340B Drug Pricing Program Database


CH04033S Jessie Trice Community Health Center, Inc. (Terminated) - information as of 5/2/2025 10:27:08 PM

Main Details
Jessie Trice Community Health Center, Inc.
Jessie Trice Community Health Center - Women's Health Center
HRSA-Funded Health Center
BPS-H80-012461
CH04033S
H80CS00732


Additional Details
Terminated
7/12/2013
10/1/2013
8/29/2013
2/2/2017

4/1/2018
Site closure

Contacts

Jessie Trice Community Health Center, Inc
Annie Neasman, President & CEO
(305) 805-1700 Ext: 1000

JESSIE TRICE COMMUNITY HEALTH SYSTEM
Ruth Duval, Executive VP & Chief Nursing Officer
(305) 805-1700 Ext: 1011

Addresses

1190 NW 95th St STE 100
Miami, FL 33150-2064

Jessie Trice Community Health Center
5607 N W 27th Ave
Miami, FL 33142


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
FL264574200 
  1235119306
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH040330ActiveBPS-H80-002322Jessie Trice Community Health System, Inc,JTCHS - Fatima Zafar MD Health & Wellness Center5361 NW 22nd Ave MiamiFL
CH04033AATerminatedBPS-H80-021571JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.JTCHS - Lotus Village Center217 NW 15th Street MiamiFL
CH04033ABActiveBPS-H80-032027JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.JTCHS Barbara J. Jordan Community Health and Wellness Center20612 NW 27TH AVE Miami GardensFL
CH04033ACActiveBPS-H80-032706JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.Florida Memorial University15800 NW 42nd Ave Bldg 3 Miami GardensFL
CH04033ADActiveBPS-H80-022118JESSIE TRICE COMMUNITYJTCHS - Dental Health Center5607 NW 27th Ave Ste 2 MiamiFL
CH04033GActiveBPS-H80-004718JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.JTCHS - Jefferson Reaves House Women's Residental SA Treatment Center (24 Hour)2985 NW 54th St MiamiFL
CH04033KActiveBPS-H80-012461Jessie Trice Community Health System, Inc.JTCHS - Health Center at North Shore1190 NW 95th St STE 100 MiamiFL
CH04033LActiveBPS-H80-002574Jessie Trice Community Health System, Inc.JTCHS Flamingo Medical Center901 E 10th Ave STE 39 HialeahFL
CH04033OTerminatedBPS-H80-004658Jessie Trice Community Health Center, Inc.MIAMI EDISON SENIOR HIGH SCHOOL6161 NW 5TH CT RM A- MIAMIFL
CH04033QTerminatedBPS-H80-002209Jessie Trice Community Health System, Inc.Norland Dental Health Center18360 NW 7th Ave MiamiFL
CH04033RActiveBPS-H80-007603Jessie Trice Community Health System, Inc.JTCHS - Children's Wellness Center1190 NW 95th St STE 304 MiamiFL
CH04033STerminatedBPS-H80-012461Jessie Trice Community Health Center, Inc.Jessie Trice Community Health Center - Women's Health Center1190 NW 95th St STE 100 MiamiFL
CH04033TTerminatedBPS-H80-012845Jessie Trice Community Health System, Inc.Jessie Trice Community Health System - Miami Gardens4692 NW 183rd Street Miami GardensFL
CH04033UActiveBPS-H80-013538Jessie Trice Community Health System, Inc.JTCHS - Corporate Office Complex5607 NW 27TH AVE MIAMIFL
CH04033VActiveBPS-H80-014071JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.JTCHS - Frederica Wilson / Juanita Mann Health Center2520 N.W. 75th Street MiamiFL
CH04033WActiveBPS-H80-017003JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.Miami Northwestern Senior High School1100 NW 71st Street MiamiFL
CH04033XActiveBPS-H80-017012JESSIE TRICE COMMUNITY HEALTH SYSTEM INCMiami Carol City Senior High School3301 NW 183rd St Carol CityFL
CH04033YActiveBPS-H80-015392JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.JTCHS - Opa Locka Youth and Children's Wellness Center490 Opa-Locka Blvd. Suite 100 Opa LockaFL
