Covered Entity Details

CH04175H SUNCOAST COMMUNITY HEALTH CENTERS, INC. (Terminated) - information as of 6/16/2025 1:06:21 AM

Main Details

Name

SUNCOAST COMMUNITY HEALTH CENTERS, INC.

Subdivision Name

SCHC PEDIATRICS

Type

HRSA-Funded Health Center

Site ID

BPS-H80-003082

340B ID

CH04175H

Grant Number

H80CS00541

Additional Details

Current Program Status

Terminated

Registration Date

11/18/2011

Participating Start Date

1/1/2012

Participating Approval Date

12/15/2011

Last Recertification Date

2/19/2018

Termination Date
Termination Reason

4/1/2019
Site closure

Contacts

Authorizing Official

Suncoast Community Health Centers, Inc.
Bradley Herremans, CEO
(813) 653-6268

Primary Contact

Suncoast Community Health Centers, Inc
Jeff Hunt, Pharmacy Director
(813) 349-7959

Addresses

Street Address

502 N Mobley St
Plant City, FL 33563-2904

Billing Address

Suncoast Community Health Centers, Inc.
P.O. Box 1349
Ruskin, FL 33575

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

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	029557403
		1053321554

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH041750	Active	BPS-H80-038395	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	820 15th ST SE	Ruskin	FL
CH04175B	Active	BPS-H80-008510	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Tom Lee Community Health Center	14254 Martin Luther King Blvd. (SR 574)	Dover	FL
CH04175D	Active	BPS-H80-027013	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	PLANT CITY FAMILY CARE	801 E BAKER ST	Plant City	FL
CH04175G	Active	BPS-H80-017445	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Brandon Community Health Center	313 S. Lakewood Drive	Brandon	FL
CH04175H	Terminated	BPS-H80-003082	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	SCHC PEDIATRICS	502 N Mobley St	Plant City	FL
CH04175J	Active	BPS-H80-011812	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Suncoast Mobile Medical Bus	14254 Martin Luther King Blvd. (SR 574)	Dover	FL
CH04175K	Terminated	BPS-H80-011894	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Oakfield Community Health Center	1463 Oakfield Dr	Brandon	FL
CH04175L	Active	BPS-H80-009993	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Suncoast Mobile Dental Bus I	313 S. Lakewood Dr.	Brandon	FL
CH04175M	Active	BPS-H80-012073	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	SCHC Women's Care of Lakeland	1729 Lakeland Hills Blvd	Lakeland	FL
CH04175N	Terminated	BPS-H80-012072	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Oakfield Community Dental Care	710 Oakfield Dr STE 105	Brandon	FL
CH04175P	Active	BPS-H80-034483	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Wimauma Community Health Center	16621 Lagoon Shore Blvd.	Wimauma	FL
CH04175Q	Active	BPS-H80-013638	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Palm River Community Health Center	7728 PALM RIVER RD	TAMPA	FL
CH04175R	Active	BPS-H80-019553	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Thonotosassa Community Health Center	9555 E. Fowler Ave.	Thonotosassa	FL
CH04175S	Active	BPS-H80-022005	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	Suncoast Mobile Dental Bus II	313 S Lakewood Dr.	Brandon	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00651	37943 EILAND BLVD	ZEPHYRHILLS	FL	33542	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05148	1904 W LUMSDEN RD	BRANDON	FL	33511	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03399	6105 US HWY 98 N	LAKELAND	FL	33809	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05110	105 S PEBBLE BEACH BLVD	SUN CITY CENTER	FL	33573	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00304	101 N. WABASH AVENUE	LAKELAND	FL	33815	07/01/2019	08/11/2023
