340B Drug Pricing Program Database


DSH100093C BAPTIST HOSPITAL (Active) - information as of 6/1/2025 4:04:21 AM

Main Details
BAPTIST HOSPITAL
Baptist Medical Park - Cardiology
Disproportionate Share Hospital
No
DSH100093C
100093


Additional Details
Active
4/9/2013
7/1/2013
6/10/2013
9/4/2024

Contacts

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

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

Addresses

9400 University Parkway
Suite 103
Pensacola, FL 32514

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
FL0100749001700979465
ALHOS0093P1700979465
AK16659311700979465
AZ838381700979465
AR1215751051700979465
CO230888421700979465
CTHOS0093P1700979465
GA000150433AA1700979465
IL590657322-0021700979465
IN3000139011700979465
IA5538421700979465
KY12917231700979465
LA17330911700979465
MD2171058001700979465
MIHOS0093P1700979465
MS977791700979465
NJ2502521700979465
NCHOS0093P1700979465
OH1427691700979465
OK200060650B1700979465
OR5007732641700979465
PA100777553-00081700979465
SC10172A-inpatient,10867B-outpatient1700979465
TN1000931700979465
VT1000931700979465
VA17009794651700979465
WI17009794651700979465
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH100093AAChildDSHBAPTIST HOSPITALBH AI PMR BMPA 102 - BH AI PMR BMPA 1025100 North 12th AvenuePensacolaFLActive
DSH100093ABChildDSHBAPTIST HOSPITALBH AI PMR HWC 4A125 Baptist WayPensacolaFLActive
DSH100093ACChildDSHBAPTIST HOSPITALBH AI PMR SM AI 208 - BH AI PMR SM AI 2081040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093ADChildDSHBAPTIST HOSPITALBH Card Con BMP9 103 - BH Card Con BMP9 1039400 University ParkwayPensacolaFLActive
DSH100093AEChildDSHBAPTIST HOSPITALBH Card Con BMPA 202 - BH Card Con BMPA 2025100 North 12th AvenuePensacolaFLActive
DSH100093AFChildDSHBAPTIST HOSPITALBH Card Con BMPN 101 - BH Card Con BMPN 1018880 Navarre ParkwayNavarreFLActive
DSH100093AGChildDSHBAPTIST HOSPITALBH Card Con HWC 3125 Baptist WayPensacolaFLActive
DSH100093AHChildDSHBAPTIST HOSPITALBH Card Con GB 102 - BH Card Con GB 1021118 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093AJChildDSHBAPTIST HOSPITALBH Card Con HRC HWC 3125 Baptist WayPensacolaFLTerminated
DSH100093AKChildDSHBAPTIST HOSPITALBH Card Con Milton 200 - BH Card Con Milton 2005907 Berryhill RoadMiltonFLActive
DSH100093ALChildDSHBAPTIST HOSPITALBH Convenient Care Southtowne - BH Convenient Care Southtowne190 East Intendencia StreetPensacolaFLActive
DSH100093AMChildDSHBAPTIST HOSPITALBH Endocrinology HWC 5B125 Baptist WayPensacolaFLActive
DSH100093ANChildDSHBAPTIST HOSPITALBH ENT BMP9 200 - BH ENT BMP9 2009400 University ParkwayPensacolaFLActive
DSH100093APChildDSHBAPTIST HOSPITALBH General Surgery Westside - BH General Surgery Westside6715 Highway 98 WestPensacolaFLActive
DSH100093AQChildDSHBAPTIST HOSPITALBH Neurosurgery Milton 200 - BH Neurosurgery Milton 2005907 Berryhill RoadMiltonFLActive
DSH100093ARChildDSHBAPTIST HOSPITALBH OBGYN HWC 5A125 Baptist WayPensacolaFLActive
DSH100093ASChildDSHBAPTIST HOSPITALBH Wellness BMPN 206 - BH Wellness BMPN 2068880 Navarre ParkwayNavarreFLTerminated
DSH100093ATChildDSHBAPTIST HOSPITALBH Radiation Onc HWC 1E125 Baptist WayPensacolaFLActive
DSH100093AUChildDSHBAPTIST HOSPITALBH General Surgery BMPN 101 - BH General Surgery BMPN 1018880 Navarre ParkwayNavarreFLActive
DSH100093AVChildDSHBAPTIST HOSPITALBH Gastroenterology HWC 4C125 Baptist WayPensacolaFLActive
DSH100093AWChildDSHBAPTIST HOSPITALBH Family Medicine GB 100 - BH Family Medicine GB 1001118 Gulf Breeze ParkwayGulf BreezeFLTerminated
DSH100093AXChildDSHBAPTIST HOSPITALBH Primary Care East Hill3417 North 12th AvenuePensacolaFLActive
DSH100093AYChildDSHBAPTIST HOSPITALBH General Surgery Pace-Hwy 90 - BH General Surgery Pace-Hwy 904498 US Highway 90PaceFLActive
DSH100093AZChildDSHBAPTIST HOSPITALBH Urology Milton 200 - BH Urology Milton 2005907 Berryhill RoadMiltonFLTerminated
DSH100093BChildDSHBAPTIST HOSPITALBaptist Hospital Outpatient Infusion at Ciano Cancer Center1114 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093BAChildDSHBAPTIST HOSPITALBH Family Medicine BMP9 409 - BH Family Medicine BMP9 4099400 University ParkwayPensacolaFLActive