CH04033ZTerminatedBPS-H80-017023JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.Jessie Trice Hialeah Women's Health CenterHialeah Medical Plaza 777 East 25th Street Suite 316 HialeahFL
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH04033UCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2018  
CH040330CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2025  
CH04033UCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2018  
CH040330CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2025  
CH040330CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/01/2021 11/14/2024
CH040330CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/01/2021 11/14/2024
CH040330CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/01/2021 11/14/2024
CH040330CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/01/2021 11/14/2024
CH040330CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/01/2021 11/14/2024
CH040330CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/01/2021 11/14/2024
CH040330CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/01/2021  
CH040330CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/01/2021 11/14/2024
CH040330COMMCARE PHARMACY-FTL, LLC855 SW 78TH AVE STE C100
PLANTATIONFL33324-322310/01/2016 07/19/2019
CH040330COMMCARE PHARMACY-MIA, LLC  1801 CORAL WAY
SUITE 115 		MIAMIFL33145-278410/01/2016 02/17/2017
CH040330CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00628 600 NE 128TH ST
NORTH MIAMIFL3316101/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00931 101 HIALEAH DR
HIALEAHFL3301001/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00113 2780 NE 8TH ST.
HOMESTEADFL3303301/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00580 4800 BISCAYNE BLVD
MIAMIFL3313701/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00402 170 SE 3RD AVE
MIAMIFL3313101/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 01277 6690 EAGLE NEST LN
MIAMI LAKESFL3301401/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA CVS/PHARMACY # 976 1177 SW 8TH ST.
MIAMIFL3313001/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 00567 591 NE 79TH STREET
MIAMIFL3313801/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05112 101 SOUTH MAIN STREET
BELLE GLADEFL3343001/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04201 2240 EAST SUNRISE BLVD
FORT LAUDERDALEFL3330401/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04222 4400 HOLLYWOOD BLVD
HOLLYWOODFL3302101/01/2021 03/13/2023
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05136 11398 QUAIL ROOST DR
MIAMIFL3315701/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04032 855 E 8TH AVE
HIALEAHFL3301001/01/2021 07/17/2024
CH040330HOLIDAY CVS, L.L.C.NAVARRO DISCOUNT PHARMACY # 10723 13250 BISCAYNE BLVD
NORTH MIAMIFL3318101/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05147 227 SW 8TH ST
MIAMIFL3313001/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05233 650 NW 27TH AVE
MIAMIFL3312501/01/2021  
CH040330HOLIDAY CVS, L.L.C.NAVARRO DISCOUNT PHARMACY # 10698 1243 SW 8TH STREET
MIAMIFL3313501/01/2021  
CH040330HOLIDAY CVS, L.L.C.CVS PHARMACY # 17268 3401 N MIAMI AVE STE 100
MIAMIFL3312701/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA CVS/PHARMACY #10132 1201 BRICKELL AVENUE
MIAMIFL3313101/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05897 3700 NW 199TH ST.
MIAMI GARDENSFL3305501/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA CVS/PHARMACY # 5466 1230 WEST 29TH STREET
