Covered Entity Details

CH04037A FLORIDA CHCS, INC. (Active) - information as of 5/20/2025 11:35:06 PM

Main Details

Name

FLORIDA CHCS, INC.

Subdivision Name

INDIANTOWN COMMUNITY HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-000491

340B ID

CH04037A

Grant Number

H80CS00798

Additional Details

Current Program Status

Active

Registration Date

12/1/1992

Participating Start Date

12/1/1992

Participating Approval Date

2/1/2005

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

Florida Community Health Center, Inc.
Margaret Virginia Russell, VP & CFO
(561) 844-9443 Ext: 1003

Primary Contact

Florida Community Health Centers, Inc
MELISSA ALLEN DAVIS, 340B Program Coordinator
(772) 462-6520

Addresses

Street Address

15858 SW WARFIELD BLVD
INDIANTOWN, FL 34956

Billing Address
Same as Street Address

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

Comments

Comment	Last Updated On
CORRECTED ENTITY NAME, 2/1/05 - NEW CONTACT INFO	02/01/2005

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	029574403,060144600	1205886223

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
Contract Detail	FAMILY DRUGS OF INDIANTOWN	15690 SW WARFIELD BLVD		INDIANTOWN	FL	34956	10/16/2023	01/01/2024			01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH040370	Active	BPS-H80-017204	FLORIDA CHC'S, INC.		5827 CORPORATE WAY	WEST PALM BEACH	FL
CH04037A	Active	BPS-H80-000491	FLORIDA CHCS, INC.	INDIANTOWN COMMUNITY HEALTH CENTER	15858 SW WARFIELD BLVD	INDIANTOWN	FL
CH04037B	Active	BPS-H80-001331	FLORIDA COMMUNITY HEALTH CENTER INC	CLEWISTON COMMUNITY HEALTH CTR	315 S W C Owen Ave	Clewiston	FL
CH04037C	Active	BPS-H80-010371	FLORIDA COMMUNITY HEALTH CENTER INC	Lakeshore Medical Adults	1100 North Parrott Ave	Okeechobee	FL
CH04037E	Active	BPS-H80-000284	FLORIDA COMMUNITY HEALTH CENTER INC	FT. PIERCE COMMUNITY HEALTH CTR	1505 Delaware Ave	Fort Pierce	FL
CH04037F	Active	BPS-H80-002248	FLORIDA COMMUNITY HEALTH CENTER INC	PAHOKEE COMMUNITY HEALTH CENTER	170 S Barfield Hwy STE 103	Pahokee	FL
CH04037G	Active	BPS-H80-003165	FLORIDA COMMUNITY HEALTH CENTER INC	PORT ST. LUCIE ADULT AND SENIOR HEALTH CENTER	1701 S.E. HILLMOOR DR. STE 19	PORT ST. LUCIE	FL
CH04037H	Active	BPS-H80-031754	FLORIDA COMMUNITY HEALTH CENTER INC	Port St. Lucie Women & Children	9576 S. US Highway 1 Bldg	Port St. Lucie	FL
CH04037J	Active	BPS-H80-010370	FLORIDA COMMUNITY HEALTH CENTER INC	Dr. Fred Brown Children's Health Center	2015 Highway 441 North	Okeechobee	FL
CH04037K	Active	BPS-H80-012067	FLORIDA COMMUNITY HEALTH CENTER INC	Florida Community Health Center, Moore Haven	1021 Health Park Drive	Moore Haven	FL
CH04037L	Active	BPS-H80-012244	FLORIDA COMMUNITY HEALTH CENTER INC	Florida Community Health Center - Stuart	3441 SE Willoughby Blvd.	Stuart	FL
CH04037M	Terminated	BPS-H80-012775	FLORIDA COMMUNITY HEALTH CENTER INC	Grace Women's Health Center	2402 Frist Blvd STE 202	Fort Pierce	FL
