| Details | Nature of Support: Support Received To Date | Update | Recertification | 12/31/2023 12:00:00 AM | | 5/7/2024 12:17 PM |
| Contacts | Primary Contact | Update | Recertification | Walsh, Victor
FINANCIAL ADMINISTRATOR
FDOH Bay
8502529643 | Clayton, Brianna
Director of Nursing
Florida Department of Health in Bay County
8502529550 | 5/7/2024 12:17 PM |
| Details | Last Recertification Date | Update | Recertification | 5/8/2023 9:57:53 AM | 5/7/2024 12:17:23 PM | 5/7/2024 12:17 PM |
| Contacts | Primary Contact | Update | PC Change Request | Bartels, Christine
Director of Nursing
Florida Dept of Health
6365241048 | Walsh, Victor
FINANCIAL ADMINISTRATOR
FDOH Bay
8502529643 | 2/14/2024 11:38 AM |
| Details | Nature of Support: Support Received To Date | Update | Recertification | 12/31/2021 12:00:00 AM | 12/31/2023 12:00:00 AM | 5/8/2023 9:57 AM |
| Details | Last Recertification Date | Update | Recertification | 5/16/2022 9:04:35 PM | 5/8/2023 9:57:53 AM | 5/8/2023 9:57 AM |
| Contacts | Primary Contact | Update | Recertification | Barron, Kayla
Director of Nursing
Florida Dept of Health
8506535877 | Bartels, Christine
Director of Nursing
Florida Dept of Health
6365241048 | 5/16/2022 9:04 PM |
| Details | Last Recertification Date | Update | Recertification | 5/21/2021 1:07:25 PM | 5/16/2022 9:04:35 PM | 5/16/2022 9:04 PM |
| Contacts | Signed By | Update | Profile Change Request | Cooksey, Adrian Charelle
County Health Department Administrator
Florida Department of Health- Gadsden
8508757200-398 | Cooksey, Adrian Charelle
County Health Department Administrator
Florida Department of Health- Gadsden
8507436081 | 4/5/2022 10:37 AM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 029006817 (FL) | | 5/21/2021 1:07 PM |
| Details | Nature of Support: Support Received From Date | Update | Recertification | | 1/1/2021 12:00:00 AM | 5/21/2021 1:07 PM |
| Details | Nature of Support: Support Received To Date | Update | Recertification | | 12/31/2021 12:00:00 AM | 5/21/2021 1:07 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1730194374 ( ) | | 5/21/2021 1:07 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1609849660 | 5/21/2021 1:07 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | FL | 5/21/2021 1:07 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1750556130 ( ) | | 5/21/2021 1:07 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1609849660 ( ) | | 5/21/2021 1:07 PM |
| Details | Last Recertification Date | Update | Recertification | 5/11/2020 9:34:38 AM | 5/21/2021 1:07:25 PM | 5/21/2021 1:07 PM |
| Details | NOFO Number | Update | Recertification | | CDC-RFA-PS19-1901 | 5/21/2021 1:07 PM |
| Contacts | Signed By | Update | | Cooksey, Adrian Charelle
County Health Department Administrator
Florida Department of Health- Gadsden
8508757200-398 | Cooksey, Adrian Charelle
County Health Department Administrator
Florida Department of Health- Gadsden
8508757200-398 | 4/1/2021 10:26 AM |
| Medicaid Billing | Medicaid: Number | Update | | 029006800 | 029006800 | 12/10/2020 4:18 PM |
| Contacts | Primary Contact | Update | Recertification | Sharp, Tanya
Public Health Services Manager
Florida Dept of Health
8502529550 | Barron, Kayla
Director of Nursing
Florida Dept of Health
8506535877 | 5/11/2020 9:34 AM |
| Details | Last Recertification Date | Update | Recertification | 6/3/2019 8:05:15 AM | 5/11/2020 9:34:38 AM | 5/11/2020 9:34 AM |
| Details | Grant Number | Update | Change Request | 5H25PS004342-04-01 | NH25PS005131 | 6/10/2019 11:19 AM |
| Contacts | Primary Contact | Update | Recertification | Parmer, Christina
Government Operations Consultant II
Florida Department of Health
8502454282 | Sharp, Tanya
Public Health Services Manager
Florida Dept of Health
8502529550 | 6/3/2019 8:05 AM |
| Details | Last Recertification Date | Update | Recertification | 4/25/2018 8:19:47 AM | 6/3/2019 8:05:15 AM | 6/3/2019 8:05 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Sharp, Tanya
Public Health Services Manager
Florida Dept of Health
8502529550 | Speedling, Sandon S.
