Covered Entity Details

CH041294K NORTH BROWARD HOSPITAL DISTRICT (Active) - information as of 4/29/2025 2:51:00 AM

Main Details

Name

NORTH BROWARD HOSPITAL DISTRICT

Subdivision Name

Bernard P. Alicki Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-000124

340B ID

CH041294K

Grant Number

H80CS00019

Additional Details

Current Program Status

Active

Registration Date

1/8/2015

Participating Start Date

4/1/2015

Participating Approval Date

1/22/2015

Last Recertification Date

2/28/2025

Contacts

Authorizing Official

North Broward Hospital District DBA Broward Health
Alisa Bert, Interim CFO/VP Financial Operations
(954) 847-7483

Primary Contact

North Broward Hospital District dba Broward Health
Dave A Lacknauth, Executive Director of Pharmacy Services
(954) 473-7078

Addresses

Street Address

1101 W Broward Blvd
Fort Lauderdale, FL 33312-1638

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
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	022454500,001919400,021748400,253794022,113196317	1134164965,1699709766,1699703660,1225073034

Shipping Addresses

Shipping Address 1

Broward Health Cora E. Braynon Family Health Center Pharmacy
200 NW 7th Avenue
Fort Lauderdale, FL 33311

Shipping Address 2

Broward Health Annie L. Weaver Health Center Pharmacy
2011 NW 3rd Avenue
Pompano Beach, FL 33060-4800

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/20/2018	07/01/2018	03/01/2019	03/12/2019
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/20/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04387	2104 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	04/19/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04141	3099 N. STATE ROAD 7	LAUDERDALE LAKES	FL	33313-1913	04/20/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04597	1 WEST SUNRISE BLVD.	FT LAUDERDALE	FL	33311	04/20/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04178	700 W. BROWARD BLVD.	FT LAUDERDALE	FL	33312	04/20/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04569	3895 W BROWARD BLVD	FORT LAUDERDALE	FL	33312-1017	04/20/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15618	871 W OAKLAND PARK BLVD STE 100	WILTON MANORS	FL	33311	04/20/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/19/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/19/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/20/2018	07/01/2018	02/26/2019	03/12/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/20/2018	07/01/2018	02/26/2019	03/12/2019