CH04037N	Active	BPS-H80-017204	FLORIDA COMMUNITY HEALTH CENTER INC	Florida Community Health Centers, Inc.	5827 Corporate Way	West Palm Beach	FL
CH04037P	Active	BPS-H80-015532	FLORIDA COMMUNITY HEALTH CENTER INC	Florida Community Health Center - Darwin Square	3235 SW PORT ST LUCIE BLVD UNIT #105	PORT ST LUCIE	FL
CH04037Q	Active	BPS-H80-032447	Florida Community Health Centers, Inc.	Florida Community Health Centers Inc.- Lincoln Park Village Center	3090 Avenue G	Fort Pierce	FL
CH04037R	Active	BPS-H80-032448	Florida Community Health Centers, Inc.	Florida Community Health Centers, Inc. Mobile Unit 1	9576 S US Highway 1	Port St Lucie	FL
CH04037S	Active	BPS-H80-035618	FLORIDA COMMUNITY HEALTH CENTER	Florida Community Health Centers, Inc - Belle Glade	941 S.E. 1st Street	Belle Glade	FL
CH04037T	Active	BPS-H80-035742	FLORIDA COMMUNITY HEALTH CENTER	Florida Community Health Centers, Inc. - Grace Women and Children	714 Avenue C	Fort Pierce	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH040370	FAMILY DRUGS OF INDIANTOWN	15690 SW WARFIELD BLVD		INDIANTOWN	FL	34956	04/01/2017
CH04037A	FAMILY DRUGS OF INDIANTOWN	15690 SW WARFIELD BLVD		INDIANTOWN	FL	34956	01/01/2024
CH040370	FORT PIERCE DISCOUNT PHARMACY, INC	1727 OKEECHOBEE RD		FORT PIERCE	FL	34950	04/01/2017
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00111	1891 N. US HWY 1	FORT PIERCE	FL	34946	04/01/2017	12/13/2018
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03164	520 W SUGARLAND HWY	CLEWISTON	FL	33440	04/01/2017	12/13/2018
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05112	101 SOUTH MAIN STREET	BELLE GLADE	FL	33430	04/01/2017	12/13/2018
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03237	106 N PARROTT AVE	OKEECHOBEE	FL	34972	04/01/2017	12/13/2018
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07923	2873 SW PORT ST. LUCIE BLVD.	PORT SAINT LUCIE	FL	34953	04/01/2021
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03487	2220 S US HWY 1	FORT PIERCE	FL	34950	04/01/2021
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03237	106 N PARROTT AVE	OKEECHOBEE	FL	34972	04/01/2021
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03164	520 W SUGARLAND HWY	CLEWISTON	FL	33440	04/01/2021	11/30/2023
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05112	101 SOUTH MAIN STREET	BELLE GLADE	FL	33430	04/01/2021
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04041	9801 US HWY 1	PORT SAINT LUCIE	FL	34952	01/01/2022
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00111	1891 N. US HWY 1	FORT PIERCE	FL	34946	01/01/2022
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05151	4780 NORTH KINGS HWY	FORT PIERCE	FL	34951	01/01/2022
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03689	4999 S FEDERAL HWY	FORT PIERCE	FL	34982	01/01/2022
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04254	301 NE PRIMA VISTA BLVD	PORT SAINT LUCIE	FL	34983	07/01/2022	09/25/2024
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05137	2284 SE FEDERAL HWY	STUART	FL	34994	07/01/2022