DSH100093BBChildDSHBAPTIST HOSPITALBH General Surgery GB 203 - BH General Surgery GB 2031118 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093BCChildDSHBAPTIST HOSPITALBH Urology HWC 4B125 Baptist WayPensacolaFLActive
DSH100093BDChildDSHBAPTIST HOSPITALBH ENT HWC 5C125 Baptist WayPensacolaFLActive
DSH100093BEChildDSHBAPTIST HOSPITALBH Primary Care BMP9 210 - BH Primary Care BMP9 2109400 University ParkwayPensacolaFLActive
DSH100093BFChildDSHBAPTIST HOSPITALBH Hematology Onc BMP9 408 - BH Hematology Onc BMP9 4089400 University ParkwayPensacolaFLActive
DSH100093BGChildDSHBAPTIST HOSPITALBH Urology GB 200 - BH Urology GB 2001118 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093BHChildDSHBAPTIST HOSPITALBH Family Medicine Tiger Point - BH Family Medicine Tiger Point1337 Country Club RdGulf BreezeFLTerminated
DSH100093BJChildDSHBAPTIST HOSPITALBH Primary Care Live Oak - BH Primary Care Live Oak2896 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093BKChildDSHBAPTIST HOSPITALBH OBGYN GB 101 - BH OBGYN GB 1011118 Gulf Breeze ParkwayGulf BreezeFLTerminated
DSH100093BLChildDSHBAPTIST HOSPITALBH Rheumatology HWC 4A125 Baptist WayPensacolaFLActive
DSH100093BMChildDSHBAPTIST HOSPITALBH Gastroenterology BMPN 101 - BH Gastroenterology BMPN 1018880 Navarre ParkwayNavarreFLActive
DSH100093BNChildDSHBAPTIST HOSPITALBH Radiation Onc GB Ciano - BH Radiation Onc GB Ciano1114 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093BPChildDSHBAPTIST HOSPITALBH Wellness BMT 533 - BH Wellness BMT 5331717 North E StreetPensacolaFLTerminated
DSH100093BQChildDSHBAPTIST HOSPITALBH OBGYN BMPP - BH OBGYN BMPP3874 Highway 90PaceFLActive
DSH100093BRChildDSHBAPTIST HOSPITALBH Hematology Onc BMPA 201 - BH Hematology Onc BMPA 2015100 North 12th AvenuePensacolaFLTerminated
DSH100093BSChildDSHBAPTIST HOSPITALBH Primary Care BMPN 206 - BH Primary Care BMPN 2068880 Navarre ParkwayNavarreFLActive
DSH100093BTChildDSHBAPTIST HOSPITALBH Neurosurgery BMPN 101 - BH Neurosurgery BMPN 1018880 Navarre ParkwayNavarreFLTerminated
DSH100093BUChildDSHBAPTIST HOSPITALBH Gastroenterology BMP9 200 - BH Gastroenterology BMP9 2009400 University ParkwayPensacolaFLActive
DSH100093BVChildDSHBAPTIST HOSPITALBH Wellness Westside - BH Wellness Westside6715 Highway 98 WestPensacolaFLTerminated
DSH100093BWChildDSHBAPTIST HOSPITALBH Gastroenterology BMPP 202 - BH Gastroenterology BMPP 2023874 Highway 90PaceFLActive
DSH100093BXChildDSHBAPTIST HOSPITALBH General Surgery BMP9 200 - BH General Surgery BMP9 2009400 University ParkwayPensacolaFLActive
DSH100093BYChildDSHBAPTIST HOSPITALBH Wellness GB 200 - BH Wellness GB 2001118 Gulf Breeze ParkwayGulf BreezeFLTerminated
DSH100093BZChildDSHBAPTIST HOSPITALBH Family Medicine WIC BMPP101 - BH Family Medicine WIC BMPP1013874 Highway 90PaceFLActive
DSH100093CChildDSHBAPTIST HOSPITALBaptist Medical Park - Cardiology9400 University ParkwayPensacolaFLActive
DSH100093CAChildDSHBAPTIST HOSPITALBH Primary Care BMPA 201 - BH Primary Care BMPA 2015100 North 12th AvenuePensacolaFLActive
DSH100093CBChildDSHBAPTIST HOSPITALBH Primary Care GB1118 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093CCChildDSHBAPTIST HOSPITALBH General Surgery HWC 5C125 Baptist WayPensacolaFLActive
DSH100093CDChildDSHBAPTIST HOSPITALBH Urology BMPN 101 - BH Urology BMPN 1018880 Navarre ParkwayNavarreFLTerminated
DSH100093CEChildDSHBAPTIST HOSPITALBH Hematology Onc HWC 1C125 Baptist WayPensacolaFLActive
DSH100093CFChildDSHBAPTIST HOSPITALBH General Surgery BMPP 202 - BH General Surgery BMPP 2023874 Highway 90PaceFLTerminated
DSH100093CGChildDSHBAPTIST HOSPITALBH Family Medicine WIC BMPN - BH Family Medicine WIC BMPN8880 Navarre Parkway, Suite 106NavarreFLActive
DSH100093CHChildDSHBAPTIST HOSPITALBH Primary Care Perdido - BH Primary Care Perdido12601 Sorrento RoadPensacolaFLActive