HIALEAHFL3301201/01/2021  
CH040330HOLIDAY CVS, L.L.C.NAVARRO DISCOUNT PHARMACY # 10722 366 EAST 4TH AVENUE
HIALEAHFL3301001/01/2021  
CH040330HOLIDAY CVS, L.L.C.NAVARRO DISCOUNT PHARMACY # 10719 3915 PALM AVENUE
HIALEAHFL3301201/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 03982 4599 SHERIDAN ST.
HOLLYWOODFL3302101/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 03765 19198 S DIXIE HWY
CUTLER BAYFL3315701/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05786 16550 NE 6TH AVE, NORTH
MIAMIFL3316201/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04249 11890 BISCAYNE BLVD
MIAMIFL3318101/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 04613 200 BISCAYNE BLVD
MIAMIFL3313201/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05125 735 NW 119TH ST
NORTH MIAMIFL3316801/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 02895 19800 NW 2ND AVE.
MIAMI GARDENSFL3316901/01/2021  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05145 4700 NW 183RD ST
MIAMI GARDENSFL3305510/01/2022  
CH040330HOLIDAY CVS, L.L.C.DBA: CVS/PHARMACY # 05182 8901 MIRAMAR PKWY
MIRAMARFL3302510/01/2022  
CH040330PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/01/2019  
CH040330PROCARE PHARMACY, L.L.C.NAVARRO SPECIALTY SERVICES # 10727 7205 CORPORATE CENTER DRIVE
SUITE 104 		MIAMIFL3312606/10/2019  
CH040330PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681310/01/2021  
CH040330PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/01/2021  
CH040330PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/01/2021  
CH040330TENNESSEE CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05671 103 FOOTHILLS MALL DR.
MARYVILLETN3780101/01/2021  
CH040330WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2019  
CH040330WAL-MART PHARMACY 10-15905851 NW 177TH STREET
HIALEAHFL3301501/01/2017  
CH040330WAL-MART PHARMACY 10-32351425 NORTHEAST 163RD STREET
NORTH MIAMI BEACHFL3316201/01/2017 06/10/2020
CH040330WAL-MART PHARMACY 10-331119501 NORTHWEST 27TH AVE
MIAMI GARDENSFL3305601/01/2017  
CH040330WAL-MART PHARMACY 10-339717650 NW 2ND AVE.
MIAMI GARDENSFL3316901/01/2017  
CH040330WAL-MART PHARMACY 10-5945400 W. 49TH
HIALEAHFL3301201/01/2017 02/08/2019
CH040330WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2019  
CH040330WALGREEN CODBA WALGREENS SPECIALTY PHARMACY #16297 9400 NORTHWEST 12TH AVE BAY 5
MIAMIFL3315007/01/2019  
CH040330WALGREEN CO.DBA: WALGREENS # 00748 12295 BISCAYNE BLVD
NORTH MIAMIFL3318108/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 01532 6700 COLLINS AVE
MIAMI BEACHFL3314108/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 02443 3705 HOLLYWOOD BLVD
HOLLYWOODFL3302108/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 02489 3007 AVENTURA BLVD., #4
AVENTURAFL3318008/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 07322 2710 N UNIVERSITY DR
HOLLYWOODFL3302408/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 02545 1480 NE MIAMI GARDENS DR
NORTH MIAMI BEACHFL3317908/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 02719 791 NE 167TH ST
NORTH MIAMI BEACHFL3316208/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 02790 3103 BISCAYNE BLVD
MIAMIFL3313708/29/2012  
CH040330WALGREEN CO.WALGREENS #16354 1780 N. UNIVERSITY DR.
PLANTATIONFL3332208/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 03105 11920 NW 27TH AVENUE
MIAMIFL3316708/29/2012 02/28/2024
CH040330WALGREEN CO.DBA: WALGREENS # 03173 9020 BISCAYNE BLVD