CH04037E	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03487	2220 S US HWY 1	FORT PIERCE	FL	34950	01/01/2024
CH04037B	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03164	520 W SUGARLAND HWY	CLEWISTON	FL	33440	01/01/2024	11/30/2023
CH04037C	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03237	106 N PARROTT AVE	OKEECHOBEE	FL	34972	01/01/2024
CH04037E	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00111	1891 N. US HWY 1	FORT PIERCE	FL	34946	01/01/2024
CH04037G	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04254	301 NE PRIMA VISTA BLVD	PORT SAINT LUCIE	FL	34983	01/01/2024	09/25/2024
CH04037T	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03689	4999 S FEDERAL HWY	FORT PIERCE	FL	34982	01/01/2024
CH04037J	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03237	106 N PARROTT AVE	OKEECHOBEE	FL	34972	01/01/2024
CH04037T	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00111	1891 N. US HWY 1	FORT PIERCE	FL	34946	01/01/2024
CH04037K	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03164	520 W SUGARLAND HWY	CLEWISTON	FL	33440	01/01/2024	11/30/2023
CH04037T	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05151	4780 NORTH KINGS HWY	FORT PIERCE	FL	34951	01/01/2024
CH04037F	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05112	101 SOUTH MAIN STREET	BELLE GLADE	FL	33430	01/01/2024
CH04037G	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04041	9801 US HWY 1	PORT SAINT LUCIE	FL	34952	01/01/2024
CH04037T	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03487	2220 S US HWY 1	FORT PIERCE	FL	34950	01/01/2024
CH04037S	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05112	101 SOUTH MAIN STREET	BELLE GLADE	FL	33430	01/01/2024
CH04037L	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05137	2284 SE FEDERAL HWY	STUART	FL	34994	01/01/2024
CH04037G	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07923	2873 SW PORT ST. LUCIE BLVD.	PORT SAINT LUCIE	FL	34953	01/01/2024
CH04037P	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04254	301 NE PRIMA VISTA BLVD	PORT SAINT LUCIE	FL	34983	01/01/2024
CH04037P	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04041	9801 US HWY 1	PORT SAINT LUCIE	FL	34952	01/01/2024
CH04037Q	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00111	1891 N. US HWY 1	FORT PIERCE	FL	34946	01/01/2024
CH04037R	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04254	301 NE PRIMA VISTA BLVD	PORT SAINT LUCIE	FL	34983	01/01/2024
CH04037Q	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03487	2220 S US HWY 1	FORT PIERCE	FL	34950	01/01/2024
CH04037Q	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03689	4999 S FEDERAL HWY	FORT PIERCE	FL	34982	01/01/2024
CH04037P	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07923	2873 SW PORT ST. LUCIE BLVD.	PORT SAINT LUCIE	FL	34953	01/01/2024
CH04037R	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07923	2873 SW PORT ST. LUCIE BLVD.	PORT SAINT LUCIE	FL	34953	01/01/2024
