| Details | Last Recertification Date | Update | Recertification | 2/1/2024 11:58:28 AM | 2/24/2025 9:56:02 AM | 2/24/2025 9:56 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2023 6:25:33 PM | 2/1/2024 11:58:28 AM | 2/1/2024 11:58 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2022 8:29:44 PM | 2/1/2023 6:25:33 PM | 2/1/2023 6:25 PM |
| Addresses | Main Address | Update | Recertification |
1229 NW 40th Avenue # 47
Lauderhill, FL 33313-5801 |
1295 NW 40th Ave
200
Lauderhill, FL 33313-5801 | 2/7/2022 8:29 PM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2021 3:32:52 PM | 2/7/2022 8:29:44 PM | 2/7/2022 8:29 PM |
| Details | Entity Subname | Update | Recertification | Central Broward Community Health Center | Broward Community and Family Health Center - Lauderhill | 2/7/2022 8:29 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2020 4:10:39 PM | 2/5/2021 3:32:52 PM | 2/5/2021 3:32 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 3:24:34 PM | 1/30/2020 4:10:39 PM | 1/30/2020 4:10 PM |
| Contacts | Primary Contact | Update | Recertification | Pruitt, Victoria
Director of Risk Managment
BROWARD COMMUNITY AND FAMILY HEALTH CENTER
9542662999 | PARDIEU, BERTHOLETTE
DIRECTOR OF RISK MANAGEMENT
BROWARD COMMUNITY AND FAMILY HEALTH CENTERS
9542662999 | 1/29/2019 3:24 PM |
| Details | Last Recertification Date | Update | Recertification | 2/15/2018 2:26:57 PM | 1/29/2019 3:24:34 PM | 1/29/2019 3:24 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 1/29/2019 3:24 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2017 12:00:00 AM | 2/15/2018 2:26:57 PM | 2/15/2018 2:26 PM |
| Contacts | Primary Contact | Update | Recertification | Pruitt, Victoria
Director of Risk Managment
9542662999 | Pruitt, Victoria
Director of Risk Managment
BROWARD COMMUNITY AND FAMILY HEALTH CENTER
9542662999 | 2/15/2018 2:00 PM |
| Contacts | Authorizing Official | Update | | FRAZIER, ROSALYN
CEO
9542662999 | FRAZIER, ROSALYN
CEO
Broward Community & Family Health Centers, Inc.
9542662999 | 10/2/2017 1:53 PM |
| Contacts | Signed By | Update | | FRAZIER, ROSALYN
CEO
9542662999 | FRAZIER, ROSALYN
CEO
Broward Community & Family Health Centers, Inc.
9542662999 | 10/2/2017 1:53 PM |
| Contacts | Authorizing Official | Insert | | | FRAZIER, ROSALYN
CEO
9542662999 | 7/18/2017 8:28 AM |
| Contacts | Signed By | Insert | | | FRAZIER, ROSALYN
CEO
9542662999 | 7/18/2017 8:28 AM |
| Addresses | Main Address | Insert | | |
1229 NW 40th Avenue # 47
Lauderhill, FL 33313-5801 | 2/1/2017 12:36 PM |
| Contacts | Primary Contact | Insert | | | Pruitt, Victoria
Director of Risk Managment
9542662999 | 2/1/2017 12:36 PM |
| Details | Last Recertification Date | Update | | 2/16/2016 12:00:00 AM | 2/1/2017 12:00:00 AM | 2/1/2017 12:36 PM |
| Details | Last Recertification Date | Update | | 2/10/2015 12:00:00 AM | 2/16/2016 12:00:00 AM | 2/16/2016 11:26 AM |
| Details | Last Recertification Date | Update | | | 2/10/2015 12:00:00 AM | 2/10/2015 3:45 PM |
| Details | Is Authorizing Official EHB Data | Update | | | False | 2/10/2015 3:45 PM |
| Details | 340B ID | Update | | ONLINE_REG | CH041531D | 1/14/2014 12:21 PM |
| Dates | Participating Approval Date | Update | | | 1/14/2014 12:00:00 AM | 1/14/2014 12:21 PM |
| Details | State | Update | | Pending | Active | 1/14/2014 12:21 PM |
| Dates | Start Date | Update | | | 4/1/2014 12:00:00 AM | 1/14/2014 12:21 PM |
| Details | Last Recertification Date | Insert | | | | 1/9/2014 4:07 PM |
| Details | Grant Number | Insert | | | H80CS00596 | 1/9/2014 4:07 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/9/2014 4:07 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/9/2014 4:07 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/9/2014 4:07 PM |
| Details | Medicare Provider Number | Insert | | | | 1/9/2014 4:07 PM |
| Details | Entity Name | Insert | | | BROWARD COMMUNITY AND FAMILY HEALTH CENTERS, INC | 1/9/2014 4:07 PM |
| Details | Program Code | Insert | | | CH | 1/9/2014 4:07 PM |
| Details | Entity Subname | Insert | | | Central Broward Community Health Center | 1/9/2014 4:07 PM |
| Dates | Participating Approval Date | Insert | | | | 1/9/2014 4:07 PM |
| Details | State | Insert | | | Pending | 1/9/2014 4:07 PM |
| Dates | Registration Date | Insert | | | 1/9/2014 12:00:00 AM | 1/9/2014 4:07 PM |
| Dates | Signed By Date | Insert | | | 1/9/2014 12:00:00 AM | 1/9/2014 4:07 PM |
| Dates | Start Date | Insert | | | | 1/9/2014 4:07 PM |
| Terminations | Termination Comments | Insert | | | | 1/9/2014 4:07 PM |
| Terminations | Termination Date | Insert | | | | 1/9/2014 4:07 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/9/2014 4:07 PM |
| Terminations | Termination Reason | Insert | | | | 1/9/2014 4:07 PM |