Covered Entity Details

CHC28344-00 BANYAN COMMUNITY HEALTH CENTER, INC. (Active) - information as of 6/14/2025 10:07:03 AM

Main Details

Name

BANYAN COMMUNITY HEALTH CENTER, INC.

Subdivision Name

BCHC Administration Only

Type

HRSA-Funded Health Center

Site ID

BPS-H80-037174

340B ID

CHC28344-00

Grant Number

H80CS28344

Additional Details

Current Program Status

Active

Registration Date

10/12/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/22/2015

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Banyan Health Systems
Gabriela Gutierrez, VP of Integrated Outpatient Services
(786) 239-1846

Primary Contact

Banyan Health SystemS
Anabel Enriquez, Pharmacy Director
(305) 442-1732

Addresses

Street Address

2300 NW 89th Place
Doral, FL 33172

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?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/04/2024	04/01/2024	04/01/2024
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/04/2024	04/01/2024	04/01/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03287	850 W SAMPLE RD	POMPANO BEACH	FL	33064	01/04/2024	04/01/2024	04/01/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03273	5555 N UNIVERSITY DR	LAUDERHILL	FL	33351	01/04/2024	04/01/2024	04/01/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04076	2901 CLINT MOORE RD	BOCA RATON	FL	33496	01/04/2024	04/01/2024	04/01/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05197	14705 SW 42ND ST	MIAMI	FL	33185	01/04/2024	04/01/2024	04/01/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05250	3090 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	01/04/2024	04/01/2024	04/01/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05919	6900 N. UNIVERSITY DR.	TAMARAC	FL	33321	01/04/2024	04/01/2024	04/01/2024
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/04/2024	04/01/2024	04/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/04/2024	04/01/2024	04/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/04/2024	04/01/2024	04/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC28344-00	Active	BPS-H80-037174	BANYAN COMMUNITY HEALTH CENTER, INC.	BCHC Administration Only	2300 NW 89th Place	Doral	FL
CHC28344-01	Active	BPS-H80-015115	BANYAN COMMUNITY HEALTH CENTER, INC.	Banyan Community Health Center 3850 Miami	3850 W FLAGLER ST	MIAMI	FL
CHC28344-02	Active	BPS-H80-015113	BANYAN COMMUNITY HEALTH CENTER, INC.	Flagler Main Site	3733 W FLAGLER ST	MIAMI	FL
CHC28344-03	Active	BPS-H80-015111	BANYAN COMMUNITY HEALTH CENTER, INC.	Banyan Community Health Center - W. Flagler	3800 West Flagler St	Miami	FL
CHC28344-04	Terminated	BPS-H80-019082	BANYAN COMMUNITY HEALTH CENTER, INC.	Banyan Community Health Center - LeJeune	10 NW 42nd Avenue Fifth Floor	Miami	FL
CHC28344-05	Active	BPS-H80-024749	Banyan Community Health Center, Inc.	Banyan Community Health Center-Cutler Bay	10720 Caribbean Blvd	Cutler Bay	FL
CHC28344-06	Active	BPS-H80-035768	Banyan Community Health Center, Inc.	Banyan Community Health Center-Lauderdale Lakes	4900 W. Oakland Park Boulevard, 3rd Floor	Lauderdale Lakes	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC28344-02	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2023
CHC28344-01	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2023
CHC28344-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2024
CHC28344-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2024
CHC28344-01	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2025
CHC28344-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2024
CHC28344-01	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2025
CHC28344-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2024
CHC28344-01	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2025
CHC28344-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2024
CHC28344-01	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2025
CHC28344-01	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2023
CHC28344-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2024
CHC28344-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2024
CHC28344-01	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2025
CHC28344-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2024
CHC28344-01	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2025
CHC28344-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2024
CHC28344-01	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2025
CHC28344-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2024
CHC28344-01	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2025
CHC28344-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2024
CHC28344-01	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2025