CH04037Q	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05151	4780 NORTH KINGS HWY	FORT PIERCE	FL	34951	01/01/2024
CH04037R	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04041	9801 US HWY 1	PORT SAINT LUCIE	FL	34952	01/01/2024
CH040370	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05157	1300 SW ST LUCIE BLVD	PORT SAINT LUCIE	FL	34986	01/01/2025
CH040370	JACKSON DRUGS, LLC	2301 OKEECHOBEE RD		FORT PIERCE	FL	34950-6554	04/01/2017
CH04037E	JACKSON DRUGS, LLC	2301 OKEECHOBEE RD		FORT PIERCE	FL	34950-6554	01/01/2024
CH04037T	JACKSON DRUGS, LLC	2301 OKEECHOBEE RD		FORT PIERCE	FL	34950-6554	01/01/2024
CH04037Q	JACKSON DRUGS, LLC	2301 OKEECHOBEE RD		FORT PIERCE	FL	34950-6554	01/01/2024
CH040370	S A S B INC	OKEECHOBEE DISCOUNT DRUGS	203 SW PARK ST OKEECHOBEE DISCOUNT DRUGS	OKEECHOBEE	FL	34972-4160	07/01/2017	07/08/2019
CH040370	VALUE HEALTH CONSULTANTS	BUTTERFIELD PHARMACY & MEDICAL SUPPLIES	1770 SE HILLMOOR DR	PORT ST LUCIE	FL	34952	04/01/2017	10/14/2019
CH040370	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH040370	WAL-MART PHARMACY 10-0814	2101 S. PARROTT AVENUE		OKEECHOBEE	FL	34974	04/01/2014
CH04037C	WAL-MART PHARMACY 10-0814	2101 S. PARROTT AVENUE		OKEECHOBEE	FL	34974	01/01/2024
CH04037J	WAL-MART PHARMACY 10-0814	2101 S. PARROTT AVENUE		OKEECHOBEE	FL	34974	01/01/2024
CH040370	WAL-MART PHARMACY 10-0929	10855 SOUTH US HWY #1		PORT ST LUCIE	FL	34952	04/01/2014
CH04037G	WAL-MART PHARMACY 10-0929	10855 SOUTH US HWY #1		PORT ST LUCIE	FL	34952	01/01/2024
CH04037P	WAL-MART PHARMACY 10-0929	10855 SOUTH US HWY #1		PORT ST LUCIE	FL	34952	01/01/2024
CH04037R	WAL-MART PHARMACY 10-0929	10855 SOUTH US HWY #1		PORT ST LUCIE	FL	34952	01/01/2024
CH040370	WAL-MART PHARMACY 10-0973	5100 OKEECHOBEE RD		FORT PIERCE	FL	34947	04/01/2014
CH04037E	WAL-MART PHARMACY 10-0973	5100 OKEECHOBEE RD		FORT PIERCE	FL	34947	01/01/2024
CH04037T	WAL-MART PHARMACY 10-0973	5100 OKEECHOBEE RD		FORT PIERCE	FL	34947	01/01/2024
CH04037Q	WAL-MART PHARMACY 10-0973	5100 OKEECHOBEE RD		FORT PIERCE	FL	34947	01/01/2024
CH040370	WAL-MART PHARMACY 10-1087	4001 SE FEDERAL HWY		STUART	FL	34997	04/01/2014
CH04037L	WAL-MART PHARMACY 10-1087	4001 SE FEDERAL HWY		STUART	FL	34997	01/01/2024
CH040370	WAL-MART PHARMACY 10-2484	1005 WEST SUGARLAND HWY		CLEWISTON	FL	33440	04/01/2014
CH04037B	WAL-MART PHARMACY 10-2484	1005 WEST SUGARLAND HWY		CLEWISTON	FL	33440	01/01/2024
CH04037K	WAL-MART PHARMACY 10-2484	1005 WEST SUGARLAND HWY		CLEWISTON	FL	33440	01/01/2024
CH040370	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH040370	WALGREEN CO	DBA: WALGREENS #09956	300 W SUGARLAND HWY	CLEWISTON	FL	33440-3318	07/01/2013
CH04037B	WALGREEN CO	DBA: WALGREENS #09956	300 W SUGARLAND HWY	CLEWISTON	FL	33440-3318	01/01/2024
CH04037K	WALGREEN CO	DBA: WALGREENS #09956	300 W SUGARLAND HWY	CLEWISTON	FL	33440-3318	01/01/2024
