Covered Entity Details

CH04033X JESSIE TRICE COMMUNITY HEALTH SYSTEM INC (Active) - information as of 6/28/2025 12:27:41 AM

Main Details

Name

JESSIE TRICE COMMUNITY HEALTH SYSTEM INC

Subdivision Name

Miami Carol City Senior High School

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017012

340B ID

CH04033X

Grant Number

H80CS00732

Additional Details

Current Program Status

Active

Registration Date

7/2/2024

Participating Start Date

10/1/2024

Participating Approval Date

9/12/2024

Last Recertification Date

2/17/2025

Contacts

Authorizing Official

Jessie Trice Community Health System
Ryan Rashaun Hawkins, President & CEO
(305) 805-1700

Primary Contact

JESSIE TRICE COMMUNITY HEALTH SYSTEM
Ruth Duval, Executive VP & Chief Nursing Officer
(305) 805-1700 Ext: 1011

Addresses

Street Address

3301 NW 183rd St
Carol City, FL 33056-3453

Billing Address

Jessie Trice Commnuity Health System
5607 NW 27th Ave
Miami, FL 33142

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

Comments

Comment	Last Updated On
Original Start Date - 4/1/2016 Termination Date - 4/1/2021 Reinstatement Date - 10/1/2024	09/12/2024

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	029541858 029541859	1861863458