DSH100093CJChildDSHBAPTIST HOSPITALBH Neurosurgery AI 205 - BH Neurosurgery AI 2051040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093CKChildDSHBAPTIST HOSPITALBH General Surgery BMPA 203 - BH General Surgery BMPA 2035100 North 12th AvenuePensacolaFLTerminated
DSH100093CLChildDSHBAPTIST HOSPITALBH Urology BMPA 201 - BH Urology BMPA 2015100 North 12th AvenuePensacolaFLTerminated
DSH100093CMChildDSHBAPTIST HOSPITALBH Wellness BMP9 200 - BH Wellness BMP9 2009400 University ParkwayPensacolaFLTerminated
DSH100093CNChildDSHBAPTIST HOSPITALBH Family Medicine Westside - BH Family Medicine Westside6715 Highway 98 WestPensacolaFLActive
DSH100093CPChildDSHBAPTIST HOSPITALBH Family Medicine BMPP 201 - BH Family Medicine BMPP 2013874 Highway 90PaceFLActive
DSH100093CQChildDSHBAPTIST HOSPITALBH Urology BMP9 408 - BH Urology BMP9 4089400 University ParkwayPensacolaFLActive
DSH100093CRChildDSHBAPTIST HOSPITALBH Primary Care GB B - BH Primary Care GB B1200 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093CSChildDSHBAPTIST HOSPITALBH Gastroenterology GB 101 - BH Gastroenterology GB 1011118 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093CTChildDSHBAPTIST HOSPITALBH Neurosurgery HWC 4C125 Baptist WayPensacolaFLActive
DSH100093CUChildDSHBAPTIST HOSPITALBH Hematology Onc GB Ciano - BH Hematology Onc GB Ciano1114 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093CVChildDSHBAPTIST HOSPITALBH Neurosurgery BMPA 201 - BH Neurosurgery BMPA 2015100 North 12th AvenuePensacolaFLTerminated
DSH100093CWChildDSHBAPTIST HOSPITALNavarre FSED - Navarre FSED8888 Navarre PkwyPensacolaFLActive
DSH100093CXChildDSHBAPTIST HOSPITALBH Card Con Perdido - BH Card Con Perdido12601 Sorrento RoadPensacolaFLActive
DSH100093CYChildDSHBAPTIST HOSPITALBH ENT GB 100B - BH ENT GB 100B1118 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093CZChildDSHBAPTIST HOSPITALPharmacotherapy Clinic125 Baptist WayPensacolaFLActive
DSH100093DChildDSHBAPTIST HOSPITALBaptist Medical Park - Radiology9400 University ParkwayPensacolaFLActive
DSH100093DAChildDSHBAPTIST HOSPITALBH Neurosurgery BMP9 200 - BH Neurosurgery BMP9 2009400 University ParkwayPensacolaFLActive
DSH100093DBChildDSHBAPTIST HOSPITALBH AI PMR GB 203 - BH AI PMR GB 2031040 Gulf Breeze ParkwayGulf BreezeFLTerminated
DSH100093DCChildDSHBAPTIST HOSPITALBH AI PMR BMPP 202 - BH AI PMR BMPP 2023874 US-90PaceFLTerminated
DSH100093DDChildDSHBAPTIST HOSPITALBH Primary Care Pine Forest - BH Primary Care Pine Forest2115 W 9 Mile RoadPensacolaFLActive
DSH100093DEChildDSHBAPTIST HOSPITALBH AI Ortho SM Westside - BH AI Ortho SM Westside12601 Sorrento RoadPensacolaFLTerminated
DSH100093DFChildDSHBAPTIST HOSPITALBH Card Con BMP9 306 - BH Card Con BMP9 3069400 University ParkwayPensacolaFLActive
DSH100093DGChildDSHBAPTIST HOSPITALBH Card Con BMPP 202 - BH Card Con BMPP 2023874 Highway 90PaceFLActive
DSH100093DHChildDSHBAPTIST HOSPITALBH Radiology - Navarre - BH Radiology - Navarre8888 Navarre ParkwayNavarreFLActive
DSH100093DJChildDSHBAPTIST HOSPITALBH AI Ortho SM BMP9 200 - BH AI Ortho SM BMP9 2009400 University ParkwayPensacolaFLActive
DSH100093DKChildDSHBAPTIST HOSPITALBH Primary Care HWC - BH Primary Care HWC125 Baptist WayPensacolaFLActive
DSH100093DLChildDSHBAPTIST HOSPITAL9 Mile FSED - 9 Mile FSED9400 University ParkwayPensacolaFLActive
DSH100093DMChildDSHBAPTIST HOSPITALBH AIPMR AI 206 - BH AIPMR AI 2061040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093DNChildDSHBAPTIST HOSPITALWound Care Center - Wound Care Center121 Baptist WayPensacolaFLApproved
DSH100093EChildDSHBAPTIST HOSPITALBaptist Medical Park - Women Services - Womens Services9400 University ParkwayPensacolaFLActive
DSH100093FChildDSHBAPTIST HOSPITALBaptist Medical Park - Ultrasound - Ultrasound9400 University ParkwayPensacolaFLActive
DSH100093GChildDSHBAPTIST HOSPITALBaptist Medical Park - CT - CT9400 University ParkwayPensacolaFLActive
DSH100093HChildDSHBAPTIST HOSPITALBaptist Medical Park - Nuclear Medicine - Nuclear Medicine9400 University ParkwayPensacolaFLActive
DSH100093JChildDSHBAPTIST HOSPITALBaptist Medical Park - MRI - MRI9400 University ParkwayPensacolaFLActive