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH041294A	Active	BPS-H80-004497	NORTH BROWARD HOSPITAL DISTRICT	SPECIALTY CARE CENTER	1111 W Broward Blvd	Fort Lauderdale	FL
CH041294B	Active	BPS-H80-005045	NORTH BROWARD HOSPITAL DISTRICT	Annie L. Weaver Health Center	2011 NW 3rd Ave	Pompano Beach	FL
CH041294I	Active	BPS-H80-004109	NORTH BROWARD HOSPITAL DISTRICT	CORA E. BRAYNON FAMILY HEALTH CENTER	200 NW 7th Avenue	Fort Lauderdale	FL
CH041294J	Terminated	BPS-H80-004634	NORTH BROWARD HOSPITAL DISTRICT	HOUSE OF HOPE	908 Arpeika St	Fort Lauderdale	FL
CH041294K	Active	BPS-H80-000124	NORTH BROWARD HOSPITAL DISTRICT	Bernard P. Alicki Health Center	1101 W Broward Blvd	Fort Lauderdale	FL
CH041294L	Active	BPS-H80-027799	NORTH BROWARD HOSPITAL DISTRICT	Clinica de las Americas	1101 NW 1st St	Ft Lauderdale	FL
CH041294M	Active	BPS-H80-027726	NORTH BROWARD HOSPITAL DISTRICT	Lauderdale Lakes Health Center	3716 W Oakland Park Blvd	Lauderdale Lakes	FL
CH041294N	Active	BPS-H80-035213	NORTH BROWARD HOSPITAL DISTRICT	Margate Health Center	5430 W Sample Rd	Margate	FL
CH041294P	Active	BPS-H80-021984	North Broward Hospital District	Mobile Medical Van	1101 W Broward Blvd	Fort Lauderdale	FL
CH041294Q	Active	BPS-H80-037468	NORTH BROWARD HOSPITAL DISTRICT	Pompano Prenatal and Pediatric Care Center	601 W Atlantic Blvd	Pompano Beach	FL
CH041294R	Active	BPS-H80-037519	NORTH BROWARD HOSPITAL DISTRICT	Comprehensive Care Center	1101 NW 1st Street STE 1A	Ft Lauderdale	FL
CH041294S	Active	BPS-H80-038689	NORTH BROWARD HOSPITAL DISTRICT	Mobile Health Center 2	201 E Sample Rd	Deerfield Beach	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH041294A	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2024
CH041294A	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2023
CH041294A	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2023
CH041294A	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2023
CH041294A	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2023
CH041294A	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2023
CH041294A	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2023
CH041294A	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2023
CH041294A	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2023
CH041294A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2023
CH041294A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2023
CH041294A	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2023
CH041294A	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2023
CH041294A	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2023
CH041294B	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2018	03/01/2019
CH041294I	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2018	03/01/2019
CH041294K	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2018	03/01/2019
CH041294A	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2018	03/01/2019
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03961	2 S. FEDERAL HWY	DEERFIELD BEACH	FL	33441	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05919	6900 N. UNIVERSITY DR.	TAMARAC	FL	33321	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05250	3090 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00990	3915 W COMMERCIAL BLVD	TAMARAC	FL	33309	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05174	1150 NE 26TH ST	WILTON MANORS	FL	33305	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02758	255 S. STATE RD. #7	MARGATE	FL	33068	01/01/2023	08/22/2024
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01302	5501 W. OAKLAND PARK BLVD.	LAUDERHILL	FL	33313	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02848	2036 E. ATLANTIC BLVD.	POMPANO BEACH	FL	33060	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00981	3501 W DAVIE BLVD	FORT LAUDERDALE	FL	33312	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03627	1 N FEDERAL HWY	FORT LAUDERDALE	FL	33301	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03905	3 S POMPANO PKWY	POMPANO BEACH	FL	33069	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00440	1200 NORTH STATE ROAD 7	MARGATE	FL	33063	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00367	3580 N FEDERAL HWY	LIGHTHOUSE POINT	FL	33064	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03287	850 W SAMPLE RD	POMPANO BEACH	FL	33064	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03285	1700 S. FEDERAL HWY.	FORT LAUDERDALE	FL	33316	01/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03273	5555 N UNIVERSITY DR	LAUDERHILL	FL	33351	10/01/2023