Shipping Addresses

Same as Street Address

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
CH040330	Active	BPS-H80-002322	Jessie Trice Community Health System, Inc,	JTCHS - Fatima Zafar MD Health & Wellness Center	5361 NW 22nd Ave	Miami	FL
CH04033AA	Terminated	BPS-H80-021571	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	JTCHS - Lotus Village Center	217 NW 15th Street	Miami	FL
CH04033AB	Active	BPS-H80-032027	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	JTCHS Barbara J. Jordan Community Health and Wellness Center	20612 NW 27TH AVE	Miami Gardens	FL
CH04033AC	Active	BPS-H80-032706	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	Florida Memorial University	15800 NW 42nd Ave Bldg 3	Miami Gardens	FL
CH04033AD	Active	BPS-H80-022118	JESSIE TRICE COMMUNITY	JTCHS - Dental Health Center	5607 NW 27th Ave Ste 2	Miami	FL
CH04033G	Active	BPS-H80-004718	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	JTCHS - Jefferson Reaves House Women's Residental SA Treatment Center (24 Hour)	2985 NW 54th St	Miami	FL
CH04033K	Active	BPS-H80-012461	Jessie Trice Community Health System, Inc.	JTCHS - Health Center at North Shore	1190 NW 95th St STE 100	Miami	FL
CH04033L	Active	BPS-H80-002574	Jessie Trice Community Health System, Inc.	JTCHS Flamingo Medical Center	901 E 10th Ave STE 39	Hialeah	FL
CH04033O	Terminated	BPS-H80-004658	Jessie Trice Community Health Center, Inc.	MIAMI EDISON SENIOR HIGH SCHOOL	6161 NW 5TH CT RM A-	MIAMI	FL
CH04033Q	Terminated	BPS-H80-002209	Jessie Trice Community Health System, Inc.	Norland Dental Health Center	18360 NW 7th Ave	Miami	FL
CH04033R	Active	BPS-H80-007603	Jessie Trice Community Health System, Inc.	JTCHS - Children's Wellness Center	1190 NW 95th St STE 304	Miami	FL
CH04033S	Terminated	BPS-H80-012461	Jessie Trice Community Health Center, Inc.	Jessie Trice Community Health Center - Women's Health Center	1190 NW 95th St STE 100	Miami	FL
CH04033T	Terminated	BPS-H80-012845	Jessie Trice Community Health System, Inc.	Jessie Trice Community Health System - Miami Gardens	4692 NW 183rd Street	Miami Gardens	FL
CH04033U	Active	BPS-H80-013538	Jessie Trice Community Health System, Inc.	JTCHS - Corporate Office Complex	5607 NW 27TH AVE	MIAMI	FL
CH04033V	Active	BPS-H80-014071	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	JTCHS - Frederica Wilson / Juanita Mann Health Center	2520 N.W. 75th Street	Miami	FL
CH04033W	Active	BPS-H80-017003	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	Miami Northwestern Senior High School	1100 NW 71st Street	Miami	FL
CH04033X	Active	BPS-H80-017012	JESSIE TRICE COMMUNITY HEALTH SYSTEM INC	Miami Carol City Senior High School	3301 NW 183rd St	Carol City	FL
CH04033Y	Active	BPS-H80-015392	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	JTCHS - Opa Locka Youth and Children's Wellness Center	490 Opa-Locka Blvd. Suite 100	Opa Locka	FL
CH04033Z	Terminated	BPS-H80-017023	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	Jessie Trice Hialeah Women's Health Center	Hialeah Medical Plaza 777 East 25th Street Suite 316	Hialeah	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH04033U	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2018	03/27/2025
CH040330	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2025
CH04033U	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2018	03/27/2025
CH040330	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2025
CH040330	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2021	11/14/2024
CH040330	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2021	11/14/2024
CH040330	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2021	11/14/2024
CH040330	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2021	11/14/2024
CH040330	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2021	11/14/2024
CH040330	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2021	11/14/2024
CH040330	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2021
CH040330	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2021	11/14/2024
CH040330	COMMCARE PHARMACY-FTL, LLC	855 SW 78TH AVE STE C100		PLANTATION	FL	33324-3223	10/01/2016	07/19/2019
