| Details | Last Recertification Date | Update | Recertification | 2/9/2024 1:33:58 PM | 2/10/2025 5:07:57 PM | 2/10/2025 5:07 PM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2023 8:55:18 AM | 2/9/2024 1:33:58 PM | 2/9/2024 1:33 PM |
| Details | Entity Name | Update | Group Change Request | COMMUNITY HEALTH CENTERS, INC. | Community Health Centers, Inc. | 2/24/2023 1:38 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Marsh, Darren
Director of Pharmacy
Community Health Centers, Inc.
4079058827-1111 | Marsh, Darren
340B Compliance Administrator
Community Health Centers, Inc.
4079058827-1111 | 2/23/2023 7:06 PM |
| Details | Last Recertification Date | Update | Recertification | 2/15/2022 4:52:19 PM | 2/16/2023 8:55:18 AM | 2/16/2023 8:55 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2021 10:39:47 AM | 2/15/2022 4:52:19 PM | 2/15/2022 4:52 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/1/2021 10:23 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 112205000 | 12/1/2021 10:23 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | FL | 12/1/2021 10:23 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1962082834 | 7/17/2021 7:32 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | FL | 7/17/2021 7:32 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/8/2021 10:39 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2020 10:12:08 AM | 2/8/2021 10:39:47 AM | 2/8/2021 10:39 AM |
| Contacts | Primary Contact | Update | Profile Change Request | MARSH, DARREN
DIRECTOR OF PHARMACY
Community Health Centers, Inc.
4079058827-1111 | Marsh, Darren
Director of Pharmacy
Community Health Centers, Inc.
4079058827-1111 | 2/8/2020 7:36 AM |
| Contacts | Primary Contact | Update | Profile Change Request | MARSH, DARREN
DIRECTOR OF PHARMACY
Community Health Centers, Inc.
4076145304 | MARSH, DARREN
DIRECTOR OF PHARMACY
Community Health Centers, Inc.
4079058827-1111 | 2/8/2020 7:35 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2019 7:47:21 AM | 2/7/2020 10:12:08 AM | 2/7/2020 10:12 AM |
| Contacts | Authorizing Official | Update | AO Change Request | BRENNAN, MARGARET
PRESIDENT/CEO
COMMUNITY HEALTH CENTERS, INC.
4079058827-1060 | Andree, Debra Sue
President / Chief Executive Officer
Community Health Centers, Inc.
4079058827-1212 | 2/3/2020 7:14 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2018 1:52:07 PM | 1/31/2019 7:47:21 AM | 1/31/2019 7:47 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2017 12:00:00 AM | 2/8/2018 1:52:07 PM | 2/8/2018 1:52 PM |
| Contacts | Authorizing Official | Update | | BRENNAN, MARGARET
PRESIDENT/CEO
4079058827-1060 | BRENNAN, MARGARET
PRESIDENT/CEO
COMMUNITY HEALTH CENTERS, INC.
4079058827-1060 | 9/29/2017 9:23 AM |
| Contacts | Primary Contact | Update | | MARSH, DARREN
DIRECTOR OF PHARMACY
4076145304 | MARSH, DARREN
DIRECTOR OF PHARMACY
Community Health Centers, Inc.
4076145304 | 9/19/2017 6:08 AM |
| Contacts | Authorizing Official | Update | | Dickinson, Mark
Interim CEO
4079058827 | BRENNAN, MARGARET
PRESIDENT/CEO
4079058827-1060 | 8/9/2017 7:53 PM |
| Contacts | Primary Contact | Insert | | | MARSH, DARREN
DIRECTOR OF PHARMACY
4076145304 | 8/9/2017 7:53 PM |
| Addresses | Main Address | Insert | | |
19108 E. Colonial Dr
Orlando, FL 32820 | 2/2/2017 11:59 AM |
| Contacts | Signed By | Insert | | | Snell, Barbara
President/CEO
4079058827-1060 | 2/2/2017 11:59 AM |
| Details | Last Recertification Date | Update | | 2/15/2016 12:00:00 AM | 2/2/2017 12:00:00 AM | 2/2/2017 11:59 AM |
| Details | Last Recertification Date | Update | | 2/12/2015 12:00:00 AM | 2/15/2016 12:00:00 AM | 2/15/2016 11:01 AM |
| Addresses | Billing Address | Insert | | | Community Health Centers, Inc.
110 S. Woodland St
Winter Garden, FL 34787-3546 | 2/19/2015 9:48 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1033409123 | 2/19/2015 9:48 AM |
| Contacts | Authorizing Official | Insert | | | Dickinson, Mark
Interim CEO
4079058827 | 2/12/2015 11:04 AM |
| Details | Last Recertification Date | Update | | 3/21/2014 12:00:00 AM | 2/12/2015 12:00:00 AM | 2/12/2015 11:04 AM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/21/2014 12:00:00 AM | 3/21/2014 10:15 PM |
| Details | Entity Name | Update | | Community Health Centers, Inc. | COMMUNITY HEALTH CENTERS, INC. | 3/21/2014 10:15 PM |
| Details | Entity Subname | Update | | Community Health Center - Bithlo Family Care | COMMUNITY HEALTH CENTER - BITHLO FAMILY CARE | 3/21/2014 10:15 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/25/2013 8:31 AM |
| Details | 340B ID | Update | | IS-FF-CH04166M | CH04166M | 9/10/2012 6:05 PM |
| Dates | Participating Approval Date | Update | | | 9/10/2012 12:00:00 AM | 9/10/2012 6:05 PM |
| Details | State | Update | | Pending | Active | 9/10/2012 6:05 PM |
| Dates | Start Date | Update | | | 10/1/2012 12:00:00 AM | 9/10/2012 6:05 PM |
| Details | 340B ID | Update | | ONLINE_REG | IS-FF-CH04166M | 8/30/2012 11:10 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 8/8/2012 3:53 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 029545123 | 8/8/2012 3:53 PM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 8/8/2012 3:53 PM |
| Details | Last Recertification Date | Insert | | | | 8/8/2012 3:53 PM |
| Details | Grant Number | Insert | | | H80CS00809 | 8/8/2012 3:53 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 8/8/2012 3:53 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/8/2012 3:53 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/8/2012 3:53 PM |
| Details | Medicare Provider Number | Insert | | | | 8/8/2012 3:53 PM |
| Details | Entity Name | Insert | | | Community Health Centers, Inc. | 8/8/2012 3:53 PM |
| Details | Program Code | Insert | | | CH | 8/8/2012 3:53 PM |
| Details | Entity Subname | Insert | | | Community Health Center - Bithlo Family Care | 8/8/2012 3:53 PM |
| Dates | Participating Approval Date | Insert | | | | 8/8/2012 3:53 PM |
| Details | State | Insert | | | Pending | 8/8/2012 3:53 PM |
| Dates | Registration Date | Insert | | | 8/8/2012 12:00:00 AM | 8/8/2012 3:53 PM |
| Dates | Signed By Date | Insert | | | 8/8/2012 12:00:00 AM | 8/8/2012 3:53 PM |
| Dates | Start Date | Insert | | | | 8/8/2012 3:53 PM |
| Terminations | Termination Comments | Insert | | | | 8/8/2012 3:53 PM |
| Terminations | Termination Date | Insert | | | | 8/8/2012 3:53 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/8/2012 3:53 PM |
| Terminations | Termination Reason | Insert | | | | 8/8/2012 3:53 PM |