Covered Entity Details

CH04032BA COMMUNITY HEALTH SOUTH FLORIDA, INC. (Terminated) - information as of 4/26/2025 11:41:07 PM

Main Details

Name

COMMUNITY HEALTH SOUTH FLORIDA, INC.

Subdivision Name

George Washington Carver Middle School

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014026

340B ID

CH04032BA

Grant Number

H80CS00821

Additional Details

Current Program Status

Terminated

Registration Date

10/15/2014

Participating Start Date

1/1/2015

Participating Approval Date

10/22/2014

Last Recertification Date

3/1/2016

Termination Date
Termination Reason

4/1/2016
Loss of qualifying grant/support

Contacts

Authorizing Official

Community Health of South FL, inc
Brodes H. Hartley, President/CEO
(305) 252-4853

Primary Contact

Community Health of South FL, inc
Toni Bowen-McDuffey, Director of Pharmacy
(305) 525-1509

Addresses

Street Address

4901 LINCOLN DR
MIAMI, FL 33133-5635

Billing Address

Community Health of South FL, Inc
10300 SW 216th St
Miami, FL 33190

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

Comments

Comment	Last Updated On
No records to display.

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	010762313
		1992128300

Shipping Addresses

Shipping Address 1

Community Health of South FL, Inc
10300 SW 216th St
Miami, FL 33190

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH040320	Active	BPS-H80-003441	COMMUNITY HEALTH OF SOUTH FL, INC	DORIS ISON COMMUNITY HEALTH CENTER	10300 S.W. 216TH ST.	MIAMI	FL
CH04032AA	Active	BPS-H80-007655	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Avocado Elementary	16969 SW 294th St	Homestead	FL
CH04032AB	Active	BPS-H80-004494	COMMUNITY HEALTH SOUTH FLORIDA, INC.	West Homestead K-8 Center	1550 SW 6th St	Homestead	FL
CH04032AC	Active	BPS-H80-004501	COMMUNITY HEALTH SOUTH FLORIDA, INC.	SOUTH DADE HEALTH CENTER	13600 SW 312th St	Homestead	FL
CH04032AD	Active	BPS-H80-005420	COMMUNITY HEALTH SOUTH FLORIDA, INC.	South Dade Senior High School	28401 SW 167th Ave	Homestead	FL
CH04032AE	Active	BPS-H80-007604	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Leisure City K-8 Center	14950 SW 288th St	Homestead	FL
CH04032AF	Active	BPS-H80-007643	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Homestead Middle School	650 NW 2nd Ave	Homestead	FL
CH04032AG	Terminated	BPS-H80-007646	COMMUNITY HEALTH SOUTH FLORIDA, INC.	AIRBASE ELEMENTARY	12829 SW 272nd St	Homestead	FL
CH04032AH	Active	BPS-H80-007654	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Redondo Elementary	18480 SW 304th St	Homestead	FL
CH04032AJ	Active	BPS-H80-001306	COMMUNITY HEALTH SOUTH FLORIDA, INC.	WEST PERRINE HEALTH CENTER	18225 Homestead Ave.	Perrine	FL
CH04032AK	Terminated	BPS-H80-001040	COMMUNITY HEALTH SOUTH FLORIDA, INC.	WEST MIAMI MIDDLE SBHC	7525 Coral Way	Miami	FL
CH04032AL	Terminated	BPS-H80-003329	COMMUNITY HEALTH SOUTH FLORIDA, INC.	CAMPBELL DRIVE MIDDLE SBHC	900 NE 23rd Ave	Homestead	FL
CH04032AM	Active	BPS-H80-007642	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Florida City Elementary	364 NW 6th Ave	Florida City	FL
CH04032AN	Terminated	BPS-H80-014079	COMMUNITY HEALTH SOUTH FLORIDA, INC.	South Miami Middle School	6750 SW 60TH ST	MIAMI	FL
CH04032AP	Terminated	BPS-H80-014076	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Sunset Elementary	5120 SUNSET DR	MIAMI	FL
CH04032AQ	Terminated	BPS-H80-014074	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Ethel F. Beckford / Richmond Elementary	16929 SW 104th Ave	Miami	FL
CH04032AR	Terminated	BPS-H80-014055	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Silver Bluff Elementary	2609 SW 25TH ST	MIAMI	FL
CH04032AS	Terminated	BPS-H80-014070	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Sylvannia Heights Elementary	5901 SW 16TH ST	MIAMI	FL