CH040330	COMMCARE PHARMACY-MIA, LLC		1801 CORAL WAY SUITE 115	MIAMI	FL	33145-2784	10/01/2016	02/17/2017
CH040330	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00628	600 NE 128TH ST	NORTH MIAMI	FL	33161	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00931	101 HIALEAH DR	HIALEAH	FL	33010	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00113	2780 NE 8TH ST.	HOMESTEAD	FL	33033	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00580	4800 BISCAYNE BLVD	MIAMI	FL	33137	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00402	170 SE 3RD AVE	MIAMI	FL	33131	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01277	6690 EAGLE NEST LN	MIAMI LAKES	FL	33014	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY # 976	1177 SW 8TH ST.	MIAMI	FL	33130	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00567	591 NE 79TH STREET	MIAMI	FL	33138	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05112	101 SOUTH MAIN STREET	BELLE GLADE	FL	33430	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04201	2240 EAST SUNRISE BLVD	FORT LAUDERDALE	FL	33304	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04222	4400 HOLLYWOOD BLVD	HOLLYWOOD	FL	33021	01/01/2021	03/13/2023
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05136	11398 QUAIL ROOST DR	MIAMI	FL	33157	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04032	855 E 8TH AVE	HIALEAH	FL	33010	01/01/2021	07/17/2024
CH040330	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10723	13250 BISCAYNE BLVD	NORTH MIAMI	FL	33181	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05147	227 SW 8TH ST	MIAMI	FL	33130	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05233	650 NW 27TH AVE	MIAMI	FL	33125	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10698	1243 SW 8TH STREET	MIAMI	FL	33135	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17268	3401 N MIAMI AVE STE 100	MIAMI	FL	33127	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY #10132	1201 BRICKELL AVENUE	MIAMI	FL	33131	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05897	3700 NW 199TH ST.	MIAMI GARDENS	FL	33055	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY # 5466	1230 WEST 29TH STREET	HIALEAH	FL	33012	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10722	366 EAST 4TH AVENUE	HIALEAH	FL	33010	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	NAVARRO DISCOUNT PHARMACY # 10719	3915 PALM AVENUE	HIALEAH	FL	33012	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03982	4599 SHERIDAN ST.	HOLLYWOOD	FL	33021	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03765	19198 S DIXIE HWY	CUTLER BAY	FL	33157	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05786	16550 NE 6TH AVE, NORTH	MIAMI	FL	33162	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04249	11890 BISCAYNE BLVD	MIAMI	FL	33181	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04613	200 BISCAYNE BLVD	MIAMI	FL	33132	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05125	735 NW 119TH ST	NORTH MIAMI	FL	33168	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02895	19800 NW 2ND AVE.	MIAMI GARDENS	FL	33169	01/01/2021
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05145	4700 NW 183RD ST	MIAMI GARDENS	FL	33055	10/01/2022
CH040330	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05182	8901 MIRAMAR PKWY	MIRAMAR	FL	33025	10/01/2022
CH040330	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2019
CH040330	PROCARE PHARMACY, L.L.C.	NAVARRO SPECIALTY SERVICES # 10727	7205 CORPORATE CENTER DRIVE SUITE 104	MIAMI	FL	33126	06/10/2019
CH040330	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2021
CH040330	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2021
CH040330	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2021
CH040330	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05671	103 FOOTHILLS MALL DR.	MARYVILLE	TN	37801	01/01/2021
CH040330	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2019
CH040330	WAL-MART PHARMACY 10-1590	5851 NW 177TH STREET		HIALEAH	FL	33015	01/01/2017