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY # 976	1177 SW 8TH ST.	MIAMI	FL	33130	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03327	3695 W FLAGLER ST	MIAMI	FL	33135	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05233	650 NW 27TH AVE	MIAMI	FL	33125	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10697	3949 SW 8TH STREET	MIAMI	FL	33134	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10698	1243 SW 8TH STREET	MIAMI	FL	33135	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10726	3105 NW 7 STREET	MIAMI	FL	33125	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 08369	10761 WEST FLAGLER ST	MIAMI	FL	33174	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10702	10720 SW 72 STREET	MIAMI	FL	33173	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00931	101 HIALEAH DR	HIALEAH	FL	33010	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05136	11398 QUAIL ROOST DR	MIAMI	FL	33157	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03443	5695 SW 8TH ST	MIAMI	FL	33144	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 06732	8720 W. FLAGLER ST.	MIAMI	FL	33174	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY # 1126	2713 SW 8TH ST.	MIAMI	FL	33135	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10696	5252 WEST FLAGLER ST.	MIAMI	FL	33134	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10699	8740 BIRD ROAD	MIAMI	FL	33165	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10705	15000 SW 72 STREET	MIAMI	FL	33193	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00564	2500 SW 22ND ST	MIAMI	FL	33145	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05118	28740 S DIXIE HWY	HOMESTEAD	FL	33033	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00591	8695 CORAL WAY	MIAMI	FL	33155	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10723	13250 BISCAYNE BLVD	NORTH MIAMI	FL	33181	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10707	14491 SW 42ND ST	MIAMI	FL	33175	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10711	16801 NW 67TH AVE	HIALEAH	FL	33015	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10721	9686 SW 24TH STREET	MIAMI	FL	33165	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00554	690 NW 57TH AVE.	MIAMI	FL	33126	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY # 10131	2393 SW 67TH AVE.	MIAMI	FL	33155	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10718	6410 NW 186 STREET	MIAMI LAKES	FL	33015	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10701	10044 WEST FLAGLER STREET	MIAMI	FL	33174	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10717	1601 WEST FLAGLER STREET	MIAMI	FL	33135	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10709	631 71 STREET	MIAMI BEACH	FL	33141	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY #02379	12180 SW 8TH STREET	MIAMI	FL	33184	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10720	13796 SW 152ND STREET	MIAMI	FL	33177	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10715	11865-A SW 26TH STREET	MIAMI	FL	33175	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10725	14055 SW 88 STREET	MIAMI	FL	33186	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10706	14665 SW 104 STREET	MIAMI	FL	33186	01/01/2021
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05145	4700 NW 183RD ST	MIAMI GARDENS	FL	33055	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03756	2391 W. 68TH ST.	HIALEAH	FL	33016	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03372	13896 SW 56TH ST	MIAMI	FL	33175	04/01/2022	01/04/2024
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05125	735 NW 119TH ST	NORTH MIAMI	FL	33168	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05147	227 SW 8TH ST	MIAMI	FL	33130	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10722	366 EAST 4TH AVENUE	HIALEAH	FL	33010	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04032	855 E 8TH AVE	HIALEAH	FL	33010	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	CVS/PHARMACY # 5966	1600 S FEDERAL HIGHWAY	HOLLYWOOD	FL	33020	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05004	5634 MERRILL RD.	JACKSONVILLE	FL	32277	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY # 925	7000 HIALEAH GARDENS BLVD.	HIALEAH	FL	33018	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01136	909 N HOMESTEAD BLVD	HOMESTEAD	FL	33030	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04249	11890 BISCAYNE BLVD	MIAMI	FL	33181	04/01/2022
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03121	10660 SW 40 STREET	MIAMI	FL	33165	01/01/2023
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03765	19198 S DIXIE HWY	CUTLER BAY	FL	33157	01/01/2023
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03764	20345 OLD CUTLER RD	CUTLER BAY	FL	33189	01/01/2023