CH04032AT	Terminated	BPS-H80-014053	COMMUNITY HEALTH SOUTH FLORIDA, INC.	South Miami Senior High School	6856 SW 53RD ST	MIAMI	FL
CH04032AU	Terminated	BPS-H80-014052	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Ludlum Elementary	6639 SW 74TH ST	MIAMI	FL
CH04032AV	Active	BPS-H80-014048	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Zora Neale Hurston Elementary School	13137 SW 26TH ST	MIAMI	FL
CH04032AW	Active	BPS-H80-014043	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Gateway Environmental K-8 Learning Center	955 SE 18TH AVE	HOMESTEAD	FL
CH04032AX	Active	BPS-H80-014035	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Irving & Beatrice Peskoe K-8 Center	29035 SW 144th Ave	Homestead	FL
CH04032AY	Terminated	BPS-H80-014034	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Coconut Grove Elementary	3351 MATILDA ST	MIAMI	FL
CH04032AZ	Terminated	BPS-H80-014028	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Ponce De Leon Middle School	5801 AUGUSTO ST	CORAL GABLES	FL
CH04032B	Active	BPS-H80-001258	COMMUNITY HEALTH OF SOUTH FL, INC	MARTIN LUTHER KING, JR. CLINICA CAMPESINA	810 W. Mowry Drive	Homestead	FL
CH04032BA	Terminated	BPS-H80-014026	COMMUNITY HEALTH SOUTH FLORIDA, INC.	George Washington Carver Middle School	4901 LINCOLN DR	MIAMI	FL
CH04032BB	Terminated	BPS-H80-014025	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Francis S. Tucker Elementary	3500 S DOUGLAS RD	MIAMI	FL
CH04032BC	Terminated	BPS-H80-014021	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Coral Gables Senior High School	450 BIRD RD	CORAL GABLES	FL
CH04032BD	Active	BPS-H80-013429	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Tavernier Health Center	91200 Overseas Hwy	Tavernier	FL
CH04032BE	Active	BPS-H80-012787	COMMUNITY HEALTH SOUTH FLORIDA, INC.	SOUTH MIAMI HEALTH CENTER	6350 Sunset Dr	Miami	FL
CH04032BF	Active	BPS-H80-015036	COMMUNITY HEALTH SOUTH FLORIDA, INC.	West Kendall Health Center	13540 SW 135TH AVE	Miami	FL
CH04032BG	Active	BPS-H80-030840	Community Health South Florida, Inc.	Mobile Medical Van #2	10300 SW 216th St	Miami	FL
CH04032BH	Active	BPS-H80-018192	Community Health South Florida, Inc.	Mobile Van #1	10300 SW 216th St	Cutler Bay	FL
CH04032BJ	Active	BPS-H80-019720	Community Health South Florida, Inc.	Goulds Elementary School	23555 SW 112th Ave	Homestead	FL
CH04032BK	Active	BPS-H80-019715	Community Health South Florida, Inc.	Dante B. Fascell Elementary School	15626 SW 80th St	Miami	FL
CH04032BL	Active	BPS-H80-019718	Community Health South Florida, Inc.	JANE ROBERTS ELEMENTARY K-8	14850 Cottonwood Cir	Miami	FL
CH04032BM	Active	BPS-H80-019714	Community Health South Florida, Inc.	Marjory Stoneman Douglas Elementary School (3-5)	11901 SW 2nd St	Miami	FL
CH04032BN	Active	BPS-H80-019721	Community Health South Florida, Inc.	Marjory Stoneman Douglas Elementary School (K)	650 NW 132nd Ave	Miami	FL
CH04032BP	Active	BPS-H80-033509	Community Health South Florida, Inc.	Miami Southridge Senior High School	19355 SW 114th Ave	Miami	FL
CH04032BQ	Active	BPS-H80-019717	Community Health South Florida, Inc.	Marjory Stoneman Douglas Elementary School (Pre K, 1rst and 2nd)	11901 SW 2nd Street Site 2	Miami	FL
CH04032BR	Active	BPS-H80-019716	Community Health South Florida, Inc.	Bent Tree Elementary School	4861 SW 140th Ave	Miami	FL
CH04032BS	Active	BPS-H80-022331	Community Health South Florida, Inc.	Cutler Bay Middle School	19400 Gulfstream Rd	Cutler Bay	FL
CH04032BT	Active	BPS-H80-019719	Community Health South Florida, Inc.	Paul W. Bell Middle School	11800 NW 2nd St	Miami	FL
CH04032BU	Active	BPS-H80-032574	Community Health South Florida, Inc.	Key West Health Center	727 Fort St	Key West	FL
CH04032BV	Active	BPS-H80-031124	COMMUNITY HEALTH OF SOUTH FLORIDA, INC.	Marathon Health Center	2805 Overseas Highway	Marathon	FL