MIAMI SHORESFL3313808/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03211 9675 NW 41ST STREET
DORALFL33178-297408/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03239 1 SE 3RD AVE STE 100
MIAMIFL3313108/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03250 18300 NW 37TH AVE.
MIAMI GARDENSFL33056-510108/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03301 1695 NW 20TH STREET
MIAMIFL3314208/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03371 7910 NW 27TH AVENUE
MIAMIFL3314708/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03493 9498 NW 7TH AVE
MIAMIFL3315008/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03525 6817 TAFT STREET
HOLLYWOODFL3302408/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03527 567 NE 125TH STREET
NORTH MIAMIFL3316108/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03566 4451 W. 12TH AVE.
HIALEAHFL3301208/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03626 1800 N NOB HILL ROAD
PLANTATIONFL3332208/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 03678 1501 NE 163RD STREET
NORTH MIAMI BEACHFL3316208/29/2012 08/19/2021
CH040330WALGREEN CO.DBA: WALGREENS # 03679 161 NE 54TH STREET
MIAMIFL3313708/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03782 5701 NW 183RD ST
HIALEAHFL3301508/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03835 19935 NW 2ND AVE
MIAMIFL3316908/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03854 15900 NW 27TH AVE
OPA LOCKAFL3305408/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 03905 1751 BONAVENTURE BLVD
WESTONFL3332608/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 03943 200 SW 13TH ST
MIAMIFL3313008/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04141 3099 N. STATE ROAD 7
LAUDERDALE LAKESFL33313-191308/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 04324 15911 PINES BLVD.
PEMBROKE PINESFL3302708/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04384 400 HIALEAH DRIVE
HIALEAHFL3301008/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04385 770 W 29TH ST
HIALEAHFL3301208/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04386 5999 PEMBROKE ROAD
HOLLYWOODFL3302308/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 04402 1300 E HALLANDALE BEACH BLVD
HALLANDALE BEACHFL3300908/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04694 6105 W SUNRISE BLVD
PLANTATIONFL3331308/29/2012 04/28/2017
CH040330WALGREEN CO.DBA: WALGREENS # 04728 6200 NW 7TH AVE
MIAMIFL3315008/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04766 9005 PINES BLVD
PEMBROKE PINESFL3302408/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04808 20340 OLD CUTLER RD
CUTLER BAYFL3318908/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04915 750 NW 119TH ST.
MIAMIFL3316808/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 04917 690 NW 183RD ST
MIAMI GARDENSFL3316908/29/2012 02/22/2024
CH040330WALGREEN CO.DBA: WALGREENS # 04955 18665 BISCAYNE BLVD
AVENTURAFL3318008/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 05050 1610 W 49TH ST
HIALEAHFL3301208/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 05130 6800 W 28TH AVE
HIALEAHFL3301808/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 05198 7340 COLLINS AVE
MIAMI BEACHFL3314108/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 05250 1699 NW 7TH ST
MIAMIFL3312508/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 05251 1 E FLAGLER ST
MIAMIFL3313108/29/2012 06/02/2021
CH040330WALGREEN CO.DBA: WALGREENS # 05293 4895 PALM AVENUE