CH041294A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07983	11300 STATE ROAD 82	FORT MYERS	FL	33905	04/01/2024
CH041294B	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2018	03/01/2019
CH041294I	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2018	03/01/2019
CH041294K	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2018	02/26/2019
CH041294A	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2018	03/01/2019
CH041294A	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2023
CH041294A	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2023
CH041294A	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2023
CH041294A	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2023
CH041294A	PROCARE PHARMACY, L.L.C.	NAVARRO SPECIALTY SERVICES # 10727	7205 CORPORATE CENTER DRIVE SUITE 104	MIAMI	FL	33126	01/01/2023
CH041294A	WALGREEN CO	WALGREENS #10373	2235 PARR DRIVE	LADY LAKE	FL	32162-5381	07/01/2023
CH041294A	WALGREEN CO	DBA: WALGREENS #10671	1260 NORTH WEST 35TH STREET	OCALA	FL	34475	07/01/2023
CH041294A	WALGREEN CO	DBA: WALGREENS #11991	89 MIDWAY RD	OCALA	FL	34472	07/01/2023
CH041294B	WALGREEN CO.	DBA: WALGREENS # 04597	1 WEST SUNRISE BLVD.	FT LAUDERDALE	FL	33311	07/01/2018	03/01/2019
CH041294K	WALGREEN CO.	DBA: WALGREENS # 04387	2104 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	07/01/2018	02/26/2019
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04178	700 W. BROWARD BLVD.	FT LAUDERDALE	FL	33312	07/01/2018	03/01/2019
CH041294K	WALGREEN CO.	DBA: WALGREENS # 04141	3099 N. STATE ROAD 7	LAUDERDALE LAKES	FL	33313-1913	07/01/2018	02/26/2019
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04597	1 WEST SUNRISE BLVD.	FT LAUDERDALE	FL	33311	07/01/2018	03/01/2019
CH041294I	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15618	871 W OAKLAND PARK BLVD STE 100	WILTON MANORS	FL	33311	07/01/2018	03/01/2019
CH041294I	WALGREEN CO.	DBA: WALGREENS # 04597	1 WEST SUNRISE BLVD.	FT LAUDERDALE	FL	33311	07/01/2018	03/01/2019
CH041294I	WALGREEN CO.	DBA: WALGREENS # 04178	700 W. BROWARD BLVD.	FT LAUDERDALE	FL	33312	07/01/2018	03/01/2019
CH041294I	WALGREEN CO.	DBA: WALGREENS # 04569	3895 W BROWARD BLVD	FORT LAUDERDALE	FL	33312-1017	07/01/2018	03/01/2019
CH041294I	WALGREEN CO.	DBA: WALGREENS # 04141	3099 N. STATE ROAD 7	LAUDERDALE LAKES	FL	33313-1913	07/01/2018	03/01/2019
CH041294K	WALGREEN CO.	DBA: WALGREENS # 04597	1 WEST SUNRISE BLVD.	FT LAUDERDALE	FL	33311	07/01/2018	02/26/2019
CH041294K	WALGREEN CO.	DBA: WALGREENS # 04178	700 W. BROWARD BLVD.	FT LAUDERDALE	FL	33312	07/01/2018	02/26/2019
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04387	2104 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	07/01/2018	03/01/2019
CH041294K	WALGREEN CO.	DBA: WALGREENS # 04569	3895 W BROWARD BLVD	FORT LAUDERDALE	FL	33312-1017	07/01/2018	02/26/2019
CH041294B	WALGREEN CO.	DBA: WALGREENS # 04387	2104 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	07/01/2018	03/01/2019
CH041294I	WALGREEN CO.	DBA: WALGREENS # 04387	2104 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	07/01/2018	03/01/2019
CH041294B	WALGREEN CO.	DBA: WALGREENS # 04178	700 W. BROWARD BLVD.	FT LAUDERDALE	FL	33312	07/01/2018	03/01/2019
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04569	3895 W BROWARD BLVD	FORT LAUDERDALE	FL	33312-1017	07/01/2018	03/01/2019
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04141	3099 N. STATE ROAD 7	LAUDERDALE LAKES	FL	33313-1913	07/01/2018	03/01/2019
CH041294K	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15618	871 W OAKLAND PARK BLVD STE 100	WILTON MANORS	FL	33311	07/01/2018	02/26/2019
CH041294B	WALGREEN CO.	DBA: WALGREENS # 04569	3895 W BROWARD BLVD	FORT LAUDERDALE	FL	33312-1017	07/01/2018	03/01/2019
CH041294B	WALGREEN CO.	DBA: WALGREENS # 04141	3099 N. STATE ROAD 7	LAUDERDALE LAKES	FL	33313-1913	07/01/2018	03/01/2019