CH04032BW	Active	BPS-H80-032768	COMMUNITY HEALTH OF SOUTH FLORIDA, INC.	Hammocks Health Center	14591 SW 120th St	Miami	FL
CH04032BX	Approved	BPS-H80-033874	COMMUNITY HEALTH OF SOUTH FLORIDA, INC.	Key Largo Health Center	228 Atlantic Blvd	Key Largo	FL
CH04032C	Active	BPS-H80-002982	COMMUNITY HEALTH OF SOUTH FL, INC	NARANJA HEALTH CENTER	13805 SW 264th Street	Naranja	FL
CH04032D	Active	BPS-H80-002755	COMMUNITY HEALTH OF SOUTH FL, INC	MARATHON HEALTH CENTER	2805 OVERSEAS HIGHWAY	MARATHON	FL
CH04032E	Terminated	BPS-H80-000095	COMMUNITY HEALTH SOUTH FLORIDA, INC.	LAURA C. SAUNDERS ELEM. SCHOOL	505 SW 8TH ST	HOMESTEAD	FL
CH04032F	Active	BPS-H80-000187	COMMUNITY HEALTH SOUTH FLORIDA, INC.	MARTIN L. KING, JR.- ANNEX	820 SW 1st St	Homestead	FL
CH04032G	Active	BPS-H80-000655	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Bowman Ashe / Doolin K-8 Lower Academy	6601 SW 152nd Ave	Miami	FL
CH04032H	Active	BPS-H80-000738	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Robert Russa Moton Elementary	18050 HOMESTEAD AVE	PERRINE	FL
CH04032J	Active	BPS-H80-001199	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Colonial Drive Elementary	10755 SW 160th St	Miami	FL
CH04032K	Active	BPS-H80-001284	COMMUNITY HEALTH SOUTH FLORIDA, INC.	EVERGLADES HEALTH CENTER	19300 SW 376TH ST	FLORIDA CITY	FL
CH04032L	Terminated	BPS-H80-001466	COMMUNITY HEALTH SOUTH FLORIDA, INC.	BRADDOCK SENIOR SBHC	3601 SW 147th Ave	Miami	FL
CH04032M	Active	BPS-H80-001499	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Campbell Drive K-8 Center	15790 SW 307th St	Homestead	FL
CH04032N	Active	BPS-H80-001781	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Dr. William A. Chapman Elementary	27190 SW 140th Ave.	Homestead	FL
CH04032P	Active	BPS-H80-003349	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Homestead Senior High School	2351 SE 12th Ave.	Homestead	FL
CH04032Q	Active	BPS-H80-003456	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Dorothy M. Wallace COPE Center	10225 SW 147th Ter	Miami	FL
CH04032R	Active	BPS-H80-012655	COMMUNITY HEALTH SOUTH FLORIDA, INC.	COCONUT GROVE HEALTH CENTER	3831 Grand Ave	Miami	FL
CH04032S	Terminated	BPS-H80-012228	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Howard A. Doolin Middle School	6401 SW 152nd Ave	Miami	FL
CH04032T	Active	BPS-H80-007656	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Howard D. McMillan Middle School	13100 SW 59th St	Miami	FL
CH04032U	Active	BPS-H80-007648	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Royal Green Elementary	13047 SW 47th St	Miami	FL
CH04032V	Terminated	BPS-H80-007645	COMMUNITY HEALTH SOUTH FLORIDA, INC.	FLAGAMI ELEMENTARY SCHOOL	920 SW 76th Ave	Miami	FL
CH04032W	Active	BPS-H80-005385	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Herbert A. Ammons Middle School	17990 SW 142nd Ave	Miami	FL
CH04032X	Active	BPS-H80-005476	COMMUNITY HEALTH SOUTH FLORIDA, INC.	John Ferguson Senior High School	15900 SW 56th St	Miami	FL
CH04032Y	Active	BPS-H80-007637	COMMUNITY HEALTH SOUTH FLORIDA, INC.	South Wood Middle School	16301 SW 80th Ave	Palmetto Bay	FL
CH04032Z	Active	BPS-H80-007638	COMMUNITY HEALTH SOUTH FLORIDA, INC.	Dr. Henry E. Perrine Academy of the Arts	8851 SW 168th St	Palmetto Bay	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
CH040320	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2024
CH040320	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2024
CH040320	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2024
CH040320	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2024
CH040320	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2024
CH040320	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2024
CH040320	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2024
