Covered Entity Details

DSH100052C WINTER HAVEN HOSPITAL (Active) - information as of 6/19/2025 11:46:58 PM

Main Details

Name

WINTER HAVEN HOSPITAL

Subdivision Name

Winter Haven Women's Hospital/Anesthesiology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100052C

Medicare Provider Number

100052

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/6/2015

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

Baycare Health System
Carl Tremonti, Chief Financial Officer
(813) 870-4020

Primary Contact

BayCare Health System
Kyle J Brauer, Manager, BayCare Pharmacy Supply Chain
(813) 901-6376

Addresses

Street Address

101 AVENUE O, SE
Winter Haven, FL 33880

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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	010169900	1477599975

Shipping Addresses

Shipping Address 1

Winter Haven Women's Hospital/Anesthesiology
101 AVENUE O, SE
Winter Haven, FL 33880

Shipping Address 2

BayCare Integrated Service Center, LLC
Dba/ BayCare Central Pharmacy
7802 E. Telecom Parkway
Temple Terrace, FL 33637

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH100052A	Child	DSH	WINTER HAVEN HOSPITAL	Winter Haven Women's Hospital	101 AVENUE O, SE	WINTER HAVEN	FL	Terminated
DSH100052B	Child	DSH	WINTER HAVEN HOSPITAL	Winter Haven Women's Hospital Diagnostic Imaging	101 AVENUE O, SE	Winter Haven	FL	Active
DSH100052C	Child	DSH	WINTER HAVEN HOSPITAL	Winter Haven Women's Hospital/Anesthesiology	101 AVENUE O, SE	Winter Haven	FL	Active
DSH100052D	Child	DSH	WINTER HAVEN HOSPITAL	Winter Haven Women's Hospital / Respiratory Care	101 AVENUE O, SE	Winter Haven	FL	Active
DSH100052E	Child	DSH	WINTER HAVEN HOSPITAL	Winter Haven Women's Hospital Surgery	101 AVENUE O, SE	Winter Haven	FL	Terminated
DSH100052F	Child	DSH	WINTER HAVEN HOSPITAL	Winter Haven Women's Hospital Maternal Fetal Med Center	101 AVENUE O, SE	Winter Haven	FL	Terminated
DSH100052G	Child	DSH	WINTER HAVEN HOSPITAL	WINTER HAVEN HOSPITAL INC - Winter Haven Women's Hospital Ultrasound	101 AVENUE O SE	WINTER HAVEN	FL	Active
DSH100052H	Child	DSH	WINTER HAVEN HOSPITAL	WINTER HAVEN HOSPITAL INC - Winter Haven Women's Hospital Breast Center	101 AVENUE O SE	WINTER HAVEN	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 7:33:40 AM	8/26/2024 6:46:21 AM	8/26/2024 6:46 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 8:20:42 AM	9/6/2023 7:33:40 AM	9/6/2023 7:33 AM
Details	Last Recertification Date	Update	Recertification	9/1/2021 8:05:07 AM	9/12/2022 8:20:42 AM	9/12/2022 8:20 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10169900 (FL)		7/20/2022 12:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/20/2022 12:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010169900	7/20/2022 12:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	7/20/2022 12:33 PM
Details	Last Recertification Date	Update	Recertification	9/8/2020 8:00:23 AM	9/1/2021 8:05:07 AM	9/1/2021 8:05 AM
Medicaid Billing	NPI: State	Update	Recertification		FL	9/8/2020 8:00 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 9:17:28 AM	9/8/2020 8:00:23 AM	9/8/2020 8:00 AM
Contacts	Primary Contact	Update	Change Request	Magee, Michael Vice President of Pharmacy BayCare Health System 8138704020	Brauer, Kyle J Manager, BayCare Pharmacy Supply Chain BayCare Health System 8139016376	6/4/2020 2:07 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 2:26:33 PM	8/20/2019 9:17:28 AM	8/20/2019 9:17 AM
Details	Last Recertification Date	Update	Recertification	11/9/2017 8:50:15 AM	8/20/2018 2:26:33 PM	8/20/2018 2:26 PM