CH041294B	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15618	871 W OAKLAND PARK BLVD STE 100	WILTON MANORS	FL	33311	07/01/2018	03/01/2019
CH041294A	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15618	871 W OAKLAND PARK BLVD STE 100	WILTON MANORS	FL	33311	07/01/2018	03/01/2019
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04120	3573 N. FEDERAL HWY	POMPANO BEACH	FL	33064	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 07468	8591 SE 165TH MULBERRY LANE	THE VILLAGES	FL	32162	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04178	700 W. BROWARD BLVD.	FT LAUDERDALE	FL	33312	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 02838	3101 N OCEAN BLVD	FT LAUDERDALE	FL	33308	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04386	5999 PEMBROKE ROAD	HOLLYWOOD	FL	33023	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 03905	1751 BONAVENTURE BLVD	WESTON	FL	33326	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 02443	3705 HOLLYWOOD BLVD	HOLLYWOOD	FL	33021	07/01/2023
CH041294A	WALGREEN CO.	WALGREENS #16541	1400 NW 12TH AVE STE 2002	MIAMI	FL	33136	07/01/2023	06/11/2024
CH041294A	WALGREEN CO.	DBA: WALGREENS #15137	120 S. POWERLINE RD.	DEERFIELD BEACH	FL	33442	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS #09915	3100 N ANDREWS AVE	OAKLAND PARK	FL	33309-6054	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04141	3099 N. STATE ROAD 7	LAUDERDALE LAKES	FL	33313-1913	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 00074	1634 S FEDERAL HWY	BOYNTON BEACH	FL	33435	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 07589	3500 SE MARICAMP ROAD	OCALA	FL	34471-6248	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 01139	1325 S MILITARY TRAIL	DEERFIELD BEACH	FL	33442	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04483	6401 W COMMERCIAL BLVD.	TAMARAC	FL	33319	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04484	8790 W. MCNAB ROAD	TAMARAC	FL	33321	07/01/2023
CH041294A	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21246	168 N POWERLINE RD STE 200	POMPANO BEACH	FL	33069	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04768	340 SW 24TH STREET	FT LAUDERDALE	FL	33315	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS #03935	11750 W. SAMPLE ROAD	CORAL SPRINGS	FL	33065	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS #13585	7921 SW HIGHWAY 200	OCALA	FL	34476	07/01/2023
CH041294A	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15299	1201 NE 26TH ST STE 110	WILTON MANORS	FL	33305	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS #12808	1041 E HILLSBORO BLVD	DEERFIELD BEACH	FL	33441	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 05519	21880 STATE ROAD 7	BOCA RATON	FL	33428	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 02214	6602 N FEDERAL HWY	FT LAUDERDALE	FL	33308	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS #11486	260 MARION OAKS BLVD	OCALA	FL	34473	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 06011	8001 MIRAMAR PKWY	MIRAMAR	FL	33025-3004	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS #06414	3000 N STATE RD 7	MARGATE	FL	33063	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04387	2104 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	07/01/2023	02/29/2024
CH041294A	WALGREEN CO.	DBA: WALGREENS # 05490	1601 S CONGRESS AVE	BOYNTON BEACH	FL	33426-6543	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 07207	6015 SW HWY 200	OCALA	FL	34476	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04706	4600 COCONUT CREEK PKWY	COCONUT CREEK	FL	33063	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04915	750 NW 119TH ST.	MIAMI	FL	33168	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 03002	202 SOUTH FEDERAL HWY	DANIA	FL	33004	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 09384	10420 FOREST HILL BLVD	WELLINGTON	FL	33414-3165	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 02224	4747 SW COLLEGE ROAD	OCALA	FL	34474-5719	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 06416	960 S POWERLINE RD	POMPANO BEACH	FL	33069	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 03613	4220 MANATEE AVENUE W	BRADENTON	FL	34205	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 06772	4351 W SAMPLE ROAD	COCONUT CREEK	FL	33073-3451	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04917	690 NW 183RD ST	MIAMI GARDENS	FL	33169	07/01/2023	02/22/2024