CH040370	WALGREEN CO.	DBA: WALGREENS # 03110	692 SW PRIMA VISTA BLVD	PORT ST LUCIE	FL	34983	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 04001	280 SW PORT ST. LUCIE BLVD.	PORT ST LUCIE	FL	34984	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 04075	100 NW PARK STREET	OKEECHOBEE	FL	34972	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 04391	2501 VIRGINIA AVE.	FT PIERCE	FL	34981	07/01/2013	04/08/2021
CH040370	WALGREEN CO.	DBA: WALGREENS # 04727	4950 S US HWY 1	FT PIERCE	FL	34952	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 04804	1661 NW ST LUCIE WEST BLVD	PORT ST LUCIE	FL	34986	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 05079	2423 ORANGE AVE	FT PIERCE	FL	34950	07/01/2013	06/27/2017
CH040370	WALGREEN CO.	DBA: WALGREENS # 05335	7620 SOUTH US HIGHWAY 1	PORT ST LUCIE	FL	34952	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 05465	1025 SE PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34952	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 06383	2901 SW PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34953	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 06832	5800 SE FEDERAL HWY	STUART	FL	34997	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS #10705	2592 S JENKINS RD	FORT PIERCE	FL	34947	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 10741	1603 SOUTH US 1	FT PIERCE	FL	34950	07/01/2013
CH040370	WALGREEN CO.	DBA: WALGREENS # 05255	3180 SE FEDERAL HWY	STUART	FL	34994	01/01/2014
CH040370	WALGREEN CO.	DBA: WALGREENS # 06016	101 N MAIN ST	BELLE GLADE	FL	33430	07/01/2017
CH040370	WALGREEN CO.	DBA: WALGREENS # 06520	1250 NE JENSEN BEACH BLVD	JENSEN BEACH	FL	34957	10/01/2017
CH040370	WALGREEN CO.	DBA: WALGREENS # 03828	2110 SE OCEAN BLVD	STUART	FL	34996	10/01/2017
CH040370	WALGREEN CO.	DBA: WALGREENS #11305	6545 S.KANNER HIGHWAY	STUART	FL	34997	01/01/2020
CH040370	WALGREEN CO.	DBA: WALGREENS #12122	1954 SW GATLIN BLVD	PORT SAINT LUCIE	FL	34953	01/01/2020
CH040370	WALGREEN CO.	WALGREEN #04391	2501 VIRGINIA AVENUE	FORT PIERCE	FL	34981	04/08/2021
CH040370	WALGREEN CO.	DBA: WALGREENS # 04174	3053 SW MARTIN DOWNS BLVD	PALM CITY	FL	34990	10/01/2022
CH040370	WALGREEN CO.	DBA: WALGREENS #12302	9000 S US HWY 1	PORT SAINT LUCIE	FL	34952	10/01/2022
CH04037E	WALGREEN CO.	DBA: WALGREENS #10705	2592 S JENKINS RD	FORT PIERCE	FL	34947	01/01/2024
CH04037C	WALGREEN CO.	DBA: WALGREENS # 04075	100 NW PARK STREET	OKEECHOBEE	FL	34972	01/01/2024
CH04037E	WALGREEN CO.	DBA: WALGREENS # 04727	4950 S US HWY 1	FT PIERCE	FL	34952	01/01/2024
CH04037E	WALGREEN CO.	WALGREEN #04391	2501 VIRGINIA AVENUE	FORT PIERCE	FL	34981	01/01/2024
CH04037E	WALGREEN CO.	DBA: WALGREENS # 10741	1603 SOUTH US 1	FT PIERCE	FL	34950	01/01/2024
CH04037G	WALGREEN CO.	DBA: WALGREENS # 06383	2901 SW PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34953	01/01/2024
CH04037J	WALGREEN CO.	DBA: WALGREENS # 04075	100 NW PARK STREET	OKEECHOBEE	FL	34972	01/01/2024
CH04037G	WALGREEN CO.	DBA: WALGREENS # 03110	692 SW PRIMA VISTA BLVD	PORT ST LUCIE	FL	34983	01/01/2024