CHD ADMINISTRATOR
FL Department of Health in Bay County
8505962938 | 5/23/2019 2:15 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Kent, Douglas
CHD ADMINISTRATOR
Florida Department of Health Bay County
8508724455-1240 | Sharp, Tanya
Public Health Services Manager
Florida Dept of Health
8502529550 | 5/8/2019 7:43 AM |
| Contacts | Signed By | Update | Profile Change Request | Cooksey, Adrian Charelle
STD Program Adm
Florida Department of Health- Gadsden
8502454602 | Cooksey, Adrian Charelle
County Health Department Administrator
Florida Department of Health- Gadsden
8508757200-398 | 4/30/2018 9:54 AM |
| Contacts | Signed By | Update | | Cooksey, Adrian
STD Program Adm
8502454602 | Cooksey, Adrian Charelle
STD Program Adm
Florida Department of Health- Gadsden
8502454602 | 4/30/2018 9:47 AM |
| Details | Last Recertification Date | Update | Recertification | 5/19/2017 12:00:00 AM | 4/25/2018 8:19:47 AM | 4/25/2018 8:19 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Tipps, Nancy
Clinic Supervisor
8502529592 | Kent, Douglas
CHD ADMINISTRATOR
Florida Department of Health Bay County
8508724455-1240 | 3/7/2018 8:01 AM |
| Contacts | Primary Contact | Update | Change Request | Parmer, Christina
Government Operations Consultant II
8502454282 | Parmer, Christina
Government Operations Consultant II
Florida Department of Health
8502454282 | 10/9/2017 8:03 AM |
| Contacts | Authorizing Official | Insert | | | Tipps, Nancy
Clinic Supervisor
8502529592 | 7/26/2017 2:10 PM |
| Contacts | Signed By | Insert | | | Cooksey, Adrian
STD Program Adm
8502454602 | 7/10/2017 12:21 PM |
| Contacts | Primary Contact | Update | | Adams, Tracy
Senior Community Health Nurse Supervisor
8508724455-1191 | Parmer, Christina
Government Operations Consultant II
8502454282 | 5/31/2017 7:20 AM |
| Addresses | Main Address | Insert | | |
597 W 11TH STREET
PANAMA CITY, FL 32401 | 5/19/2017 6:50 AM |
| Details | Last Recertification Date | Update | | 2/18/2016 12:00:00 AM | 5/19/2017 12:00:00 AM | 5/19/2017 6:49 AM |
| Details | Grant Number | Update | | 5H25PS004342 | 5H25PS004342-04-01 | 5/19/2017 6:49 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/23/2017 7:47 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 029006800 | 3/23/2017 7:47 AM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 3/23/2017 7:47 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/23/2017 7:47 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 029006817 | 3/23/2017 7:47 AM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 3/23/2017 7:47 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1750556130 | 3/23/2017 7:47 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1609849660 | 3/23/2017 7:47 AM |
| Contacts | Primary Contact | Insert | | | Adams, Tracy
Senior Community Health Nurse Supervisor
8508724455-1191 | 2/18/2016 10:16 AM |
| Details | Last Recertification Date | Update | | | 2/18/2016 12:00:00 AM | 2/18/2016 10:16 AM |
| Details | Entity Name | Update | | CHD - BAY | Florida Department of Health | 1/30/2015 4:29 PM |
| Details | Entity Subname | Update | | | BAY County Health Department | 1/30/2015 4:29 PM |
| Dates | Participating Approval Date | Update | | | 1/30/2015 12:00:00 AM | 1/30/2015 4:29 PM |
| Details | State | Update | | Pending | Active | 1/30/2015 4:29 PM |
| Dates | Start Date | Update | | | 4/1/2015 12:00:00 AM | 1/30/2015 4:29 PM |
| Details | Grant Number | Update | | 5H25PS00432-02 | 5H25PS004342 | 1/30/2015 4:16 PM |
| Details | Grant Number | Update | | 5H25P500432-02 | 5H25PS00432-02 | 1/26/2015 2:39 PM |
| Details | Grant Number | Update | | | 5H25P500432-02 | 1/22/2015 1:31 PM |
| Details | 340B ID | Update | | ONLINE_REG_49294 | STD32401 | 1/22/2015 1:31 PM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_49294 | 1/14/2015 3:22 PM |
| Details | Nature Of Support | Insert | | | Direct Funding (dollars received from CDC or an intermediate organization) | 1/14/2015 3:22 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1730194374 | 1/14/2015 3:22 PM |
| Details | Last Recertification Date | Insert | | | | 1/14/2015 3:22 PM |
| Details | Grant Number | Insert | | | | 1/14/2015 3:22 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/14/2015 3:22 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/14/2015 3:22 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/14/2015 3:22 PM |
| Details | Medicare Provider Number | Insert | | | | 1/14/2015 3:22 PM |
| Details | Entity Name | Insert | | | CHD - BAY | 1/14/2015 3:22 PM |
| Details | Program Code | Insert | | | STD | 1/14/2015 3:22 PM |
| Details | Entity Subname | Insert | | | | 1/14/2015 3:22 PM |
| Dates | Participating Approval Date | Insert | | | | 1/14/2015 3:22 PM |
| Details | State | Insert | | | Pending | 1/14/2015 3:22 PM |
| Dates | Registration Date | Insert | | | 1/14/2015 12:00:00 AM | 1/14/2015 3:22 PM |
| Dates | Signed By Date | Insert | | | 1/14/2015 12:00:00 AM | 1/14/2015 3:22 PM |
| Dates | Start Date | Insert | | | | 1/14/2015 3:22 PM |
| Terminations | Termination Comments | Insert | | | | 1/14/2015 3:22 PM |
| Terminations | Termination Date | Insert | | | | 1/14/2015 3:22 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/14/2015 3:22 PM |
| Terminations | Termination Reason | Insert | | | | 1/14/2015 3:22 PM |