CH040330	WAL-MART PHARMACY 10-3235	1425 NORTHEAST 163RD STREET		NORTH MIAMI BEACH	FL	33162	01/01/2017	06/10/2020
CH040330	WAL-MART PHARMACY 10-3311	19501 NORTHWEST 27TH AVE		MIAMI GARDENS	FL	33056	01/01/2017
CH040330	WAL-MART PHARMACY 10-3397	17650 NW 2ND AVE.		MIAMI GARDENS	FL	33169	01/01/2017
CH040330	WAL-MART PHARMACY 10-5945	400 W. 49TH		HIALEAH	FL	33012	01/01/2017	02/08/2019
CH040330	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019
CH040330	WALGREEN CO	DBA WALGREENS SPECIALTY PHARMACY #16297	9400 NORTHWEST 12TH AVE BAY 5	MIAMI	FL	33150	07/01/2019
CH040330	WALGREEN CO.	DBA: WALGREENS # 00748	12295 BISCAYNE BLVD	NORTH MIAMI	FL	33181	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 01532	6700 COLLINS AVE	MIAMI BEACH	FL	33141	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 02443	3705 HOLLYWOOD BLVD	HOLLYWOOD	FL	33021	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 02489	3007 AVENTURA BLVD., #4	AVENTURA	FL	33180	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 07322	2710 N UNIVERSITY DR	HOLLYWOOD	FL	33024	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 02545	1480 NE MIAMI GARDENS DR	NORTH MIAMI BEACH	FL	33179	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 02719	791 NE 167TH ST	NORTH MIAMI BEACH	FL	33162	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 02790	3103 BISCAYNE BLVD	MIAMI	FL	33137	08/29/2012
CH040330	WALGREEN CO.	WALGREENS #16354	1780 N. UNIVERSITY DR.	PLANTATION	FL	33322	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 03105	11920 NW 27TH AVENUE	MIAMI	FL	33167	08/29/2012	02/28/2024
CH040330	WALGREEN CO.	DBA: WALGREENS # 03173	9020 BISCAYNE BLVD	MIAMI SHORES	FL	33138	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03211	9675 NW 41ST STREET	DORAL	FL	33178-2974	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03239	1 SE 3RD AVE STE 100	MIAMI	FL	33131	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03250	18300 NW 37TH AVE.	MIAMI GARDENS	FL	33056-5101	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03301	1695 NW 20TH STREET	MIAMI	FL	33142	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03371	7910 NW 27TH AVENUE	MIAMI	FL	33147	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03493	9498 NW 7TH AVE	MIAMI	FL	33150	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03525	6817 TAFT STREET	HOLLYWOOD	FL	33024	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03527	567 NE 125TH STREET	NORTH MIAMI	FL	33161	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03566	4451 W. 12TH AVE.	HIALEAH	FL	33012	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03626	1800 N NOB HILL ROAD	PLANTATION	FL	33322	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 03678	1501 NE 163RD STREET	NORTH MIAMI BEACH	FL	33162	08/29/2012	08/19/2021
CH040330	WALGREEN CO.	DBA: WALGREENS # 03679	161 NE 54TH STREET	MIAMI	FL	33137	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03782	5701 NW 183RD ST	HIALEAH	FL	33015	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03835	19935 NW 2ND AVE	MIAMI	FL	33169	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03854	15900 NW 27TH AVE	OPA LOCKA	FL	33054	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 03905	1751 BONAVENTURE BLVD	WESTON	FL	33326	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 03943	200 SW 13TH ST	MIAMI	FL	33130	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 04141	3099 N. STATE ROAD 7	LAUDERDALE LAKES	FL	33313-1913	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 04324	15911 PINES BLVD.	PEMBROKE PINES	FL	33027	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 04384	400 HIALEAH DRIVE	HIALEAH	FL	33010	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 04385	770 W 29TH ST	HIALEAH	FL	33012	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 04386	5999 PEMBROKE ROAD	HOLLYWOOD	FL	33023	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 04402	1300 E HALLANDALE BEACH BLVD	HALLANDALE BEACH	FL	33009	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 04694	6105 W SUNRISE BLVD	PLANTATION	FL	33313	08/29/2012	04/28/2017
CH040330	WALGREEN CO.	DBA: WALGREENS # 04728	6200 NW 7TH AVE	MIAMI	FL	33150	08/29/2012	06/25/2025