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03638	10623 GIBSONTON DR	RIVERVIEW	FL	33578	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05201	403 N ALEXANDER ST	PLANT CITY	FL	33563	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07225	5905 US HWY. 301 S.	RIVERVIEW	FL	33578	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03660	2109 STATE RD 60 E	VALRICO	FL	33594	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02825	715 W. BRANDON BLVD.	BRANDON	FL	33511	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00404	2302 JIM REDMAN PKWY	PLANT CITY	FL	33563	07/01/2019	08/27/2024
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03520	6202 US HWY 41 N	APOLLO BEACH	FL	33572	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00579	110 BULLARD PKWY	TEMPLE TERRACE	FL	33617	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03257	704 W MARTIN LUTHER KING JR BLVD	SEFFNER	FL	33584	07/01/2019
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07937	8700 US HIGHWAY, 301 NORTH	PARRISH	FL	34219	01/01/2020	08/11/2023
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00613	9202 N FLORIDA AVE	TAMPA	FL	33612	01/01/2020	08/11/2023
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03650	625 W. DR. MARTIN LUTHER KING JR BLVD	TAMPA	FL	33603	10/01/2020	07/13/2020
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03204	5010 S FLORIDA AVE	LAKELAND	FL	33813	10/01/2020	07/13/2020
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03204	5010 S FLORIDA AVE	LAKELAND	FL	33813	01/01/2021
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03650	625 W. DR. MARTIN LUTHER KING JR BLVD	TAMPA	FL	33603	01/01/2021	08/11/2023
CH041750	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05237	909 E LUMSDEN RD	BRANDON	FL	33511	10/01/2022	08/27/2024
CH041750	SAMSON MERGER SUB, LLC	WINN DIXIE #2454	750 MARTIN LUTHER KING BLVD WEST	SEFFNER	FL	33584	04/01/2021	03/07/2023
CH041750	SAMSON MERGER SUB, LLC	WINN DIXIE #2435	205 W. ALEXANDER STREET	PLANT CITY	FL	33566	04/01/2021	03/07/2023
CH041750	SAMSON MERGER SUB, LLC	WINN DIXIE #2505	2535 STATE ROAD 60 E.	VALRICO	FL	33594	04/01/2021	03/07/2023
CH041750	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/12/2021	04/06/2023
CH041750	WAL-MART PHARMACY 10-0547	2602 JIM REDMAN PARKWAY		PLANT CITY	FL	33566	10/01/2016	01/31/2019
CH041750	WAL-MART PHARMACY 10-0547	2602 JIM REDMAN PARKWAY		PLANT CITY	FL	33566	01/01/2021	04/06/2023
CH041750	WAL-MART PHARMACY 10-1203	4928 STATE ROAD 674		WIMAUMA	FL	33598	01/01/2021	04/06/2023
CH041750	WAL-MART PHARMACY 10-2387	11110 CAUSEWAY BLVD		BRANDON	FL	33511	01/01/2021	04/06/2023
CH041750	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/12/2021	04/06/2023
CH041750	WALGREEN CO.	DBA: WALGREENS # 02887	1001 78TH ST SOUTH	TAMPA	FL	33619	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS # 04962	128 E. BRANDON BLVD.	BRANDON	FL	33511	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS # 06732	2102 W BAKER STREET	PLANT CITY	FL	33563-1643	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS # 07010	2110 EAST STATE RD 60	VALRICO	FL	33594-3701	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS # 07177	705 N PEBBLE BEACH BLVD	SUN CITY CENTER	FL	33573-5350	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS #09297	10427 BIG BEND RD	RIVERVIEW	FL	33578	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS # 03093	311 E. MEMORIAL BLVD	LAKELAND	FL	33801	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS # 04523	930 PROVIDENCE ROAD	BRANDON	FL	33511	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS # 09475	10624 GIBSONTON DRIVE	RIVERVIEW	FL	33578	10/01/2015
CH041750	WALGREEN CO.	DBA: WALGREENS # 06029	11115 E DR MLK JR BLVD	SEFFNER	FL	33584	07/01/2017
CH041750	WALGREEN CO.	DBA: WALGREENS # 01934	1802 JAMES L REDMAN PKWY	PLANT CITY	FL	33563	04/01/2018
CH041750	WALGREEN CO.	DBA: WALGREENS # 04573	9202 N. 56TH STREET	TEMPLE TERRACE	FL	33617	10/01/2022