DSH100093KChildDSHBAPTIST HOSPITALBH AI Non-Surg SM AI 204 - BH AI Non-Surg SM AI 2041040 Gulf Breeze ParkwayGulf BreezeFLTerminated
DSH100093LChildDSHBAPTIST HOSPITALBH AI Non-Surg SM BMP9 101B - BH AI Non-Surg SM BMP9 101B9400 University ParkwayPensacolaFLTerminated
DSH100093MChildDSHBAPTIST HOSPITALBH AI Non-Surg SM BMPA 102 - BH AI Non-Surg SM BMPA 1025100 North 12th AvenuePensacolaFLActive
DSH100093NChildDSHBAPTIST HOSPITALBH AI Non-Surg SM BMPN 201 - BH AI Non-Surg SM BMPN 2018880 Navarre ParkwayNavarreFLActive
DSH100093PChildDSHBAPTIST HOSPITALBH AI Non-Surg SM HWC125 Baptist WayPensacolaFLTerminated
DSH100093QChildDSHBAPTIST HOSPITALBH AI Ortho SM AI 203 - BH AI Ortho SM AI 2031040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093RChildDSHBAPTIST HOSPITALBH AI Ortho SM AI 204 - BH AI Ortho SM AI 2041040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093SChildDSHBAPTIST HOSPITALBH AI Ortho SM AI 206 - BH AI Ortho SM AI 2061040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093TChildDSHBAPTIST HOSPITALBH AI Ortho SM AI 208 - BH AI Ortho SM AI 2081040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093UChildDSHBAPTIST HOSPITALBH AI Ortho SM BMP9 101B - BH AI Ortho SM BMP9 101B9400 University ParkwayPensacolaFLActive
DSH100093VChildDSHBAPTIST HOSPITALBH AI Ortho SM BMPA 102 - BH AI Ortho SM BMPA 1025100 North 12th AvenuePensacolaFLActive
DSH100093WChildDSHBAPTIST HOSPITALBH AI Ortho Trauma AI 205 - BH AI Ortho Trauma AI 2051040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093XChildDSHBAPTIST HOSPITALBH AI Ortho Trauma HWC 4A125 Baptist WayPensacolaFLActive
DSH100093YChildDSHBAPTIST HOSPITALBH AI PMR AI 210 - BH AI PMR AI 2101040 Gulf Breeze ParkwayGulf BreezeFLActive
DSH100093ZChildDSHBAPTIST HOSPITALBH AI PMR BMP9 101B - BH AI PMR BMP9 101B9400 University ParkwayPensacolaFLActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateChange RequestTerry, Andrew L. Vice President Revenue Management Baptist Health Care 8504697643Cadena, Valerie Cyd Senior Vice President - Operations Baptist Health Care 44822780534/14/2025 11:17 AM
ContactsPrimary ContactUpdateProfile Change RequestSeelmann, Frederick Director of Pharmacy BHC 8504697567Seelmann, Frederick Executive Director of Pharmacy BHC 85046975672/20/2025 12:19 PM
DetailsLast Recertification DateUpdateRecertification9/5/2023 4:51:14 PM9/4/2024 2:54:06 PM9/4/2024 2:54 PM
DetailsLast Recertification DateUpdateRecertification9/15/2022 12:26:55 PM9/5/2023 4:51:14 PM9/5/2023 4:51 PM
DetailsLast Recertification DateUpdateRecertification9/8/2021 2:00:21 PM9/15/2022 12:26:55 PM9/15/2022 12:26 PM
DetailsLast Recertification DateUpdateRecertification9/11/2020 10:57:24 AM9/8/2021 2:00:21 PM9/8/2021 2:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 16659319/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification AK9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 838389/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification AZ9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 1215751059/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification AR9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 230888429/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification CO9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification HOS0093P9/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification CT9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 000150433AA9/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification GA9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 590657322-0029/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification IL9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 3000139019/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification IN9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 5538429/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification IA9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 