| Details | Last Recertification Date | Update | Recertification | 2/11/2024 1:33:13 PM | 3/7/2025 10:29:16 AM | 3/7/2025 10:29 AM |
| Details | Last Recertification Date | Update | Recertification | 2/26/2023 8:42:37 AM | 2/11/2024 1:33:13 PM | 2/11/2024 1:33 PM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2022 1:36:32 PM | 2/26/2023 8:42:37 AM | 2/26/2023 8:42 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2021 10:19:29 AM | 2/17/2022 1:36:32 PM | 2/17/2022 1:36 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2020 9:30:32 AM | 2/13/2021 10:19:29 AM | 2/13/2021 10:19 AM |
| Details | Last Recertification Date | Update | Recertification | 2/20/2019 5:56:15 PM | 1/30/2020 9:30:32 AM | 1/30/2020 9:30 AM |
| Contacts | Primary Contact | Update | Recertification | Graham, Nellie
HR and Credentialing Manager
Neighborhood Medical Center, Inc.
8505770045 | Kirksey, Otis W
Director of Pharmacy Services
Neighborhood Medical Center
8505133267 | 2/20/2019 5:56 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2018 8:24:48 AM | 2/20/2019 5:56:15 PM | 2/20/2019 5:56 PM |
| Contacts | Primary Contact | Update | Recertification | Freeman, Jeanne S
CEO
Neighborhood Medical Center, Inc.
8505771558 | Graham, Nellie
HR and Credentialing Manager
Neighborhood Medical Center, Inc.
8505770045 | 2/12/2018 8:24 AM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2017 12:00:00 AM | 2/12/2018 8:24:48 AM | 2/12/2018 8:24 AM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/12/2018 8:24 AM |
| Contacts | Authorizing Official | Update | | Freeman, Jeanne
CEO
8505771558 | Freeman, Jeanne S
CEO
Neighborhood Medical Center, Inc.
8505771558 | 9/18/2017 1:27 PM |
| Contacts | Primary Contact | Update | | Freeman, Jeanne
CEO
8505771558 | Freeman, Jeanne S
CEO
Neighborhood Medical Center, Inc.
8505771558 | 9/18/2017 1:27 PM |
| Contacts | Signed By | Update | | Freeman, Jeanne
CEO
8505771558 | Freeman, Jeanne S
CEO
Neighborhood Medical Center, Inc.
8505771558 | 9/18/2017 1:27 PM |
| Contacts | Authorizing Official | Insert | | | Freeman, Jeanne
CEO
8505771558 | 7/5/2017 9:43 AM |
| Contacts | Primary Contact | Insert | | | Freeman, Jeanne
CEO
8505771558 | 7/5/2017 9:43 AM |
| Contacts | Signed By | Insert | | | Freeman, Jeanne
CEO
8505771558 | 7/5/2017 9:43 AM |
| Addresses | Main Address | Insert | | |
1210 KEMP RD
HAVANA, FL 32333-1938 | 2/13/2017 10:10 AM |
| Details | Last Recertification Date | Update | | | 2/13/2017 12:00:00 AM | 2/13/2017 10:09 AM |
| Addresses | Billing Address | Insert | | | Neighborhood Medical Center Inc.
438 W BREVARD ST
TALLAHASSEE, FL 32301 | 4/18/2016 5:58 PM |
| Dates | Participating Approval Date | Update | | | 4/18/2016 12:00:00 AM | 4/18/2016 5:58 PM |
| Details | State | Update | | Pending | Active | 4/18/2016 5:58 PM |
| Dates | Start Date | Update | | | 7/1/2016 12:00:00 AM | 4/18/2016 5:58 PM |
| Details | 340B ID | Update | | ONLINE_REG_60656 | CHC26803-03 | 4/18/2016 2:49 PM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_60656 | 4/15/2016 4:35 PM |
| Details | Last Recertification Date | Insert | | | | 4/15/2016 4:35 PM |
| Details | Grant Number | Insert | | | H80CS26803 | 4/15/2016 4:35 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/15/2016 4:35 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 4/15/2016 4:35 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/15/2016 4:35 PM |
| Details | Medicare Provider Number | Insert | | | | 4/15/2016 4:35 PM |
| Details | Entity Name | Insert | | | NEIGHBORHOOD MEDICAL CENTER INC. | 4/15/2016 4:35 PM |
| Details | Program Code | Insert | | | CH | 4/15/2016 4:35 PM |
| Details | Entity Subname | Insert | | | Neighborhood Medical Center Havana Middle School | 4/15/2016 4:35 PM |
| Dates | Participating Approval Date | Insert | | | | 4/15/2016 4:35 PM |
| Details | State | Insert | | | Pending | 4/15/2016 4:35 PM |
| Dates | Registration Date | Insert | | | 4/15/2016 12:00:00 AM | 4/15/2016 4:35 PM |
| Dates | Signed By Date | Insert | | | 4/15/2016 12:00:00 AM | 4/15/2016 4:35 PM |
| Dates | Start Date | Insert | | | | 4/15/2016 4:35 PM |
| Terminations | Termination Comments | Insert | | | | 4/15/2016 4:35 PM |
| Terminations | Termination Date | Insert | | | | 4/15/2016 4:35 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/15/2016 4:35 PM |
| Terminations | Termination Reason | Insert | | | | 4/15/2016 4:35 PM |