CH041294A	WALGREEN CO.	DBA: WALGREENS # 00456	1723 E YOUNG CIRCLE	HOLLYWOOD	FL	33020	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04426	4920 SE ABSHIER BLVD	BELLEVIEW	FL	34420	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 06221	1515 E SUNRISE BLVD	FT LAUDERDALE	FL	33304	07/01/2023
CH041294A	WALGREEN CO.	WALGREENS #16466	620 KRISTINE WAY	THE VILLAGES	FL	32163-0286	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 03389	3529 E SILVER SPRINGS BLVD	OCALA	FL	34470	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04402	1300 E HALLANDALE BEACH BLVD	HALLANDALE BEACH	FL	33009	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04597	1 WEST SUNRISE BLVD.	FT LAUDERDALE	FL	33311	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 06941	1005 S FEDERAL HWY	DEERFIELD BEACH	FL	33441-7032	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS #16474	8073 W OAKLAND PARK BLVD	SUNRISE	FL	33351	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 03063	2355 NE 26TH STREET	FT LAUDERDALE	FL	33305	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 03391	807 E SILVER SPRINGS BLVD	OCALA	FL	34470	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 07125	1680 SE 17TH STREET	FT LAUDERDALE	FL	33316	07/01/2023
CH041294A	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21200	1120 E UNIVERSITY AVE STE 200	GAINESVILLE	FL	32641	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 12724	1251 SOUTH STATE ROAD 7	DAVIE	FL	33317	07/01/2023
CH041294A	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15618	871 W OAKLAND PARK BLVD STE 100	WILTON MANORS	FL	33311	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04569	3895 W BROWARD BLVD	FORT LAUDERDALE	FL	33312-1017	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 03193	7150 W ATLANTIC BLVD	MARGATE	FL	33063	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 10984	3914 W. COMMERCIAL BLVD	TAMARAC	FL	33309	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 01508	2855 STIRLING RD	FT LAUDERDALE	FL	33312	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 05578	11283 N WILLIAMS ST	DUNNELLON	FL	34432	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 01724	4899 NW BLITCHTON RD	OCALA	FL	34482	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 03932	1101 E ATLANTIC BLVD	POMPANO BEACH	FL	33060	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04810	601 E COMMERCIAL BLVD	OAKLAND PARK	FL	33334	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 06538	1201 S FEDERAL HWY	FT LAUDERDALE	FL	33316	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 09115	8200 ROYAL PALM BLVD	CORAL SPRINGS	FL	33065	07/01/2023
CH041294A	WALGREEN CO.	WALGREENS #16354	1780 N. UNIVERSITY DR.	PLANTATION	FL	33322	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 05433	3900 N FEDERAL HWY	BOCA RATON	FL	33431	07/01/2023
CH041294A	WALGREEN CO.	DBA: WALGREENS # 04773	110 NE 44TH ST	OAKLAND PARK	FL	33334	07/01/2023
CH041294A	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	07/01/2023
CH041294B	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2018	03/01/2019
CH041294K	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2018	02/26/2019
CH041294K	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2018	02/26/2019
CH041294K	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2018	02/26/2019
CH041294I	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2018	03/01/2019
CH041294A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2018	03/01/2019
CH041294A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2018	03/01/2019
CH041294I	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2018	03/01/2019
CH041294B	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2018	03/01/2019
CH041294A	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2018	03/01/2019
CH041294B	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2018	03/01/2019
CH041294A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2018	03/01/2019
CH041294B	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2018	03/01/2019
