| Details | Last Recertification Date | Update | Recertification | 1/31/2024 8:05:51 AM | 2/14/2025 10:21:28 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 | 1/31/2024 8:05 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 9:55:05 AM | 1/31/2024 8:05:51 AM | 1/31/2024 8:05 AM |
| 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 3:19:48 PM | 1/30/2023 9:55:05 AM | 1/30/2023 9:55 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 9:25:22 AM | 2/1/2022 3:19:48 PM | 2/1/2022 3:19 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/3/2021 9:25 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/3/2021 9:25 AM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2020 7:49:38 AM | 2/3/2021 9:25:22 AM | 2/3/2021 9:25 AM |
| Addresses | Shipping Address | Delete | Recertification | Brandon Community Health Center Pharmacy
313 S. Lakewood Drive
Brandon, FL 33511-4931 | | 1/29/2020 7:49 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 3:48:46 PM | 1/29/2020 7:49:38 AM | 1/29/2020 7:49 AM |
| 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 11:51 AM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2018 2:16:58 PM | 1/30/2019 3:48:46 PM | 1/30/2019 3:48 PM |
| Medicaid Billing | Medicaid: Number | Update | Recertification | 000165565 | 016556500 | 2/19/2018 2:16 PM |
| Details | Last Recertification Date | Update | Recertification | 2/10/2017 12:00:00 AM | 2/19/2018 2:16:58 PM | 2/19/2018 2:16 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 | Update | | Hunt, Jeff
Pharmacy Director
8133497959 | Hunt, Jeff
Pharmacy Director
8133497959 | 8/9/2017 11:03 AM |
| Contacts | Authorizing Official | Insert | | | Herremans, Bradley
CEO
8136536268 | 8/9/2017 11:03 AM |
| Addresses | Main Address | Insert | | |
313 S. Lakewood Drive
Brandon, FL 33511-4931 | 6/16/2017 1:59 PM |
| Addresses | Billing Address | Insert | | | Suncoast Community Health Centers, Inc.
P.O. Box 1349
Ruskin, FL 33575 | 6/16/2017 1:59 PM |
| Addresses | Shipping Address | Insert | | | Brandon Community Health Center Pharmacy
313 S. Lakewood Drive
Brandon, FL 33511-4931 | 6/16/2017 1:59 PM |
| Contacts | Signed By | Insert | | | Rodriguez, Robert
CFO
8133497563 | 6/16/2017 1:59 PM |
| Medicaid Billing | NPI: Number | Update | | 1295013852 | 1669830832 | 2/10/2017 11:25 AM |
| Contacts | Primary Contact | Update | | Rodriguez, Cynthia
Finance Assistant
8133497575 | Hunt, Jeff
Pharmacy Director
8133497959 | 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 | Insert | | | False | 5/26/2016 1:55 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 000165565 | 5/26/2016 1:55 PM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 5/26/2016 1:55 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1326410952 | 5/26/2016 1:55 PM |
| 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 |
| Details | Last Recertification Date | Update | | 3/21/2014 12:00:00 AM | 2/3/2015 12:00:00 AM | 2/3/2015 12:33 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 Name | Update | | Suncoast Community Health Centers, Inc. | SUNCOAST COMMUNITY HEALTH CENTERS, INC. | 3/21/2014 10:20 PM |
| Contacts | Primary Contact | Insert | | | Rodriguez, Cynthia
Finance Assistant
8133497575 | 1/9/2014 1:32 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/19/2013 10:48 AM |
| Dates | Participating Approval Date | Update | | | 11/10/2011 12:00:00 AM | 11/10/2011 3:51 PM |
| Details | State | Update | | Pending | Active | 11/10/2011 3:51 PM |
| Dates | Start Date | Update | | | 1/1/2012 12:00:00 AM | 11/10/2011 3:51 PM |
| Details | Grant Number | Update | | | H80CS00541 | 11/10/2011 10:56 AM |
| Details | 340B ID | Update | | ONLINE_REG | CH04175G | 11/10/2011 10:56 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 11/7/2011 10:31 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 029557409 | 11/7/2011 10:31 AM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 11/7/2011 10:31 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1295013852 | 11/7/2011 10:31 AM |
| Details | Last Recertification Date | Insert | | | | 11/7/2011 10:31 AM |
| Details | Grant Number | Insert | | | | 11/7/2011 10:31 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 11/7/2011 10:31 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 11/7/2011 10:31 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 11/7/2011 10:31 AM |
| Details | Medicare Provider Number | Insert | | | | 11/7/2011 10:31 AM |
| Details | Entity Name | Insert | | | Suncoast Community Health Centers, Inc. | 11/7/2011 10:31 AM |
| Details | Program Code | Insert | | | CH | 11/7/2011 10:31 AM |
| Details | Entity Subname | Insert | | | Brandon Community Health Center | 11/7/2011 10:31 AM |
| Dates | Participating Approval Date | Insert | | | | 11/7/2011 10:31 AM |
| Details | State | Insert | | | Pending | 11/7/2011 10:31 AM |
| Dates | Registration Date | Insert | | | 11/7/2011 12:00:00 AM | 11/7/2011 10:31 AM |
| Dates | Signed By Date | Insert | | | 11/7/2011 12:00:00 AM | 11/7/2011 10:31 AM |
| Dates | Start Date | Insert | | | | 11/7/2011 10:31 AM |
| Terminations | Termination Comments | Insert | | | | 11/7/2011 10:31 AM |
| Terminations | Termination Date | Insert | | | | 11/7/2011 10:31 AM |
| Terminations | Termination Effective Date | Insert | | | | 11/7/2011 10:31 AM |
| Terminations | Termination Reason | Insert | | | | 11/7/2011 10:31 AM |