CH040320	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2024
CH040320	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2024
CH040320	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2024
CH040320	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2024
CH040320	CCN AMERICA, LP	COORDINATED CARE NETWORK PHARMACY	1500 W CYPRESS CREEK RD STE 203	FT LAUDERDALE	FL	33309	01/01/2018
CH040320	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	07/01/2015
CH040320	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2024
CH040320	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2024
CH040320	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2024
CH040320	GENOA HEALTHCARE LLC	5711 SOUTH DIXIE HIGHWAY		MIAMI	FL	33143	07/01/2024
CH040320	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00113	2780 NE 8TH ST.	HOMESTEAD	FL	33033	07/01/2024
CH040320	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01136	909 N HOMESTEAD BLVD	HOMESTEAD	FL	33030	07/01/2024
CH040320	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10724	2614 NE 10 COURT	HOMESTEAD	FL	33033	04/01/2025
CH040320	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05118	28740 S DIXIE HWY	HOMESTEAD	FL	33033	04/01/2025
CH040320	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05136	11398 QUAIL ROOST DR	MIAMI	FL	33157	04/01/2025
CH040320	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 08000	24799 SW 112TH AVE.	HOMESTEAD	FL	33032	04/01/2025
CH040320	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03765	19198 S DIXIE HWY	CUTLER BAY	FL	33157	04/01/2025
CH040320	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04994	3215 GRAND AVE.	COCONUT GROVE	FL	33133	04/01/2025
CH040320	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05126	11221 SW 152ND ST	MIAMI	FL	33157	04/01/2025
CH040320	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2024
CH040320	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2024
CH040320	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2024
CH040320	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	07/01/2024
CH040320	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	07/01/2024
CH040320	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1136	2950 NE 8TH ST	HOMESTEAD	FL	33033-5694	07/01/2024
CH040320	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2024
CH040320	WAL-MART PHARMACY #10-5912	21151 S DIXIE HWY		MIAMI	FL	33189	04/01/2024
CH040320	WAL-MART PHARMACY 10-2727	33501 S. DIXIE HIGHWAY		FLORIDA CITY	FL	33034	04/01/2024
CH040320	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2024
CH040320	WALGREEN CO	DBA: WALGREENS #10356	13680 SW 88TH ST	MIAMI	FL	33186	07/01/2024
CH040320	WALGREEN CO	DBA: WALGREENS #09401	15711 SW 152ND ST	MIAMI	FL	33187-5417	07/01/2024
CH040320	WALGREEN CO	DBA: WALGREENS #10470	16795 S DIXIE HWY	MIAMI	FL	33157	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #11880	6701 MILLER DR	MIAMI	FL	33155	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #11482	1820 N. CANAL DR.	HOMESTEAD	FL	33035	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 05250	1699 NW 7TH ST	MIAMI	FL	33125	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 03943	200 SW 13TH ST	MIAMI	FL	33130	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 04809	3595 CORAL WAY	MIAMI	FL	33145	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 03574	10870 OVERSEAS HIGHWAY	MARATHON	FL	33050	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #11920	12711 SW 200TH ST	MIAMI	FL	33177	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 03565	18590 SOUTH DIXIE HWY.	CUTLER BAY	FL	33157-6818	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 09361	3090 NE 43RD AVE	HOMESTEAD	FL	33033-3028	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 04808	20340 OLD CUTLER RD	CUTLER BAY	FL	33189	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 09572	11211 S DIXIE HWY	PINECREST	FL	33156-4441	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #12723	23201 SW 112TH AVE.	HOMESTEAD	FL	33032	07/01/2024