CH041294I	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2018	03/01/2019
CH041294I	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2018	03/01/2019
CH041294K	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2018	02/26/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/2/2024 11:51:18 AM	2/28/2025 2:09:29 PM	2/28/2025 2:09 PM
Contacts	Authorizing Official	Update	Group Change Request	Layne, Romaine Kamara Chief Financial Officer Broward Health 9544737431	Bert, Alisa Interim CFO/VP Financial Operations North Broward Hospital District DBA Broward Health 9548477483	7/22/2024 5:24 PM
Details	Last Recertification Date	Update	Recertification	2/6/2023 2:21:40 PM	2/2/2024 11:51:18 AM	2/2/2024 11:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/6/2023 2:21 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		253794022	2/6/2023 2:21 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/6/2023 2:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/6/2023 2:21 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		113196317	2/6/2023 2:21 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/6/2023 2:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1225073034	2/6/2023 2:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	2/6/2023 2:21 PM
Details	Last Recertification Date	Update	Recertification	2/2/2022 9:44:24 AM	2/6/2023 2:21:40 PM	2/6/2023 2:21 PM
Details	Last Recertification Date	Update	Recertification	2/11/2021 12:40:09 PM	2/2/2022 9:44:24 AM	2/2/2022 9:44 AM
Contacts	Primary Contact	Update	Profile Change Request	Lacknauth, Dave A Executive Director of Pharmacy Services North Broward Hospital District dba Broward Health 9543555559	Lacknauth, Dave A Executive Director of Pharmacy Services North Broward Hospital District dba Broward Health 9544737078	7/13/2021 12:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/11/2021 12:40 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		022454500	2/11/2021 12:40 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/11/2021 12:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/11/2021 12:40 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		001919400	2/11/2021 12:40 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/11/2021 12:40 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1699703660 ( )		2/11/2021 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134164965	2/11/2021 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	2/11/2021 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1699709766	2/11/2021 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	2/11/2021 12:40 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1699703660	2/11/2021 12:40 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	2/11/2021 12:40 PM
Details	Last Recertification Date	Update	Recertification	1/29/2020 8:03:36 AM	2/11/2021 12:40:09 PM	2/11/2021 12:40 PM
Contacts	Authorizing Official	Update	Change Request	Ta, Andrew K. EVP, Chief Medical Officer North Broward Hospital District dba Broward Health 9544737020	Layne, Romaine Kamara Chief Financial Officer Broward Health 9544737431	10/26/2020 7:06 AM
Contacts	Primary Contact	Update	Profile Change Request	Lacknauth, Dave A Executive Director of Pharmacy Services Broward Health Medical Center 9543555559	Lacknauth, Dave A Executive Director of Pharmacy Services North Broward Hospital District dba Broward Health 9543555559	4/29/2020 3:57 PM
Contacts	Primary Contact	Update	Profile Change Request	Lacknauth, Dave A Director of Pharmacy Services Broward Health Medical Center 9543555559	Lacknauth, Dave A Executive Director of Pharmacy Services Broward Health Medical Center 9543555559	4/29/2020 3:20 PM
Contacts	Primary Contact	Update	Change Request	Shorter-Meares, Bernice Regional Pharmacy Manager North Broward Hospital District d/b/a Broward Health 9547596651	Lacknauth, Dave A Director of Pharmacy Services Broward Health Medical Center 9543555559	4/23/2020 1:58 PM
Details	Last Recertification Date	Update	Recertification	2/26/2019 12:42:37 PM	1/29/2020 8:03:36 AM	1/29/2020 8:03 AM
Addresses	Shipping Address	Insert	Change Request		Broward Health Cora E. Braynon Family Health Center Pharmacy 200 NW 7th Avenue Fort Lauderdale, FL 33311	9/19/2019 7:59 AM