Addresses	Shipping Address	Insert	Change Request		Winter Haven Women's Hospital/Anesthesiology 101 AVENUE O, SE Winter Haven, FL 33880	8/7/2018 8:27 AM
Addresses	Shipping Address	Insert	Change Request		BayCare Integrated Service Center, LLC Dba/ BayCare Central Pharmacy 7802 E. Telecom Parkway Temple Terrace, FL 33637	8/7/2018 8:27 AM
Details	Last Recertification Date	Update	Recertification	9/2/2016 12:00:00 AM	11/9/2017 8:50:15 AM	11/9/2017 8:50 AM
Contacts	Authorizing Official	Update		Tremonti, Carl Chief Financial Officer 8138704020	Tremonti, Carl Chief Financial Officer Baycare Health System 8138704020	10/2/2017 2:52 PM
Contacts	Signed By	Update		Tremonti, Carl Chief Financial Officer 8138704020	Tremonti, Carl Chief Financial Officer Baycare Health System 8138704020	10/2/2017 2:52 PM
Contacts	Primary Contact	Update		Magee, Michael Vice President of Pharmacy 8138704020	Magee, Michael Vice President of Pharmacy BayCare Health System 8138704020	10/1/2017 6:33 PM
Contacts	Authorizing Official	Insert			Tremonti, Carl Chief Financial Officer 8138704020	8/9/2017 10:58 AM
Contacts	Signed By	Insert			Tremonti, Carl Chief Financial Officer 8138704020	8/9/2017 10:58 AM
Contacts	Primary Contact	Insert			Magee, Michael Vice President of Pharmacy 8138704020	8/4/2017 1:11 PM
Addresses	Main Address	Insert			101 AVENUE O, SE Winter Haven, FL 33880	9/2/2016 8:04 AM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	9/2/2016 12:00:00 AM	9/2/2016 8:04 AM
Details	Last Recertification Date	Update			8/31/2015 12:00:00 AM	8/31/2015 11:24 AM
Details	Entity Subname	Update		Winter Haven Women's Hospital/Anesthesiology / ANESTHESIOLOGY	Winter Haven Women's Hospital/Anesthesiology	3/6/2015 2:36 PM
Dates	Participating Approval Date	Update			3/6/2015 12:00:00 AM	3/6/2015 2:35 PM
Details	State	Update		Pending	Active	3/6/2015 2:35 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/6/2015 2:35 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48968	DSH100052C	1/21/2015 11:20 AM
Details	Entity Subname	Update		Winter Haven Women's Hospital / ANESTHESIOLOGY	Winter Haven Women's Hospital/Anesthesiology / ANESTHESIOLOGY	1/21/2015 11:20 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48968	1/13/2015 4:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/13/2015 4:12 PM
Medicaid Billing	Medicaid: Number	Insert			10169900	1/13/2015 4:12 PM
Medicaid Billing	Medicaid: State	Insert			FL	1/13/2015 4:12 PM
Medicaid Billing	NPI: Number	Insert			1477599975	1/13/2015 4:12 PM
Details	Last Recertification Date	Insert				1/13/2015 4:12 PM
Details	Grant Number	Insert				1/13/2015 4:12 PM
Details	340B ID	Insert				1/13/2015 4:12 PM
Details	Is Authorizing Official EHB Data	Insert				1/13/2015 4:12 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2015 4:12 PM
Details	Medicare Provider Number	Insert			100052	1/13/2015 4:12 PM
Details	Entity Name	Insert			WINTER HAVEN HOSPITAL	1/13/2015 4:12 PM
Details	Program Code	Insert			DSH	1/13/2015 4:12 PM
Details	Entity Subname	Insert			Winter Haven Women's Hospital / ANESTHESIOLOGY	1/13/2015 4:12 PM
Dates	Participating Approval Date	Insert				1/13/2015 4:12 PM
Details	State	Insert			Pending	1/13/2015 4:12 PM
Dates	Registration Date	Insert			1/13/2015 12:00:00 AM	1/13/2015 4:12 PM
Dates	Signed By Date	Insert			1/13/2015 12:00:00 AM	1/13/2015 4:12 PM
Dates	Start Date	Insert				1/13/2015 4:12 PM
Terminations	Termination Comments	Insert				1/13/2015 4:12 PM
Terminations	Termination Date	Insert				1/13/2015 4:12 PM
Terminations	Termination Effective Date	Insert				1/13/2015 4:12 PM
Terminations	Termination Reason	Insert				1/13/2015 4:12 PM