01/2014  
CH042710WALGREEN CO.DBA: WALGREENS # 06263 2094 W US HIGHWAY 90
LAKE CITYFL32055-772207/01/2014  
CH042710WALGREEN CO.DBA: WALGREENS # 09231 205 WEST MADISON STREET
STARKEFL32091-392107/01/2014  
CH042710WALGREEN CO.DBA: WALGREENS # 09787 2227 N YOUNG BLVD
CHIEFLANDFL3262607/01/2014  
CH042710WALGREEN CO.DBA: WALGREENS #11244 15155 NW US HIGHWAY 441
ALACHUAFL32615-860307/01/2015  
CH042710WALGREEN CO.DBA: WALGREENS # 09724 1515 OHIO AVE S
LIVE OAKFL32064-451307/01/2015  
CH042710WALGREEN CO.DBA: WALGREENS # 04037 1615 NW 13TH ST.
GAINESVILLEFL3260907/01/2017  
CH042710WALGREEN CO.DBA: WALGREENS # 05024 2415 SW 75TH ST
GAINESVILLEFL3260807/01/2017  
CH042710WALGREEN CO.DBA: WALGREENS # 09304 3455 SW ARCHER RD
GAINESVILLEFL32608-240807/01/2017  
CH042710WALGREEN CO.DBA: WALGREENS #12316 3909 NW 13TH ST
GAINESVILLEFL3260907/01/2017  
CH042710WALGREEN CO.DBA: WALGREENS # 06928 609 KINGSLEY AVENUE
ORANGE PARKFL3207307/01/2018  
CH042710WALGREEN CO.DBA: WALGREENS # 05297 42 BLANDING BLVD
ORANGE PARKFL3207301/01/2019  
CH042710WALGREEN CO.DBA: WALGREENS # 04736 7546 103RD STREET
JACKSONVILLEFL3221004/01/2019  
CH042710WALGREEN CO.DBA: WALGREENS # 09025 5990 TOWNSEND RD
JACKSONVILLEFL3224404/01/2019  
CH042710WALGREEN CO.DBA: WALGREENS # 09617 9125 NW 39TH AVE
GAINESVILLEFL3260604/01/2019  
CH042710WALGREEN CO.DBA: WALGREENS # 04081 630 BLANDING BLVD.
ORANGE PARKFL3207304/01/2019  
CH042710WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21200 1120 E UNIVERSITY AVE STE 200
GAINESVILLEFL3264107/01/2019  
CH042710WALGREEN CO.DBA: WALGREENS # 07979 9700 ARGYLE FOREST BLVD
JACKSONVILLEFL3222207/01/2019  
CH042710WALGREEN CO.DBA: WALGREENS # 06385 1565 COUNTY ROAD 220
ORANGE PARKFL3200304/01/2020  
CH042710WALGREEN CO.DBA: WALGREENS # 04440 1320 BLANDING BLVD.
ORANGE PARKFL3206507/01/2020  
CH042710WALGREEN CO.DBA: WALGREENS # 09421 115 N LAWRENCE BLVD
KEYSTONE HGTSFL32656-935110/01/2021  
CH042710WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16527 1801 N MAIN ST
JACKSONVILLEFL3220601/01/2023  
CH042710WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16550 836 PRUDENTIAL DR STE 120
JACKSONVILLEFL3220701/01/2023  
CH042710WALGREEN CO.DBA: WALGREENS # 03172 7512 LEM TURNER ROAD
JACKSONVILLEFL3220801/01/2024  
CH04271SWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21200 1120 E UNIVERSITY AVE STE 200
GAINESVILLEFL3264104/01/2024  
CH04271RWALGREEN CO.DBA: WALGREENS # 05297 42 BLANDING BLVD
ORANGE PARKFL3207304/01/2024  
CH04271HWALGREEN CO.DBA: WALGREENS #11244 15155 NW US HIGHWAY 441
ALACHUAFL32615-860304/01/2024  
CH04271JWALGREEN CO.DBA: WALGREENS # 09724 1515 OHIO AVE S
LIVE OAKFL32064-451304/01/2024  
CH04271GWALGREEN CO.DBA: WALGREENS # 09231 205 WEST MADISON STREET
STARKEFL32091-392104/01/2024  
CH04271EWALGREEN CO.DBA: WALGREENS # 05024 2415 SW 75TH ST
GAINESVILLEFL3260804/01/2024  
CH04271PWALGREEN CO.DBA: WALGREENS # 06263 2094 W US HIGHWAY 90
LAKE CITYFL32055-772204/01/2024  
CH042710Walgreens #21395Walgreens Central Fill #21395 5710 Young Pine Rd
OrlandoFL3282901/01/2023  
CH042710WALGREENS CODBA: WALGREENS #10469 103 S ORANGE AVE
GREEN COVE SPRINGSFL3204307/01/2020  
CH042710WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904907/01/2014 02/18/2016
CH042710WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2022  
CH042710WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2022  
CH042710WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2022  