Addresses	Shipping Address	Insert	Change Request		Broward Health Annie L. Weaver Health Center Pharmacy 2011 NW 3rd Avenue Pompano Beach, FL 33060-4800	9/19/2019 7:59 AM
Contacts	Authorizing Official	Update	Change Request	Cherry, Beth A Vice President North Broward Hospital District dba Broward Health 9544733076	Ta, Andrew K. EVP, Chief Medical Officer North Broward Hospital District dba Broward Health 9544737020	9/19/2019 7:59 AM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		9/19/2019 7:59 AM
Details	Last Recertification Date	Update	Recertification	3/5/2018 12:19:37 PM	2/26/2019 12:42:37 PM	2/26/2019 12:42 PM
Details	Last Recertification Date	Update	Recertification	2/14/2017 12:00:00 AM	3/5/2018 12:19:37 PM	3/5/2018 12:19 PM
Contacts	Authorizing Official	Update	AO Change Request	Shirley, Jasmin D. Senior Vice President North Broward Hospital District, dba Broward Health 9543555903	Cherry, Beth A Vice President North Broward Hospital District dba Broward Health 9544733076	3/2/2018 7:33 AM
Contacts	Primary Contact	Update		Shorter-Meares, Bernice Regional Pharmacy Manager 9547596651	Shorter-Meares, Bernice Regional Pharmacy Manager North Broward Hospital District d/b/a Broward Health 9547596651	10/23/2017 12:02 PM
Contacts	Authorizing Official	Update		Shirley, Jasmin D. Senior Vice President 9543555903	Shirley, Jasmin D. Senior Vice President North Broward Hospital District, dba Broward Health 9543555903	10/5/2017 12:41 PM
Contacts	Signed By	Update		Shirley, Jasmin D. Senior Vice President 9543555903	Shirley, Jasmin D. Senior Vice President North Broward Hospital District, dba Broward Health 9543555903	10/5/2017 12:41 PM
Contacts	Authorizing Official	Insert			Shirley, Jasmin D. Senior Vice President 9543555903	2/15/2017 7:44 AM
Contacts	Signed By	Insert			Shirley, Jasmin D. Senior Vice President 9543555903	2/15/2017 7:44 AM
Contacts	Primary Contact	Insert			Shorter-Meares, Bernice Regional Pharmacy Manager 9547596651	2/14/2017 2:26 PM
Addresses	Main Address	Insert			1101 W Broward Blvd Fort Lauderdale, FL 33312-1638	2/14/2017 2:22 PM
Details	Last Recertification Date	Update		2/19/2016 12:00:00 AM	2/14/2017 12:00:00 AM	2/14/2017 2:22 PM
Details	Last Recertification Date	Update			2/19/2016 12:00:00 AM	2/19/2016 4:26 PM
Dates	Participating Approval Date	Update			1/22/2015 12:00:00 AM	1/22/2015 3:58 PM
Details	State	Update		Pending	Active	1/22/2015 3:58 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	1/22/2015 3:58 PM
Details	340B ID	Update		CH041294D	CH041294K	1/22/2015 2:39 PM
Details	340B ID	Update		ONLINE_REG_48426	CH041294D	1/8/2015 1:50 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_48426	1/8/2015 12:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/8/2015 12:28 PM
Medicaid Billing	Medicaid: Number	Insert			021748400	1/8/2015 12:28 PM
Medicaid Billing	Medicaid: State	Insert			FL	1/8/2015 12:28 PM
Medicaid Billing	NPI: Number	Insert			1699703660	1/8/2015 12:28 PM
Details	Last Recertification Date	Insert				1/8/2015 12:28 PM
Details	Grant Number	Insert			H80CS00019	1/8/2015 12:28 PM
Details	340B ID	Insert			ONLINE_REG	1/8/2015 12:28 PM
Details	Is Authorizing Official EHB Data	Insert			False	1/8/2015 12:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/8/2015 12:28 PM
Details	Medicare Provider Number	Insert				1/8/2015 12:28 PM
Details	Entity Name	Insert			NORTH BROWARD HOSPITAL DISTRICT	1/8/2015 12:28 PM
Details	Program Code	Insert			CH	1/8/2015 12:28 PM
Details	Entity Subname	Insert			Bernard P. Alicki Health Center	1/8/2015 12:28 PM
Dates	Participating Approval Date	Insert				1/8/2015 12:28 PM
Details	State	Insert			Pending	1/8/2015 12:28 PM
Dates	Registration Date	Insert			1/8/2015 12:00:00 AM	1/8/2015 12:28 PM
Dates	Signed By Date	Insert			1/8/2015 12:00:00 AM	1/8/2015 12:28 PM
Dates	Start Date	Insert				1/8/2015 12:28 PM
Terminations	Termination Comments	Insert				1/8/2015 12:28 PM
Terminations	Termination Date	Insert				1/8/2015 12:28 PM
Terminations	Termination Effective Date	Insert				1/8/2015 12:28 PM
Terminations	Termination Reason	Insert				1/8/2015 12:28 PM

340B Drug Pricing Program Database