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00113	2780 NE 8TH ST.	HOMESTEAD	FL	33033	01/01/2023
CHC28344-01	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16455	20500 SW 112TH AVE	MIAMI	FL	33189	01/01/2023
CHC28344-00	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03287	850 W SAMPLE RD	POMPANO BEACH	FL	33064	04/01/2024
CHC28344-00	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03273	5555 N UNIVERSITY DR	LAUDERHILL	FL	33351	04/01/2024
CHC28344-00	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04076	2901 CLINT MOORE RD	BOCA RATON	FL	33496	04/01/2024
CHC28344-00	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05197	14705 SW 42ND ST	MIAMI	FL	33185	04/01/2024
CHC28344-00	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05250	3090 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	04/01/2024
CHC28344-00	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05919	6900 N. UNIVERSITY DR.	TAMARAC	FL	33321	04/01/2024
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03287	850 W SAMPLE RD	POMPANO BEACH	FL	33064	04/01/2025
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05197	14705 SW 42ND ST	MIAMI	FL	33185	04/01/2025
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05250	3090 W OAKLAND PARK BLVD	OAKLAND PARK	FL	33311	04/01/2025
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03273	5555 N UNIVERSITY DR	LAUDERHILL	FL	33351	04/01/2025
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05919	6900 N. UNIVERSITY DR.	TAMARAC	FL	33321	04/01/2025
CHC28344-01	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04076	2901 CLINT MOORE RD	BOCA RATON	FL	33496	04/01/2025
CHC28344-01	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2023
CHC28344-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2024
CHC28344-01	PROCARE PHARMACY, L.L.C.	NAVARRO SPECIALTY SERVICES # 10727	7205 CORPORATE CENTER DRIVE SUITE 104	MIAMI	FL	33126	01/01/2021
CHC28344-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2024
CHC28344-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2024
CHC28344-01	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2025
CHC28344-01	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 2:44:34 PM	2/12/2025 10:07:19 AM	2/12/2025 10:07 AM
Contacts	Primary Contact	Update	Group Change Request	Fernandez, Manuel Executive Vice President of Operations Banyan Health Systems 3053986100	Enriquez, Anabel Pharmacy Director Banyan Health SystemS 3054421732	12/9/2024 1:35 PM
Contacts	Authorizing Official	Update	Group Change Request	Aprigliano, Mark Vice President of Administration Banyan Health Systems 3053986100-7408	Gutierrez, Gabriela VP of Integrated Outpatient Services Banyan Health Systems 7862391846	6/3/2024 9:45 AM
Contacts	Primary Contact	Update	Group Change Request	Gutierrez, Gabriela VP of Integrated Outpatient Services Banyan Health Systems 7862391846	Fernandez, Manuel Executive Vice President of Operations Banyan Health Systems 3053986100	6/3/2024 9:45 AM
Contacts	Primary Contact	Update	Profile Change Request	Gutierrez, Gabriela Business Operations Manager Banyan Community Health Center, Inc. 7862391846-7408	Gutierrez, Gabriela VP of Integrated Outpatient Services Banyan Health Systems 7862391846	6/3/2024 9:27 AM
Addresses	Shipping Address	Delete	Recertification	Banyan Community Health Center 3850 West Flagler Street Miami, FL 33135		1/30/2024 2:44 PM
Details	Last Recertification Date	Update	Recertification	2/2/2023 2:07:47 PM	1/30/2024 2:44:34 PM	1/30/2024 2:44 PM
Addresses	Main Address	Update	Change Request	6100 BLUE LAGOON DR MIAMI, FL 33126-2079	2300 NW 89th Place Doral, FL 33172	10/4/2023 3:03 PM
Contacts	Authorizing Official	Update	Change Request	Garcia, Ileana Ruiz Executive DIrector Banyan Community Health Center 3053986132	Aprigliano, Mark Vice President of Administration Banyan Health Systems 3053986100-7408	2/21/2023 4:11 PM
Details	Last Recertification Date	Update	Recertification	2/8/2022 1:40:29 PM	2/2/2023 2:07:47 PM	2/2/2023 2:07 PM
Contacts	Primary Contact	Update	Change Request	Gutierrez, Gabriela Business Operations Manager Banyan Community Health Center, Inc. 7862391846	Gutierrez, Gabriela Business Operations Manager Banyan Community Health Center, Inc. 7862391846-7408	10/6/2022 2:34 PM
Contacts	Primary Contact	Update	Recertification	Sirota, Emy Lou QI Director Banyan Community Health Center 3053986197	Gutierrez, Gabriela Business Operations Manager Banyan Community Health Center, Inc. 7862391846	2/8/2022 1:40 PM