CH042710WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275607/01/2023  
CH042710WALMART PHARMACY 10-69787075 COLLINS ROAD
JACKSONVILLEFL3224407/01/2017  
CH042710WINN DIXIE PHARMACY #220615912 E STATE RD #40
SILVER SPRINGSFL3448807/01/2020 12/01/2023
CH042710WINN DIXIE STORE #1682202 N. YOUNG BLVD, SUITE 300
CHIEFLANDFL3262607/01/2014 12/01/2023
CH042710WINN DIXIE STORE #171727 W NOBLE AVENUE
WILLISTONFL3269607/01/2014 12/01/2023
CH042710WINN DIXIE STORE #1768560 ARGYLE FOREST BLVD
JACKSONVILLEFL3224407/01/2020 12/01/2023
CH042710WINN DIXIE STORE #3020303 N US HWY 441
HIGH SPRINGSFL3264307/01/2020 12/01/2023
CH042710WINN-DIXIE PHARMACY #81580 SOUTH MARION AVE
LAKE CITYFL3202510/01/2016 12/01/2023
CH042710WINN-DIXIE PHARMACY 85470 W MADISON STREET
STARKEFL3209110/01/2016 12/01/2023
CH042710WINN-DIXIE STORES, INCWINN-DIXIE # 197 300 S.W. 16TH AVENUE
GAINESVILLEFL3260107/01/2020 12/01/2023
CH042710WINN-DIXIE STORES, INC.WINN-DIXIE PHARAMCY #198 911 PINEWOOD DRIVE SW
LIVE OAKFL3206410/01/2016 12/01/2023
CH042710WINN-DIXIE STORES, INC.PATHSTONE HEALTH SERVICES 5244 EDGEWOOD COURT, SUITE 2
JACKSONVILLEFL3225407/01/2020 12/01/2023
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesBilling AddressUpdateChange RequestTRENTON MEDICAL CENTER, INC. 23343 NW County Road 236 TRENTON, FL 32643-3239TRENTON MEDICAL CENTER, INC. 23476 NW 186th Ave TRENTON, FL 32643-32392/17/2025 12:49 PM
DetailsLast Recertification DateUpdateRecertification1/29/2024 12:07:23 PM2/14/2025 4:46:25 PM2/14/2025 4:46 PM
DetailsLast Recertification DateUpdateRecertification1/30/2023 9:38:48 AM1/29/2024 12:07:23 PM1/29/2024 12:07 PM
AddressesMain AddressUpdateChange Request 103 US Hwy 27 S.W Branford, FL 32008-3048 103 US Hwy 27 SW Branford, FL 32008-30489/28/2023 3:44 PM
DetailsEntity SubnameUpdateChange RequestPalms Medical GroupPalms Medical Group - Branford9/28/2023 3:44 PM
DetailsLast Recertification DateUpdateRecertification1/31/2022 10:10:51 AM1/30/2023 9:38:48 AM1/30/2023 9:38 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestRiels, Anita CEO Trenton Medical Center, Inc. 3524634501Rembert, Anita CEO Trenton Medical Center, Inc. 35246345012/1/2022 8:03 AM
DetailsLast Recertification DateUpdateRecertification2/5/2021 1:09:21 PM1/31/2022 10:10:51 AM1/31/2022 10:10 AM
Medicaid BillingNPI: StateUpdateRecertification FL2/5/2021 1:09 PM
Medicaid BillingNPI: StateUpdateRecertification FL2/5/2021 1:09 PM
DetailsLast Recertification DateUpdateRecertification1/28/2020 8:39:46 AM2/5/2021 1:09:21 PM2/5/2021 1:09 PM
DetailsLast Recertification DateUpdateRecertification1/29/2019 9:51:10 PM1/28/2020 8:39:46 AM1/28/2020 8:39 AM
DetailsLast Recertification DateUpdateRecertification2/9/2018 4:10:42 PM1/29/2019 9:51:10 PM1/29/2019 9:51 PM
AddressesMain AddressUpdateChange Request 109 SW Savannah Ave Branford, FL 32008-3048 103 US Hwy 27 S.W Branford, FL 32008-30481/4/2019 8:18 AM
DetailsLast Recertification DateUpdateRecertification1/27/2017 12:00:00 AM2/9/2018 4:10:42 PM2/9/2018 4:10 PM
ContactsAuthorizing OfficialUpdate Riels, Anita CEO 3524634501Riels, Anita CEO Trenton Medical Center, Inc. 352463450111/28/2017 3:36 PM
ContactsPrimary ContactUpdateProfile Change RequestTurley, Charles Pharmacy Director Trenton Medical Center Inc. 3524634511Turley, Charles Pharmacy Director Trenton Medical Center Inc. 3524634511-100011/17/2017 11:34 AM
ContactsPrimary ContactUpdateProfile Change RequestTurley, Charles Pharmacy Coordinator Trenton Medical Center Inc. 3524634511Turley, Charles Pharmacy Director Trenton Medical Center Inc. 352463451111/17/2017 11:34 AM