CH04037N	WALGREEN CO.	DBA: WALGREENS # 04174	3053 SW MARTIN DOWNS BLVD	PALM CITY	FL	34990	01/01/2024
CH04037L	WALGREEN CO.	DBA: WALGREENS # 06832	5800 SE FEDERAL HWY	STUART	FL	34997	01/01/2024
CH04037G	WALGREEN CO.	DBA: WALGREENS # 05465	1025 SE PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34952	01/01/2024
CH04037L	WALGREEN CO.	DBA: WALGREENS # 05255	3180 SE FEDERAL HWY	STUART	FL	34994	01/01/2024
CH04037G	WALGREEN CO.	DBA: WALGREENS # 05335	7620 SOUTH US HIGHWAY 1	PORT ST LUCIE	FL	34952	01/01/2024
CH04037F	WALGREEN CO.	DBA: WALGREENS # 06016	101 N MAIN ST	BELLE GLADE	FL	33430	01/01/2024
CH04037G	WALGREEN CO.	DBA: WALGREENS #12122	1954 SW GATLIN BLVD	PORT SAINT LUCIE	FL	34953	01/01/2024
CH04037L	WALGREEN CO.	DBA: WALGREENS # 03828	2110 SE OCEAN BLVD	STUART	FL	34996	01/01/2024
CH04037G	WALGREEN CO.	DBA: WALGREENS # 04001	280 SW PORT ST. LUCIE BLVD.	PORT ST LUCIE	FL	34984	01/01/2024
CH04037L	WALGREEN CO.	DBA: WALGREENS #11305	6545 S.KANNER HIGHWAY	STUART	FL	34997	01/01/2024
CH04037G	WALGREEN CO.	DBA: WALGREENS # 04804	1661 NW ST LUCIE WEST BLVD	PORT ST LUCIE	FL	34986	01/01/2024
CH04037G	WALGREEN CO.	DBA: WALGREENS #12302	9000 S US HWY 1	PORT SAINT LUCIE	FL	34952	01/01/2024
CH04037S	WALGREEN CO.	DBA: WALGREENS # 06016	101 N MAIN ST	BELLE GLADE	FL	33430	01/01/2024
CH04037T	WALGREEN CO.	DBA: WALGREENS #10705	2592 S JENKINS RD	FORT PIERCE	FL	34947	01/01/2024
CH04037T	WALGREEN CO.	WALGREEN #04391	2501 VIRGINIA AVENUE	FORT PIERCE	FL	34981	01/01/2024
CH04037T	WALGREEN CO.	DBA: WALGREENS # 04727	4950 S US HWY 1	FT PIERCE	FL	34952	01/01/2024
CH04037R	WALGREEN CO.	DBA: WALGREENS #12302	9000 S US HWY 1	PORT SAINT LUCIE	FL	34952	01/01/2024
CH04037R	WALGREEN CO.	DBA: WALGREENS # 04804	1661 NW ST LUCIE WEST BLVD	PORT ST LUCIE	FL	34986	01/01/2024
CH04037R	WALGREEN CO.	DBA: WALGREENS #12122	1954 SW GATLIN BLVD	PORT SAINT LUCIE	FL	34953	01/01/2024
CH04037R	WALGREEN CO.	DBA: WALGREENS # 04001	280 SW PORT ST. LUCIE BLVD.	PORT ST LUCIE	FL	34984	01/01/2024
CH04037P	WALGREEN CO.	DBA: WALGREENS # 06383	2901 SW PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34953	01/01/2024
CH04037P	WALGREEN CO.	DBA: WALGREENS # 05335	7620 SOUTH US HIGHWAY 1	PORT ST LUCIE	FL	34952	01/01/2024
CH04037Q	WALGREEN CO.	WALGREEN #04391	2501 VIRGINIA AVENUE	FORT PIERCE	FL	34981	01/01/2024
CH04037P	WALGREEN CO.	DBA: WALGREENS # 04804	1661 NW ST LUCIE WEST BLVD	PORT ST LUCIE	FL	34986	01/01/2024
CH04037Q	WALGREEN CO.	DBA: WALGREENS # 10741	1603 SOUTH US 1	FT PIERCE	FL	34950	01/01/2024
CH04037P	WALGREEN CO.	DBA: WALGREENS # 03110	692 SW PRIMA VISTA BLVD	PORT ST LUCIE	FL	34983	01/01/2024
CH04037Q	WALGREEN CO.	DBA: WALGREENS #10705	2592 S JENKINS RD	FORT PIERCE	FL	34947	01/01/2024
CH04037T	WALGREEN CO.	DBA: WALGREENS # 10741	1603 SOUTH US 1	FT PIERCE	FL	34950	01/01/2024
CH04037Q	WALGREEN CO.	DBA: WALGREENS # 04727	4950 S US HWY 1	FT PIERCE	FL	34952	01/01/2024
CH04037P	WALGREEN CO.	DBA: WALGREENS # 04001	280 SW PORT ST. LUCIE BLVD.	PORT ST LUCIE	FL	34984	01/01/2024