CH040320	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21155	5966 S DIXIE HWY STE 103B	SOUTH MIAMI	FL	33143	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 07533	12630 SW 120TH STREET	MIAMI	FL	33186	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 07309	15701 SW 56TH STREET	MIAMI	FL	33185-4184	07/01/2024
CH040320	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13849	2540 NE 15TH AVE	WILTON MANORS	FL	33305	07/01/2024
CH040320	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15106	1250 NW 7TH STREET SUITE 205	MIAMI	FL	33125	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 10900	3490 BIRD RD	MIAMI	FL	33133	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 04654	861 NE 8TH STREET	HOMESTEAD	FL	33030	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 06603	16690 SW 88TH STREET	MIAMI	FL	33196	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 03784	3655 S DIXIE HWY	MIAMI	FL	33133	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #10264	28875 S. DIXIE HWY	HOMESTEAD	FL	33033	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 01600	14720 N KENDALL DR	MIAMI	FL	33196	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #11938	10700 W FLAGLER ST	MIAMI	FL	33174	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 07458	11190 SW 88TH STREET	MIAMI	FL	33176	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 07089	527 DUVAL STREET	KEY WEST	FL	33040	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 09788	2800 NE 8TH STREET	HOMESTEAD	FL	33033	07/01/2024
CH040320	WALGREEN CO.	DBA WALGREENS #16543	5555 PONCE DE LEON BLVD. SUITE 186	CORAL GABLES	FL	33146	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 11939	8450 CORAL WAY	MIAMI	FL	33155	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 04917	690 NW 183RD ST	MIAMI GARDENS	FL	33169	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 02832	4010 S W 137TH AVE	MIAMI	FL	33175	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 03854	15900 NW 27TH AVE	OPA LOCKA	FL	33054	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 00748	12295 BISCAYNE BLVD	NORTH MIAMI	FL	33181	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 04385	770 W 29TH ST	HIALEAH	FL	33012	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 03211	9675 NW 41ST STREET	DORAL	FL	33178-2974	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #09018	1155 W. 68TH ST	HIALEAH	FL	33014-5152	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #11481	52 EAST PALM DRIVE	FLORIDA CITY	FL	33034	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 03721	15255 SW 137TH AVENUE	MIAMI	FL	33177	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 03318	11690 SW 72ND ST	MIAMI	FL	33173	07/01/2024
CH040320	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15299	1201 NE 26TH ST STE 110	WILTON MANORS	FL	33305	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS #10793	15705 SW 72ND ST	MIAMI	FL	33193	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 06407	99501 OVERSEAS HWY	KEY LARGO	FL	33037-2459	07/01/2024
CH040320	WALGREEN CO.	DBA: WALGREENS # 05696	14501 MIRAMAR PARKWAY	MIRAMAR	FL	33027	07/01/2024
CH040320	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	07/01/2024
CH040320	WALMART PHARMACY #10-3183	1499 SOUTH DIXIE HWY		HOMESTEAD	FL	33033	04/01/2024
CH040320	WALMART PHARMACY #10-5671	13600 SW 288TH ST		HOMESTEAD	FL	33033	04/01/2024
CH040320	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2024