CH041750	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	04/01/2023
CH041750	WALMART PHARMACY #10-5964	1720 E. HILLSBOROUGH AVE.		TAMPA	FL	33610	01/01/2021	04/06/2023
CH041750	WALMART PHARMACY #10-6968	10327 BIG BEND ROAD		RIVERVIEW	FL	33578	01/01/2021	04/06/2023
CH041750	WALMART PHARMACY 10-3463	1208 E BRANDON BLVD		BRANDON	FL	33511	01/01/2021	04/06/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		12/31/2018 12:00:00 AM	1/31/2019 8:22 AM
Details	State	Update	Recertification	Active	To Be Terminated	1/31/2019 8:22 AM
Terminations	Termination Comments	Update	Recertification		Closed this location and merged with a new facility down the road...	1/31/2019 8:22 AM
Terminations	Termination Date	Update	Recertification		4/1/2019 12:00:00 AM	1/31/2019 8:22 AM
Terminations	Termination Effective Date	Update	Recertification		1/7/2019 12:00:00 AM	1/31/2019 8:22 AM
Terminations	Termination Reason	Update	Recertification		Site closure	1/31/2019 8:22 AM
Details	Last Recertification Date	Update	Recertification	2/10/2017 12:00:00 AM	2/19/2018 2:24:19 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	Insert			Herremans, Bradley CEO 8136536268	8/9/2017 11:03 AM
Contacts	Signed By	Insert			Rodriguez, Robert CFO 8133497563	6/16/2017 1:59 PM
Addresses	Main Address	Insert			502 N Mobley St Plant City, FL 33563-2904	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
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 1347 Ruskin, FL 33575	7/13/2015 3:39 PM
Addresses	Billing Address	Update		Suncoast Community Health Centers, Inc. P.O. Box 1347 Ruskin, FL 33575	Suncoast Community Health Centers, Inc. P.O. Box 1349 Ruskin, FL 33575	7/13/2015 3:39 PM
Medicaid Billing	NPI: Number	Insert			1053321554	7/13/2015 3:39 PM
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 10:21 PM
Details	Entity Subname	Update		S.C.H.C. Pediatrics	SCHC PEDIATRICS	3/21/2014 10:21 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/19/2013 10:49 AM
Details	Entity Name	Update		Suncoast Community Health Centers, Inc.	SUNCOAST COMMUNITY HEALTH CENTERS, INC.	1/10/2013 6:50 AM
Dates	Participating Approval Date	Update			12/15/2011 12:00:00 AM	12/15/2011 2:20 PM
Details	State	Update		Pending	Active	12/15/2011 2:20 PM
Dates	Start Date	Update			1/1/2012 12:00:00 AM	12/15/2011 2:20 PM
Details	Grant Number	Update			H80CS00541	11/22/2011 10:23 AM
Details	340B ID	Update		ONLINE_REG	CH04175H	11/22/2011 10:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/18/2011 11:27 AM
Medicaid Billing	Medicaid: Number	Insert			029557403	11/18/2011 11:27 AM
Medicaid Billing	Medicaid: State	Insert			FL	11/18/2011 11:27 AM
Details	Last Recertification Date	Insert				11/18/2011 11:27 AM
Details	Grant Number	Insert				11/18/2011 11:27 AM
Details	340B ID	Insert			ONLINE_REG	11/18/2011 11:27 AM
Details	Is Authorizing Official EHB Data	Insert				11/18/2011 11:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert				11/18/2011 11:27 AM
Details	Medicare Provider Number	Insert				11/18/2011 11:27 AM
Details	Entity Name	Insert			Suncoast Community Health Centers, Inc.	11/18/2011 11:27 AM
Details	Program Code	Insert			CH	11/18/2011 11:27 AM
Details	Entity Subname	Insert			S.C.H.C. Pediatrics	11/18/2011 11:27 AM
Dates	Participating Approval Date	Insert				11/18/2011 11:27 AM
Details	State	Insert			Pending	11/18/2011 11:27 AM
Dates	Registration Date	Insert			11/18/2011 12:00:00 AM	11/18/2011 11:27 AM
Dates	Signed By Date	Insert			11/18/2011 12:00:00 AM	11/18/2011 11:27 AM
Dates	Start Date	Insert				11/18/2011 11:27 AM
Terminations	Termination Comments	Insert				11/18/2011 11:27 AM
Terminations	Termination Date	Insert				11/18/2011 11:27 AM
Terminations	Termination Effective Date	Insert				11/18/2011 11:27 AM
Terminations	Termination Reason	Insert				11/18/2011 11:27 AM

340B Drug Pricing Program Database