CH040330	WALGREEN CO.	DBA: WALGREENS # 04766	9005 PINES BLVD	PEMBROKE PINES	FL	33024	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 04808	20340 OLD CUTLER RD	CUTLER BAY	FL	33189	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 04915	750 NW 119TH ST.	MIAMI	FL	33168	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 04917	690 NW 183RD ST	MIAMI GARDENS	FL	33169	08/29/2012	02/22/2024
CH040330	WALGREEN CO.	DBA: WALGREENS # 04955	18665 BISCAYNE BLVD	AVENTURA	FL	33180	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 05050	1610 W 49TH ST	HIALEAH	FL	33012	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 05130	6800 W 28TH AVE	HIALEAH	FL	33018	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 05198	7340 COLLINS AVE	MIAMI BEACH	FL	33141	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 05250	1699 NW 7TH ST	MIAMI	FL	33125	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 05251	1 E FLAGLER ST	MIAMI	FL	33131	08/29/2012	06/02/2021
CH040330	WALGREEN CO.	DBA: WALGREENS # 05293	4895 PALM AVENUE	HIALEAH	FL	33012	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 05521	12400 PEMBROKE RD	MIRAMAR	FL	33027	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 05696	14501 MIRAMAR PARKWAY	MIRAMAR	FL	33027	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 05845	14901 NE 6TH AVE	MIAMI	FL	33161	08/29/2012	06/27/2017
CH040330	WALGREEN CO.	DBA: WALGREENS # 06011	8001 MIRAMAR PKWY	MIRAMAR	FL	33025-3004	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 06012	655 NW 57TH AVE	MIAMI	FL	33126	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 06403	199 WESTON ROAD	WESTON	FL	33326	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 06512	6812 MIRAMAR PKWY	MIRAMAR	FL	33023-6003	08/29/2012	06/27/2017
CH040330	WALGREEN CO.	DBA: WALGREENS # 06949	2499 S PALM AVE	MIRAMAR	FL	33025	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 07844	7605 W 33RD CT	HIALEAH	FL	33018	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 10984	3914 W. COMMERCIAL BLVD	TAMARAC	FL	33309	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS #11638	15050 BISCAYNE BLVD	NORTH MIAMI	FL	33181	08/29/2012	11/18/2016
CH040330	WALGREEN CO.	DBA: WALGREENS #11657	2000 NORMANDY DR.	MIAMI BEACH	FL	33141	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 11939	8450 CORAL WAY	MIAMI	FL	33155	08/29/2012	05/04/2016
CH040330	WALGREEN CO.	DBA: WALGREENS # 12285	780 EAST 9TH STREET	HIALEAH	FL	33010	08/29/2012
CH040330	WALGREEN CO.	DBA: WALGREENS # 12724	1251 SOUTH STATE ROAD 7	DAVIE	FL	33317	04/01/2013	05/04/2016
CH040330	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16331	5361 NW 22ND AVE STE 2	MIAMI	FL	33142	07/01/2016
CH040330	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15106	1250 NW 7TH STREET SUITE 205	MIAMI	FL	33125	10/01/2017
CH040330	WALGREEN CO.	WALGREENS #16541	1400 NW 12TH AVE STE 2002	MIAMI	FL	33136	07/01/2019
CH040330	WALGREEN CO.	DBA: WALGREENS #15912	7100 W 20TH AVENUE, STE G177	HIALEAH	FL	33016	10/01/2021	03/22/2023
CH040330	WALGREEN CO.	DBA: WALGREENS #10264	28875 S. DIXIE HWY	HOMESTEAD	FL	33033	01/01/2022
CH040330	WALGREEN CO.	DBA: WALGREENS #09018	1155 W. 68TH ST	HIALEAH	FL	33014-5152	01/01/2022
CH040330	WALGREEN CO.	DBA: WALGREENS # 00621	5731 BIRD ROAD	MIAMI	FL	33155	01/01/2022
CH040330	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21359	275 NE 35TH ST	MIAMI	FL	33137	01/01/2022
CH040330	WALGREEN CO.	DBA: WALGREENS # 06873	1201 SW 1ST STREET	MIAMI	FL	33135-2401	01/01/2022	01/21/2025
CH040330	WALGREEN CO.	DBA: WALGREENS #15994	801 SW 8TH ST	MIAMI	FL	33130	01/01/2022
CH040330	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	07/01/2023
CH040330	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	08/31/2012	08/03/2015
CH040330	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	08/03/2015
CH040330	WALMART PHARMACY #10-4303	3200 NW 79TH STREET		MIAMI	FL	33147	04/01/2019