HIALEAHFL3301208/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 05521 12400 PEMBROKE RD
MIRAMARFL3302708/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 05696 14501 MIRAMAR PARKWAY
MIRAMARFL3302708/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 05845 14901 NE 6TH AVE
MIAMIFL3316108/29/2012 06/27/2017
CH040330WALGREEN CO.DBA: WALGREENS # 06011 8001 MIRAMAR PKWY
MIRAMARFL33025-300408/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 06012 655 NW 57TH AVE
MIAMIFL3312608/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 06403 199 WESTON ROAD
WESTONFL3332608/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 06512 6812 MIRAMAR PKWY
MIRAMARFL33023-600308/29/2012 06/27/2017
CH040330WALGREEN CO.DBA: WALGREENS # 06949 2499 S PALM AVE
MIRAMARFL3302508/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 07844 7605 W 33RD CT
HIALEAHFL3301808/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 10984 3914 W. COMMERCIAL BLVD
TAMARACFL3330908/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS #11638 15050 BISCAYNE BLVD
NORTH MIAMIFL3318108/29/2012 11/18/2016
CH040330WALGREEN CO.DBA: WALGREENS #11657 2000 NORMANDY DR.
MIAMI BEACHFL3314108/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 11939 8450 CORAL WAY
MIAMIFL3315508/29/2012 05/04/2016
CH040330WALGREEN CO.DBA: WALGREENS # 12285 780 EAST 9TH STREET
HIALEAHFL3301008/29/2012  
CH040330WALGREEN CO.DBA: WALGREENS # 12724 1251 SOUTH STATE ROAD 7
DAVIEFL3331704/01/2013 05/04/2016
CH040330WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16331 5361 NW 22ND AVE STE 2
MIAMIFL3314207/01/2016  
CH040330WALGREEN CO.WALGREENS SPECIALTY PHARMACY #15106 1250 NW 7TH STREET SUITE 205
MIAMIFL3312510/01/2017  
CH040330WALGREEN CO.WALGREENS #16541 1400 NW 12TH AVE STE 2002
MIAMIFL3313607/01/2019  
CH040330WALGREEN CO.DBA: WALGREENS #15912 7100 W 20TH AVENUE, STE G177
HIALEAHFL3301610/01/2021 03/22/2023
CH040330WALGREEN CO.DBA: WALGREENS #10264 28875 S. DIXIE HWY
HOMESTEADFL3303301/01/2022  
CH040330WALGREEN CO.DBA: WALGREENS #09018 1155 W. 68TH ST
HIALEAHFL33014-515201/01/2022  
CH040330WALGREEN CO.DBA: WALGREENS # 00621 5731 BIRD ROAD
MIAMIFL3315501/01/2022  
CH040330WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21359 275 NE 35TH ST
MIAMIFL3313701/01/2022  
CH040330WALGREEN CO.DBA: WALGREENS # 06873 1201 SW 1ST STREET
MIAMIFL33135-240101/01/2022 01/21/2025
CH040330WALGREEN CO.DBA: WALGREENS #15994 801 SW 8TH ST
MIAMIFL3313001/01/2022  
CH040330Walgreens #21395Walgreens Central Fill #21395 5710 Young Pine Rd
OrlandoFL3282907/01/2023  
CH040330WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904908/31/2012 08/03/2015
CH040330WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528407/01/2013 08/03/2015
CH040330WALMART PHARMACY #10-43033200 NW 79TH STREET
MIAMIFL3314704/01/2019  
CH040330WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275607/01/2023  
CH040330Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated4/1/2018 12:00 AM
DatesLast Date That 340B Drugs PurchasedUpdateRecertification 7/3/2017 12:00:00 AM2/22/2018 8:41 AM
DetailsStateUpdateRecertificationActiveTo Be Terminated2/22/2018 8:41 AM
TerminationsTermination DateUpdateRecertification 4/1/2018 12:00:00 AM2/22/2018 8:41 AM
TerminationsTermination Effective DateUpdateRecertification 8/31/2017 12:00:00 AM2/22/2018 8:41 AM
TerminationsTermination ReasonUpdateRecertification Site closure2/22/2018 8:41 AM
ContactsPrimary ContactUpdateProfile Change RequestDuval, Ruth Sr. Vice President JESSIE TRICE COMMUNITY HEALTH CENTER, INC 3058051700-1000Duval, Ruth Executive VP & Chief Nursing Officer JESSIE TRICE COMMUNITY HEALTH SYSTEM 3058051700-10111/25/2018 5:09 PM