CH04037P	WALGREEN CO.	DBA: WALGREENS #12122	1954 SW GATLIN BLVD	PORT SAINT LUCIE	FL	34953	01/01/2024
CH04037R	WALGREEN CO.	DBA: WALGREENS # 05335	7620 SOUTH US HIGHWAY 1	PORT ST LUCIE	FL	34952	01/01/2024
CH04037P	WALGREEN CO.	DBA: WALGREENS #12302	9000 S US HWY 1	PORT SAINT LUCIE	FL	34952	01/01/2024
CH04037P	WALGREEN CO.	DBA: WALGREENS # 05465	1025 SE PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34952	01/01/2024
CH04037R	WALGREEN CO.	DBA: WALGREENS # 05465	1025 SE PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34952	01/01/2024
CH04037R	WALGREEN CO.	DBA: WALGREENS # 06383	2901 SW PORT ST LUCIE BLVD	PORT ST LUCIE	FL	34953	01/01/2024
CH040370	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	01/01/2023
CH040370	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	06/30/2015
CH040370	WALMART PHARMACY #10-6190	1951 W HICKPOCHEE AVE		LABELLE	FL	33935	10/01/2016	12/16/2023
CH040370	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH040370	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 6:04:16 PM	2/13/2025 10:05:37 AM	2/13/2025 10:05 AM
Details	Last Recertification Date	Update	Recertification	2/9/2023 5:16:05 PM	1/30/2024 6:04:16 PM	1/30/2024 6:04 PM
Details	Last Recertification Date	Update	Recertification	2/4/2022 11:39:35 AM	2/9/2023 5:16:05 PM	2/9/2023 5:16 PM
Details	Last Recertification Date	Update	Recertification	2/23/2021 9:01:38 AM	2/4/2022 11:39:35 AM	2/4/2022 11:39 AM
Contacts	Primary Contact	Update	Profile Change Request	DAVIS, MELISSA ALLEN PHARMACY DIRECTOR Florida Community Health Centers, Inc 7724626520	DAVIS, MELISSA ALLEN 340B Program Coordinator Florida Community Health Centers, Inc 7724626520	11/24/2021 11:25 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1205886223 ( )		2/23/2021 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205886223	2/23/2021 9:01 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	2/23/2021 9:01 AM
Details	Last Recertification Date	Update	Recertification	2/12/2020 4:19:33 PM	2/23/2021 9:01:38 AM	2/23/2021 9:01 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 10:12:45 AM	2/12/2020 4:19:33 PM	2/12/2020 4:19 PM
Details	Last Recertification Date	Update	Recertification	3/1/2018 10:15:51 AM	1/30/2019 10:12:45 AM	1/30/2019 10:12 AM
Contacts	Authorizing Official	Update	AO Change Request	AMATO, KATHY VICE PRESIDENT & CFO Florida Community Health Centers, Inc. 5618449443-311	Russell, Margaret Virginia VP & CFO Florida Community Health Center, Inc. 5618449443-1003	4/24/2018 10:42 AM
Contacts	Primary Contact	Update	Recertification	AMATO, KATHY VICE PRESIDENT & CFO Florida Community Health Centers, Inc. 5618449443-311	DAVIS, MELISSA ALLEN PHARMACY DIRECTOR Florida Community Health Centers, Inc 7724626520	3/1/2018 10:15 AM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	3/1/2018 10:15:51 AM	3/1/2018 10:15 AM
Contacts	Authorizing Official	Update		AMATO, KATHY VICE PRESIDENT & CFO 5618449443-311	AMATO, KATHY VICE PRESIDENT & CFO Florida Community Health Centers, Inc. 5618449443-311	11/13/2017 8:05 AM