12917239/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification KY9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 17330919/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification LA9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 2171058009/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification MD9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification HOS0093P9/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification MI9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 977799/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification MS9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 2502529/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification NJ9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification HOS0093P9/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification NC9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 1427699/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification OH9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 200060650B9/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification OK9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 5007732649/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification OR9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 100777553-00089/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10172A-inpatient9/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification SC9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10867B-outpatient9/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification SC9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 1000939/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification TN9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 1000939/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification VT9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification VA9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 10:57 AM
Medicaid BillingMedicaid: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingMedicaid: StateInsertRecertification WI9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification FL9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification AL9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification AK9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification AZ9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification AR9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification CO9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification CT9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification GA9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification IL9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification IN9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification IA9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification KY9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification LA9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification MD9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification MI9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification MS9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification NJ9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification NC9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification OH9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification OK9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification OR9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification PA9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification SC9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification TN9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification VT9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification VA9/11/2020 10:57 AM
Medicaid BillingNPI: NumberInsertRecertification 17009794659/11/2020 10:57 AM
Medicaid BillingNPI: StateInsertRecertification WI9/11/2020 10:57 AM
Medicaid BillingNPI: NumberDeleteRecertification1700979465 ( ) 9/11/2020 10:57 AM