CH040330	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH040330	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/17/2025 12:50:57 PM	2/17/2025 12:50 PM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Details	Comments Public	Insert	OPA Edit		Original Start Date - 4/1/2016 Termination Date - 4/1/2021 Reinstatement Date - 10/1/2024	9/12/2024 12:27 PM
Addresses	Billing Address	Insert	Reinstatement		Jessie Trice Commnuity Health System 5607 NW 27th Ave Miami, FL 33142	9/12/2024 12:27 PM
Addresses	Main Address	Update	Reinstatement	3301 NW 183rd Street Carol City, FL 33056-2999	3301 NW 183rd St Carol City, FL 33056-3453	9/12/2024 12:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	9/12/2024 12:27 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		029541858 029541859	9/12/2024 12:27 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		FL	9/12/2024 12:27 PM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1861863458	9/12/2024 12:27 PM
Medicaid Billing	NPI: State	Insert	Reinstatement		FL	9/12/2024 12:27 PM
Contacts	Authorizing Official	Update	Reinstatement	Neasman, Annie President & CEO Jessie Trice Community Health Center, Inc 3058051700-1000	Hawkins, Ryan Rashaun President & CEO Jessie Trice Community Health System 3058051700	9/12/2024 12:27 PM
Contacts	Signed By	Update	Reinstatement	Neasman, Annie President & CEO Jessie Trice Community Health Center, Inc 3058051700-1000	Hawkins, Ryan Rashaun President & CEO Jessie Trice Community Health System 3058051700	9/12/2024 12:27 PM
Details	Last Recertification Date	Update	Reinstatement	2/10/2020 12:57:26 PM		9/12/2024 12:27 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	1/1/2021 12:00:00 AM		9/12/2024 12:27 PM
Details	Entity Name	Update	Reinstatement	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	JESSIE TRICE COMMUNITY HEALTH SYSTEM INC	9/12/2024 12:27 PM
Dates	Participating Approval Date	Update	Reinstatement	2/17/2016 12:00:00 AM	9/12/2024 12:27:09 PM	9/12/2024 12:27 PM
Details	State	Update	Reinstatement	Terminated	Approved	9/12/2024 12:27 PM
Dates	Registration Date	Update	Reinstatement	1/14/2016 12:00:00 AM	7/2/2024 12:07:44 PM	9/12/2024 12:27 PM
Dates	Signed By Date	Update	Reinstatement	1/14/2016 12:00:00 AM	7/8/2024 4:10:42 PM	9/12/2024 12:27 PM
Dates	Start Date	Update	Reinstatement	4/1/2016 12:00:00 AM	10/1/2024 12:00:00 AM	9/12/2024 12:27 PM
Terminations	Termination Date	Update	Reinstatement	4/1/2021 12:00:00 AM		9/12/2024 12:27 PM
Terminations	Termination Effective Date	Update	Reinstatement	1/1/2021 12:00:00 AM		9/12/2024 12:27 PM
Terminations	Termination Reason	Update	Reinstatement	Never implemented the 340B Program		9/12/2024 12:27 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		1/1/2021 12:00:00 AM	2/8/2021 7:07 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/8/2021 7:07 AM
Terminations	Termination Date	Update	Recertification		4/1/2021 12:00:00 AM	2/8/2021 7:07 AM
Terminations	Termination Effective Date	Update	Recertification		1/1/2021 12:00:00 AM	2/8/2021 7:07 AM
Terminations	Termination Reason	Update	Recertification		Never implemented the 340B Program	2/8/2021 7:07 AM
Details	Last Recertification Date	Update	Recertification	2/25/2019 10:07:17 PM	2/10/2020 12:57:26 PM	2/10/2020 12:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	259421800 (FL)		2/25/2019 10:07 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	029541858 (FL)		2/25/2019 10:07 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	100054100 (FL)		2/25/2019 10:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1881659365 ( )		2/25/2019 10:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1861863458 ( )		2/25/2019 10:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1174031199 ( )		2/25/2019 10:07 PM
Details	Last Recertification Date	Update	Recertification	2/19/2018 12:30:12 PM	2/25/2019 10:07:17 PM	2/25/2019 10:07 PM