Details	Last Recertification Date	Update	Recertification	2/10/2021 12:56:30 PM	2/8/2022 1:40:29 PM	2/8/2022 1:40 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	013881900 (FL)		2/10/2021 12:56 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	013881902 (FL)		2/10/2021 12:56 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	013881903 (FL)		2/10/2021 12:56 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	013881908 (FL)		2/10/2021 12:56 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	109574900 (FL)		2/10/2021 12:56 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1033155643 ( )		2/10/2021 12:56 PM
Details	Last Recertification Date	Update	Recertification	2/3/2020 9:42:57 AM	2/10/2021 12:56:30 PM	2/10/2021 12:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		013881900	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		013881902	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		013881903	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		013881908	2/3/2020 9:42 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/3/2020 9:42 AM
Details	Last Recertification Date	Update	Recertification	2/4/2019 2:49:40 PM	2/3/2020 9:42:57 AM	2/3/2020 9:42 AM
Details	Last Recertification Date	Update	Recertification	2/8/2018 3:16:34 PM	2/4/2019 2:49:40 PM	2/4/2019 2:49 PM
Contacts	Primary Contact	Update		Sirota, Emy QI Director Banyan Community Health Center 3053986197	Sirota, Emy Lou QI Director Banyan Community Health Center 3053986197	2/8/2018 3:16 PM
Contacts	Primary Contact	Update	Recertification	Garcia, Ileana Ruiz Executive DIrector Banyan Community Health Center 3053986132	Sirota, Emy QI Director Banyan Community Health Center 3053986197	2/8/2018 3:16 PM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/8/2018 3:16:34 PM	2/8/2018 3:16 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/8/2018 3:16 PM
Contacts	Authorizing Official	Update		Garcia, Ileana Ruiz Executive DIrector 3053986132	Garcia, Ileana Ruiz Executive DIrector Banyan Community Health Center 3053986132	2/7/2018 12:43 PM
Contacts	Primary Contact	Update		Garcia, Ileana Ruiz Executive DIrector 3053986132	Garcia, Ileana Ruiz Executive DIrector Banyan Community Health Center 3053986132	2/7/2018 12:43 PM
Contacts	Authorizing Official	Update		Ruiz-Garcia, Ileana COO 3053986132	Garcia, Ileana Ruiz Executive DIrector 3053986132	7/13/2017 2:58 PM
Contacts	Primary Contact	Update		Crain, Kevin M. Executive Director 3053986110	Garcia, Ileana Ruiz Executive DIrector 3053986132	7/13/2017 2:58 PM
Contacts	Signed By	Insert			Ruiz-Garcia, Ileana COO 3053986132	6/14/2017 3:41 PM
Addresses	Main Address	Insert			6100 BLUE LAGOON DR MIAMI, FL 33126-2079	6/14/2017 3:24 PM
Addresses	Shipping Address	Insert			Banyan Community Health Center 3850 West Flagler Street Miami, FL 33135	6/14/2017 3:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/14/2017 3:23 PM
Medicaid Billing	Medicaid: Number	Insert			109574900	6/14/2017 3:23 PM
Medicaid Billing	Medicaid: State	Insert			FL	6/14/2017 3:23 PM
Medicaid Billing	NPI: Number	Insert			1033155643	6/14/2017 3:23 PM
Contacts	Primary Contact	Insert			Crain, Kevin M. Executive Director 3053986110	2/1/2017 12:51 PM
Details	Last Recertification Date	Update		2/29/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 12:51 PM
Details	Last Recertification Date	Update			2/29/2016 12:00:00 AM	2/29/2016 9:24 AM
Contacts	Authorizing Official	Insert			Ruiz-Garcia, Ileana COO 3053986132	10/22/2015 10:16 AM
Dates	Participating Approval Date	Update			10/22/2015 12:00:00 AM	10/22/2015 10:16 AM
Details	State	Update		Pending	Active	10/22/2015 10:16 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/22/2015 10:16 AM
Details	340B ID	Update		ONLINE_REG_55075	CHC28344-00	10/13/2015 2:54 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_55075	10/12/2015 3:11 PM
Details	Last Recertification Date	Insert				10/12/2015 3:11 PM
Details	Grant Number	Insert			H80CS28344	10/12/2015 3:11 PM
Details	340B ID	Insert			ONLINE_REG	10/12/2015 3:11 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/12/2015 3:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/12/2015 3:11 PM
Details	Medicare Provider Number	Insert				10/12/2015 3:11 PM
Details	Entity Name	Insert			BANYAN COMMUNITY HEALTH CENTER, INC.	10/12/2015 3:11 PM
Details	Program Code	Insert			CH	10/12/2015 3:11 PM
Details	Entity Subname	Insert			BCHC Administration Only	10/12/2015 3:11 PM
Dates	Participating Approval Date	Insert				10/12/2015 3:11 PM
Details	State	Insert			Pending	10/12/2015 3:11 PM
Dates	Registration Date	Insert			10/12/2015 12:00:00 AM	10/12/2015 3:11 PM
Dates	Signed By Date	Insert			10/12/2015 12:00:00 AM	10/12/2015 3:11 PM
Dates	Start Date	Insert				10/12/2015 3:11 PM
Terminations	Termination Comments	Insert				10/12/2015 3:11 PM
Terminations	Termination Date	Insert				10/12/2015 3:11 PM
Terminations	Termination Effective Date	Insert				10/12/2015 3:11 PM
Terminations	Termination Reason	Insert				10/12/2015 3:11 PM

340B Drug Pricing Program Database