DetailsLast Recertification DateUpdateRecertification9/9/2019 3:24:07 PM9/11/2020 10:57:24 AM9/11/2020 10:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/13/2020 1:01 PM
Medicaid BillingMedicaid: NumberInsertChange Request HOS0093P1/13/2020 1:01 PM
Medicaid BillingMedicaid: StateInsertChange Request AL1/13/2020 1:01 PM
DetailsLast Recertification DateUpdateRecertification8/29/2018 4:19:18 PM9/9/2019 3:24:07 PM9/9/2019 3:24 PM
DetailsLast Recertification DateUpdateRecertification11/10/2017 10:31:45 AM8/29/2018 4:19:18 PM8/29/2018 4:19 PM
DetailsLast Recertification DateUpdateRecertification9/6/2016 12:00:00 AM11/10/2017 10:31:45 AM11/10/2017 10:31 AM
ContactsPrimary ContactUpdate Seelmann, Frederick Director of Pharmacy 8504697567Seelmann, Frederick Director of Pharmacy BHC 850469756710/5/2017 2:50 PM
ContactsAuthorizing OfficialUpdate Terry, Andrew L. Vice President Revenue Management 8504697643Terry, Andrew L. Vice President Revenue Management Baptist Health Care 850469764310/4/2017 9:14 AM
ContactsAuthorizing OfficialUpdate Nobles, Sharon CFO 8504692315Terry, Andrew L. Vice President Revenue Management 85046976439/11/2017 3:29 PM
ContactsPrimary ContactUpdate Willingham, Harold Director of Pharmacy 8504694989Seelmann, Frederick Director of Pharmacy 85046975673/8/2017 1:53 PM
ContactsAuthorizing OfficialInsert  Nobles, Sharon CFO 85046923159/28/2016 3:32 PM
ContactsSigned ByInsert  Nobles, Sharon CFO 85046923159/28/2016 3:32 PM
AddressesMain AddressInsert   9400 University Parkway Suite 103 Pensacola, FL 325149/28/2016 3:32 PM
Medicaid BillingNPI: NumberInsert  17009794659/6/2016 5:49 PM
ContactsPrimary ContactInsert  Willingham, Harold Director of Pharmacy 85046949899/6/2016 5:49 PM
DetailsLast Recertification DateUpdate 8/27/2015 12:00:00 AM9/6/2016 12:00:00 AM9/6/2016 5:49 PM
DetailsLast Recertification DateUpdate 9/10/2014 12:00:00 AM8/27/2015 12:00:00 AM8/27/2015 4:35 PM
DetailsLast Recertification DateUpdate 9/13/2013 12:00:00 AM9/10/2014 12:00:00 AM9/10/2014 6:57 AM
DetailsLast Recertification DateUpdate  9/13/2013 12:00:00 AM9/13/2013 11:12 AM
Details340B IDUpdate ISAPDSH100093CDSH100093C6/10/2013 7:00 PM
DatesParticipating Approval DateUpdate  6/10/2013 12:00:00 AM6/10/2013 7:00 PM
DetailsStateUpdate PendingActive6/10/2013 7:00 PM
DatesStart DateUpdate  7/1/2013 12:00:00 AM6/10/2013 7:00 PM
Details340B IDUpdate AP?-DSH100093CISAPDSH100093C5/20/2013 3:23 PM
Details340B IDUpdate ISAPDSH100093CAP?-DSH100093C5/17/2013 1:27 PM
Details340B IDUpdate AP?-DSH100093CISAPDSH100093C5/6/2013 9:09 AM
Details340B IDUpdate ISAPDSH100093CAP?-DSH100093C5/3/2013 10:22 AM
Details340B IDUpdate AP0409131ISAPDSH100093C4/26/2013 3:25 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REGAP04091314/10/2013 5:25 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/9/2013 4:33 PM
Medicaid BillingMedicaid: NumberInsert  0100749004/9/2013 4:33 PM
Medicaid BillingMedicaid: StateInsert  FL4/9/2013 4:33 PM
DetailsLast Recertification DateInsert   4/9/2013 4:33 PM
DetailsGrant NumberInsert   4/9/2013 4:33 PM
Details340B IDInsert  OUTPATIENT_ONLINE_REG4/9/2013 4:33 PM
DetailsIs Authorizing Official EHB DataInsert   4/9/2013 4:33 PM
DatesLast Date That 340B Drugs PurchasedInsert   4/9/2013 4:33 PM
DetailsMedicare Provider NumberInsert  1000934/9/2013 4:33 PM
DetailsEntity NameInsert  BAPTIST HOSPITAL4/9/2013 4:33 PM
DetailsProgram CodeInsert  DSH4/9/2013 4:33 PM
DetailsEntity SubnameInsert  Baptist Medical Park - Cardiology4/9/2013 4:33 PM
DatesParticipating Approval DateInsert   4/9/2013 4:33 PM
DetailsStateInsert  Pending4/9/2013 4:33 PM
DatesRegistration DateInsert  4/9/2013 12:00:00 AM4/9/2013 4:33 PM
DatesSigned By DateInsert  4/9/2013 12:00:00 AM4/9/2013 4:33 PM
DatesStart DateInsert   4/9/2013 4:33 PM
TerminationsTermination CommentsInsert   4/9/2013 4:33 PM
TerminationsTermination DateInsert   4/9/2013 4:33 PM
TerminationsTermination Effective DateInsert   4/9/2013 4:33 PM
TerminationsTermination ReasonInsert   4/9/2013 4:33 PM