CH040320	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Hartley, Brodes H. President/CEO 3052524853	Hartley, Brodes H. President/CEO Community Health of South FL, inc 3052524853	2/26/2018 12:19 PM
Contacts	Signed By	Update	Hartley, Brodes H. President/CEO 3052524853	Hartley, Brodes H. President/CEO Community Health of South FL, inc 3052524853	2/26/2018 12:19 PM
Contacts	Primary Contact	Update	Bowen-McDuffey, Toni Director of Pharmacy 3055251509	Bowen-McDuffey, Toni Director of Pharmacy Community Health of South FL, inc 3055251509	2/26/2018 12:07 PM
Contacts	Authorizing Official	Insert		Hartley, Brodes H. President/CEO 3052524853	2/16/2017 1:44 PM
Contacts	Signed By	Insert		Hartley, Brodes H. President/CEO 3052524853	2/16/2017 1:44 PM
Contacts	Primary Contact	Insert		Bowen-McDuffey, Toni Director of Pharmacy 3055251509	2/16/2017 1:44 PM
Details	Last Recertification Date	Update	3/3/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 10:56 AM
Dates	Last Date That 340B Drugs Purchased	Update		6/4/2015 12:00:00 AM	3/1/2016 10:56 AM
Details	State	Update	Active	Terminated	3/1/2016 10:56 AM
Terminations	Termination Comments	Update		This school based site was removed from the grant/contract at the end of the school year.	3/1/2016 10:56 AM
Terminations	Termination Date	Update		4/1/2016 12:00:00 AM	3/1/2016 10:56 AM
Terminations	Termination Effective Date	Update		6/4/2015 12:00:00 AM	3/1/2016 10:56 AM
Terminations	Termination Reason	Update		Loss of qualifying grant/support	3/1/2016 10:56 AM
Addresses	Main Address	Insert		4901 LINCOLN DR MIAMI, FL 33133-5635	3/1/2016 10:56 AM
Addresses	Billing Address	Insert		Community Health of South FL, Inc 10300 SW 216th St Miami, FL 33190	3/3/2015 10:50 AM
Addresses	Shipping Address	Insert		Community Health of South FL, Inc 10300 SW 216th St Miami, FL 33190	3/3/2015 10:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert		False	3/3/2015 10:50 AM
Medicaid Billing	Medicaid: Number	Insert		010762313	3/3/2015 10:50 AM
Medicaid Billing	Medicaid: State	Insert		FL	3/3/2015 10:50 AM
Medicaid Billing	NPI: Number	Update	1336152347	1992128300	3/3/2015 10:50 AM
Details	Last Recertification Date	Update		3/3/2015 12:00:00 AM	3/3/2015 10:50 AM
Dates	Participating Approval Date	Update		10/22/2014 12:00:00 AM	10/22/2014 6:12 PM
Details	State	Update	Pending	Active	10/22/2014 6:12 PM
Dates	Start Date	Update		1/1/2015 12:00:00 AM	10/22/2014 6:12 PM
Details	340B ID	Update	ONLINE_REG_47576	CH04032BA	10/20/2014 12:18 PM
Details	340B ID	Update	ONLINE_REG	ONLINE_REG_47576	10/15/2014 3:51 PM
Medicaid Billing	NPI: Number	Insert		1336152347	10/15/2014 3:51 PM
Details	Last Recertification Date	Insert			10/15/2014 3:51 PM
Details	Grant Number	Insert		H80CS00821	10/15/2014 3:51 PM
Details	340B ID	Insert		ONLINE_REG	10/15/2014 3:51 PM
Details	Is Authorizing Official EHB Data	Insert		False	10/15/2014 3:51 PM
Dates	Last Date That 340B Drugs Purchased	Insert			10/15/2014 3:51 PM
Details	Medicare Provider Number	Insert			10/15/2014 3:51 PM
Details	Entity Name	Insert		COMMUNITY HEALTH SOUTH FLORIDA, INC.	10/15/2014 3:51 PM
Details	Program Code	Insert		CH	10/15/2014 3:51 PM
Details	Entity Subname	Insert		George Washington Carver Middle School	10/15/2014 3:51 PM
Dates	Participating Approval Date	Insert			10/15/2014 3:51 PM
Details	State	Insert		Pending	10/15/2014 3:51 PM
Dates	Registration Date	Insert		10/15/2014 12:00:00 AM	10/15/2014 3:51 PM
Dates	Signed By Date	Insert		10/15/2014 12:00:00 AM	10/15/2014 3:51 PM
Dates	Start Date	Insert			10/15/2014 3:51 PM
Terminations	Termination Comments	Insert			10/15/2014 3:51 PM
Terminations	Termination Date	Insert			10/15/2014 3:51 PM
Terminations	Termination Effective Date	Insert			10/15/2014 3:51 PM
Terminations	Termination Reason	Insert			10/15/2014 3:51 PM

340B Drug Pricing Program Database