ContactsPrimary ContactUpdate Turley, Charles Pharmacy Coordinator 3524634511Turley, Charles Pharmacy Coordinator Trenton Medical Center Inc. 352463451111/17/2017 6:07 AM
ContactsAuthorizing OfficialUpdate YATES, DEWAYNE CEO 3524632374-100Riels, Anita CEO 35246345018/2/2017 1:46 PM
ContactsPrimary ContactUpdate Turley, Melissa Pharmacy Director 3524632374Turley, Charles Pharmacy Coordinator 35246345118/2/2017 1:46 PM
AddressesMain AddressInsert   109 SW Savannah Ave Branford, FL 32008-30482/1/2017 1:20 PM
AddressesBilling AddressInsert  TRENTON MEDICAL CENTER, INC. 23343 NW County Road 236 TRENTON, FL 32643-32392/1/2017 1:20 PM
DetailsLast Recertification DateUpdate 2/12/2016 12:00:00 AM1/27/2017 12:00:00 AM2/1/2017 1:19 PM
DetailsLast Recertification DateUpdate 3/4/2015 12:00:00 AM2/12/2016 12:00:00 AM2/12/2016 9:20 AM
AddressesShipping AddressInsert  Palms Pharmacy of Branford 103 US Hwy 27 SW Branford, FL 320081/7/2016 4:23 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/7/2016 4:23 PM
Medicaid BillingMedicaid: NumberInsert  0158914001/7/2016 4:23 PM
Medicaid BillingMedicaid: StateInsert  FL1/7/2016 4:23 PM
Medicaid BillingNPI: NumberInsert  194267616810/12/2015 8:51 AM
DetailsLast Recertification DateUpdate 3/20/2014 12:00:00 AM3/4/2015 12:00:00 AM3/4/2015 8:55 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/20/2014 12:00:00 AM3/20/2014 8:57 AM
DetailsEntity NameUpdate TRENTON MEDICAL CENTER, INC.TRENTON MEDICAL CENTER3/20/2014 8:57 AM
DetailsEntity SubnameUpdate PALMS MEDICAL GROUPPalms Medical Group3/20/2014 8:57 AM
ContactsPrimary ContactInsert  Turley, Melissa Pharmacy Director 35246323743/20/2013 4:44 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/20/2013 4:44 PM
DetailsEntity SubnameUpdate DBA PALMS MEDICAL GROUPPALMS MEDICAL GROUP3/20/2013 4:44 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/31/2013 6:54 AM
Medicaid BillingMedicaid: NumberInsert  0295060071/31/2013 6:54 AM
Medicaid BillingMedicaid: StateInsert  FL1/31/2013 6:54 AM
Medicaid BillingNPI: NumberInsert  15080485961/31/2013 6:54 AM
ContactsAuthorizing OfficialInsert  YATES, DEWAYNE CEO 3524632374-10011/23/2010 3:39 PM
DetailsLast Recertification DateInsert   11/23/2010 3:39 PM
DetailsGrant NumberInsert  H80CS0069111/23/2010 3:39 PM
Details340B IDInsert  CH04271F11/23/2010 3:39 PM
DetailsIs Authorizing Official EHB DataInsert   11/23/2010 3:39 PM
DatesLast Date That 340B Drugs PurchasedInsert   11/23/2010 3:39 PM
DetailsMedicare Provider NumberInsert   11/23/2010 3:39 PM
DetailsEntity NameInsert  TRENTON MEDICAL CENTER, INC.11/23/2010 3:39 PM
DetailsProgram CodeInsert  CH11/23/2010 3:39 PM
DetailsEntity SubnameInsert  DBA PALMS MEDICAL GROUP11/23/2010 3:39 PM
DatesParticipating Approval DateInsert  12/3/2009 12:00:00 AM11/23/2010 3:39 PM
DetailsStateInsert  Active11/23/2010 3:39 PM
DatesRegistration DateInsert  11/12/2009 12:00:00 AM11/23/2010 3:39 PM
DatesSigned By DateInsert  10/6/2009 12:00:00 AM11/23/2010 3:39 PM
DatesStart DateInsert  1/1/2010 12:00:00 AM11/23/2010 3:39 PM
TerminationsTermination CommentsInsert   11/23/2010 3:39 PM
TerminationsTermination DateInsert   11/23/2010 3:39 PM
TerminationsTermination Effective DateInsert   11/23/2010 3:39 PM
TerminationsTermination ReasonInsert   11/23/2010 3:39 PM
DetailsComments PublicInsert  11/23/10 UPDATED SUB-DIV NAME (WAS DBA BRANFORD HEALTH AND WELLNESS)11/23/2010 3:39 PM