Addresses	Billing Address	Update	Change Request	Jessie Trice Commnuity Health Center 5607 NW 27th Ave Miami, FL 33142	Jessie Trice Commnuity Health System 5607 NW 27th Ave Miami, FL 33142	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		259421800	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		029541858	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100054100	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	9/7/2018 10:41 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	009966100 (FL)		9/7/2018 10:41 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1447599121 ( )		9/7/2018 10:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1881659365	9/7/2018 10:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1861863458	9/7/2018 10:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1174031199	9/7/2018 10:41 AM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		9/7/2018 10:41 AM
Details	Entity Name	Update	Change Request	JESSIE TRICE COMMUNITY HEALTH CENTER, INC.	JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC.	9/7/2018 10:41 AM
Details	Last Recertification Date	Update	Recertification	2/2/2017 12:00:00 AM	2/19/2018 12:30:12 PM	2/19/2018 12:30 PM
Contacts	Primary Contact	Update	Profile Change Request	Duval, Ruth Sr. Vice President JESSIE TRICE COMMUNITY HEALTH CENTER, INC 3058051700-1000	Duval, Ruth Executive VP & Chief Nursing Officer JESSIE TRICE COMMUNITY HEALTH SYSTEM 3058051700-1011	1/25/2018 5:09 PM
Contacts	Authorizing Official	Update		Neasman, Annie President & CEO 3058051700-1000	Neasman, Annie President & CEO Jessie Trice Community Health Center, Inc 3058051700-1000	10/16/2017 5:19 PM
Contacts	Signed By	Update		Neasman, Annie President & CEO 3058051700-1000	Neasman, Annie President & CEO Jessie Trice Community Health Center, Inc 3058051700-1000	10/16/2017 5:19 PM
Contacts	Primary Contact	Update		Duval, Ruth Sr. Vice President 3058051700-1000	Duval, Ruth Sr. Vice President JESSIE TRICE COMMUNITY HEALTH CENTER, INC 3058051700-1000	10/13/2017 12:06 PM
Contacts	Authorizing Official	Insert			Neasman, Annie President & CEO 3058051700-1000	2/15/2017 8:43 AM
Contacts	Signed By	Insert			Neasman, Annie President & CEO 3058051700-1000	2/15/2017 8:43 AM
Contacts	Primary Contact	Insert			Duval, Ruth Sr. Vice President 3058051700-1000	2/15/2017 8:43 AM
Addresses	Main Address	Insert			3301 NW 183rd Street Carol City, FL 33056-2999	2/2/2017 4:35 PM
Details	Last Recertification Date	Update			2/2/2017 12:00:00 AM	2/2/2017 4:35 PM
Addresses	Billing Address	Insert			Jessie Trice Commnuity Health Center 5607 NW 27th Ave Miami, FL 33142	5/26/2016 11:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/26/2016 11:42 AM
Medicaid Billing	Medicaid: Number	Insert			009966100	5/26/2016 11:42 AM
Medicaid Billing	Medicaid: State	Insert			FL	5/26/2016 11:42 AM
Medicaid Billing	NPI: Number	Insert			1447599121	5/26/2016 11:42 AM
Dates	Participating Approval Date	Update			2/17/2016 12:00:00 AM	2/17/2016 2:06 PM
Details	State	Update		Pending	Active	2/17/2016 2:06 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	2/17/2016 2:06 PM
Details	340B ID	Update		ONLINE_REG_57996	CH04033X	1/20/2016 10:17 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_57996	1/14/2016 2:00 PM
Details	Last Recertification Date	Insert				1/14/2016 2:00 PM
Details	Grant Number	Insert			H80CS00732	1/14/2016 2:00 PM
Details	340B ID	Insert			ONLINE_REG	1/14/2016 2:00 PM
Details	Is Authorizing Official EHB Data	Insert			False	1/14/2016 2:00 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2016 2:00 PM
Details	Medicare Provider Number	Insert				1/14/2016 2:00 PM
Details	Entity Name	Insert			JESSIE TRICE COMMUNITY HEALTH CENTER, INC.	1/14/2016 2:00 PM
Details	Program Code	Insert			CH	1/14/2016 2:00 PM
Details	Entity Subname	Insert			Miami Carol City Senior High School	1/14/2016 2:00 PM
Dates	Participating Approval Date	Insert				1/14/2016 2:00 PM
Details	State	Insert			Pending	1/14/2016 2:00 PM
Dates	Registration Date	Insert			1/14/2016 12:00:00 AM	1/14/2016 2:00 PM
Dates	Signed By Date	Insert			1/14/2016 12:00:00 AM	1/14/2016 2:00 PM
Dates	Start Date	Insert				1/14/2016 2:00 PM
Terminations	Termination Comments	Insert				1/14/2016 2:00 PM
Terminations	Termination Date	Insert				1/14/2016 2:00 PM
Terminations	Termination Effective Date	Insert				1/14/2016 2:00 PM
Terminations	Termination Reason	Insert				1/14/2016 2:00 PM

340B Drug Pricing Program Database