Contacts	Primary Contact	Update		AMATO, KATHY VICE PRESIDENT & CFO 5618449443-311	AMATO, KATHY VICE PRESIDENT & CFO Florida Community Health Centers, Inc. 5618449443-311	11/13/2017 8:05 AM
Contacts	Authorizing Official	Update		BROWN, EDWIN W. CEO 5618449443-305	AMATO, KATHY VICE PRESIDENT & CFO 5618449443-311	7/28/2017 11:00 AM
Contacts	Primary Contact	Insert			AMATO, KATHY VICE PRESIDENT & CFO 5618449443-311	7/28/2017 11:00 AM
Addresses	Main Address	Insert			15858 SW WARFIELD BLVD INDIANTOWN, FL 34956	1/25/2017 8:11 AM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 8:11 AM
Details	Last Recertification Date	Update		1/29/2015 12:00:00 AM	2/12/2016 12:00:00 AM	2/12/2016 8:12 AM
Details	Last Recertification Date	Update		2/12/2014 12:00:00 AM	1/29/2015 12:00:00 AM	1/29/2015 10:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	12/10/2014 12:54 PM
Medicaid Billing	Medicaid: Number	Insert			060144600	12/10/2014 12:54 PM
Medicaid Billing	Medicaid: State	Insert			FL	12/10/2014 12:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	12/5/2014 4:30 PM
Medicaid Billing	Medicaid: Number	Insert			029574403	12/5/2014 4:30 PM
Medicaid Billing	Medicaid: State	Insert			FL	12/5/2014 4:30 PM
Medicaid Billing	NPI: Number	Insert			1205886223	12/5/2014 4:30 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/12/2014 12:00:00 AM	2/12/2014 4:55 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/6/2013 8:27 AM
Dates	Participating Approval Date	Update		2/1/2005 6:46:52 AM	2/1/2005 12:00:00 AM	7/23/2012 2:48 PM
Contacts	Authorizing Official	Insert			BROWN, EDWIN W. CEO 5618449443-305	1/22/2010 3:36 PM
Details	Last Recertification Date	Insert				2/1/2005 6:46 AM
Details	Grant Number	Insert			H80CS00798	2/1/2005 6:46 AM
Details	340B ID	Insert			CH04037A	2/1/2005 6:46 AM
Details	Is Authorizing Official EHB Data	Insert				2/1/2005 6:46 AM
Dates	Last Date That 340B Drugs Purchased	Insert				2/1/2005 6:46 AM
Details	Medicare Provider Number	Insert				2/1/2005 6:46 AM
Details	Entity Name	Insert			FLORIDA CHCS, INC.	2/1/2005 6:46 AM
Details	Program Code	Insert			CH	2/1/2005 6:46 AM
Details	Entity Subname	Insert			INDIANTOWN COMMUNITY HEALTH CENTER	2/1/2005 6:46 AM
Dates	Participating Approval Date	Insert			2/1/2005 6:46:52 AM	2/1/2005 6:46 AM
Details	State	Insert			Active	2/1/2005 6:46 AM
Dates	Registration Date	Insert			12/1/1992 12:00:00 AM	2/1/2005 6:46 AM
Dates	Signed By Date	Insert				2/1/2005 6:46 AM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	2/1/2005 6:46 AM
Terminations	Termination Comments	Insert				2/1/2005 6:46 AM
Terminations	Termination Date	Insert				2/1/2005 6:46 AM
Terminations	Termination Effective Date	Insert				2/1/2005 6:46 AM
Terminations	Termination Reason	Insert				2/1/2005 6:46 AM
Details	Comments Public	Insert			CORRECTED ENTITY NAME, 2/1/05 - NEW CONTACT INFO	2/1/2005 6:46 AM

340B Drug Pricing Program Database