ContactsPrimary ContactUpdateChange RequestLawrence, Joycelyn Chief Medical Officer 3058051700-1000Duval, Ruth Sr. Vice President JESSIE TRICE COMMUNITY HEALTH CENTER, INC 3058051700-100010/18/2017 1:34 PM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 10/18/2017 1:34 PM
ContactsAuthorizing OfficialUpdate Neasman, Annie President & CEO 3058051700-1000Neasman, Annie President & CEO Jessie Trice Community Health Center, Inc 3058051700-100010/16/2017 5:19 PM
ContactsSigned ByInsert  Neasman, Annie CEO 3058051700-231518/9/2017 2:50 PM
ContactsAuthorizing OfficialInsert  Neasman, Annie President & CEO 3058051700-10002/15/2017 8:43 AM
AddressesMain AddressInsert   1190 NW 95th St STE 100 Miami, FL 33150-20642/2/2017 4:35 PM
ContactsPrimary ContactUpdate Jones, Claude CHIEF MEDICAL OFFICER 3058051700-23162Lawrence, Joycelyn Chief Medical Officer 3058051700-10002/2/2017 4:35 PM
DetailsLast Recertification DateUpdate 3/7/2016 12:00:00 AM2/2/2017 12:00:00 AM2/2/2017 4:35 PM
AddressesBilling AddressInsert  Jessie Trice Community Health Center 5607 N W 27th Ave Miami, FL 331425/26/2016 11:44 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False5/26/2016 11:43 AM
Medicaid BillingMedicaid: NumberInsert  2645742005/26/2016 11:43 AM
Medicaid BillingMedicaid: StateInsert  FL5/26/2016 11:43 AM
Medicaid BillingNPI: NumberInsert  12351193065/26/2016 11:43 AM
DetailsLast Recertification DateUpdate 2/12/2015 12:00:00 AM3/7/2016 12:00:00 AM3/7/2016 8:53 AM
ContactsPrimary ContactInsert  Jones, Claude CHIEF MEDICAL OFFICER 3058051700-231623/7/2016 8:52 AM
DetailsLast Recertification DateUpdate 3/20/2014 12:00:00 AM2/12/2015 12:00:00 AM2/12/2015 2:34 PM
DetailsIs Authorizing Official EHB DataUpdate  False2/12/2015 2:34 PM
DetailsLast Recertification DateUpdate  3/20/2014 12:00:00 AM3/20/2014 7:48 AM
DetailsEntity NameUpdate JESSIE TRICE COMMUNITY HEALTH CENTER, INC.Jessie Trice Community Health Center, Inc.3/20/2014 7:48 AM
Details340B IDUpdate ISJMCH04033SCH04033S8/29/2013 12:26 PM
DatesParticipating Approval DateUpdate  8/29/2013 12:00:00 AM8/29/2013 12:26 PM
DetailsStateUpdate PendingActive8/29/2013 12:26 PM
DatesStart DateUpdate  10/1/2013 12:00:00 AM8/29/2013 12:26 PM
Details340B IDUpdate ONLINE_REGISJMCH04033S8/9/2013 11:04 PM
DetailsLast Recertification DateInsert   7/12/2013 3:42 PM
DetailsGrant NumberInsert  H80CS007327/12/2013 3:42 PM
Details340B IDInsert  ONLINE_REG7/12/2013 3:42 PM
DetailsIs Authorizing Official EHB DataInsert   7/12/2013 3:42 PM
DatesLast Date That 340B Drugs PurchasedInsert   7/12/2013 3:42 PM
DetailsMedicare Provider NumberInsert   7/12/2013 3:42 PM
DetailsEntity NameInsert  JESSIE TRICE COMMUNITY HEALTH CENTER, INC.7/12/2013 3:42 PM
DetailsProgram CodeInsert  CH7/12/2013 3:42 PM
DetailsEntity SubnameInsert  Jessie Trice Community Health Center - Women's Health Center7/12/2013 3:42 PM
DatesParticipating Approval DateInsert   7/12/2013 3:42 PM
DetailsStateInsert  Pending7/12/2013 3:42 PM
DatesRegistration DateInsert  7/12/2013 12:00:00 AM7/12/2013 3:42 PM
DatesSigned By DateInsert  7/12/2013 12:00:00 AM7/12/2013 3:42 PM
DatesStart DateInsert   7/12/2013 3:42 PM
TerminationsTermination CommentsInsert   7/12/2013 3:42 PM
TerminationsTermination DateInsert   7/12/2013 3:42 PM
TerminationsTermination Effective DateInsert   7/12/2013 3:42 PM
TerminationsTermination ReasonInsert   7/12/2013 3:42 PM