Covered Entity Details

CH04021K CENTRAL FLORIDA HEALTH CARE, INC. (Active) - information as of 5/7/2025 10:40:54 PM

Main Details

Name

CENTRAL FLORIDA HEALTH CARE, INC.

Subdivision Name

CFHC Lakeland Pediatrics and Dental

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017744

340B ID

CH04021K

Grant Number

H80CS00423

Additional Details

Current Program Status

Active

Registration Date

4/15/2016

Participating Start Date

7/1/2016

Participating Approval Date

4/18/2016

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

CENTRAL FLORIDA HEALTH CARE INC
ANN CLAUSSEN, CEO
(863) 291-5115

Primary Contact

Central Florida Health Care
Ron M Pickos, Chief Pharmacy Officer
(863) 206-3710

Addresses

Street Address

601 S Florida Ave
Lakeland, FL 33801-5237

Billing Address

CFHC Administrative Office
47 5TH ST NW
WINTER HAVEN, FL 33881-4672

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?
Yes

State	Medicaid Number	NPI Number
FL	029549324,100382300,029549327,029549312,029549311	1851751549,1811358757,1831232669,1811577307,1205336690

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
CH040210	Active	BPS-H80-004632	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Avon Park Primary Care	950 COUNTY ROAD 17-A, WEST	AVON PARK	FL
CH04021A	Active	BPS-H80-003358	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Frostproof Primary Care	109 W Wall St	Frostproof	FL
CH04021B	Terminated	BPS-H80-003402	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC WAUCHULA CLINIC	204 E Palmetto St	Wauchula	FL
CH04021D	Active	BPS-H80-004190	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Dundee Primary Care	916 DUNDEE RD	DUNDEE	FL
CH04021E	Active	BPS-H80-013605	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Lakeland Primary Care	1129 N Missouri Ave	Lakeland	FL
CH04021G	Active	BPS-H80-011624	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Winter Haven Primary Care	1514 1st St N	Winter Haven	FL
CH04021H	Active	BPS-H80-034162	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Wauchula Primary Care	807 Cobb Ct	Wauchula	FL
CH04021J	Active	BPS-H80-013190	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Mulberry Primary Care	106 NW 9th Ave	Mulberry	FL
CH04021K	Active	BPS-H80-017744	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Lakeland Pediatrics and Dental	601 S Florida Ave	Lakeland	FL
CH04021L	Terminated	BPS-H80-015035	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Lake Wales Medical and Dental	225 Lincoln Ave.	Lake Wales	FL
CH04021M	Active	BPS-H80-035770	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Winter Haven Behavioral Health and Integrated Medical	244 Avenue D SW	Winter Haven	FL
CH04021N	Active	BPS-H80-018256	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Winter Haven Women and Children	201 Magnolia Ave SW	Winter Haven	FL
CH04021P	Active	BPS-H80-018217	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Lake Wales Primary Care	305 W Central Ave	Lake Wales	FL
CH04021Q	Active	BPS-H80-018998	Central Florida Health Care, Inc.	CFHC Haines City Primary Care	705 Ingraham Ave	Haines City	FL
CH04021R	Terminated	BPS-H80-021315	Central Florida Health Care, Inc.	CFHC Haines City Pediatrics	1011 E Main St	Haines City	FL
CH04021S	Active	BPS-H80-022303	Central Florida Health Care, Inc.	CFHC School Based Crystal Lake Elementary.	903 Lowry Ave STE 1	Lakeland	FL
CH04021T	Active	BPS-H80-030414	Central Florida Health Care, Inc.	CFHC Lakeland Hills Dental	1417 Lakeland Hills Blvd Ste 101	Lakeland	FL
CH04021U	Active	BPS-H80-030162	Central Florida Health Care, Inc.	CFHC Mobile Unit 1	950 County Road 17A W	Avon Park	FL
CH04021V	Active	BPS-H80-030372	Central Florida Health Care, Inc.	CFHC Mobile Unit 2	705 Ingraham Ave	Haines City	FL
CH04021W	Active	BPS-H80-034161	Central Florida Health Care, Inc.	CFHC Davenport Primary Care	130 Ridge Center Dr	Davenport	FL
CH04021X	Active	BPS-H80-035536	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Mobile Unit 3	201 Magnolia	Winter Haven	FL
CH04021Y	Active	BPS-H80-038501	CENTRAL FLORIDA HEALTH CARE, INC.	CFHC Bartow Primary Care	1190 E Church St	Bartow	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH040210	ACARIAHEALTH PHARMACY #26, INC	8715 HENDERSON RD		TAMPA	FL	33634	07/01/2024	12/31/2024
CH040210	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2024
CH040210	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2024
CH040210	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2024
CH040210	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2024
CH040210	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2024
CH040210	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2024
CH040210	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/01/2020
CH040210	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2024
CH040210	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2024
CH040210	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2024	07/01/2024
CH040210	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2024
CH040210	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2024
CH040210	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2025
CH040210	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2020
CH040210	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2020
CH040210	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2020
CH040210	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2020
CH040210	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2020
CH040210	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2020
CH040210	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2020
CH040210	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2020
CH040210	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2020
CH040210	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2023
CH040210	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2024
CH040210	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2024
CH040210	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2024
CH040210	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2024
CH040210	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2024
CH040210	FOUNDATION CARE LLC	111 CHESTERFIELD INDUSTRIAL BLVD STE 115		CHESTERFIELD	MO	63005	07/01/2024	12/31/2024
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03670	7009 CYPRESS GARDENS BLVD	WINTER HAVEN	FL	33884	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00176	970 CYPRESS GARDENS BLVD.	WINTER HAVEN	FL	33880	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02444	1105 W MAIN ST	AVON PARK	FL	33825	01/01/2020	07/13/2023
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02030	301 S. 6TH AVE.	WAUCHULA	FL	33873	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05122	2536 US HIGHWAY 92 EAST	LAKELAND	FL	33801	01/01/2020	07/13/2023
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07917	3005 SR 540 WEST	WINTER HAVEN	FL	33880	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00411	500 S 11TH ST	LAKE WALES	FL	33853	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00304	101 N. WABASH AVENUE	LAKELAND	FL	33815	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00163	1635 BARTOW RD	LAKELAND	FL	33801	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00262	400 6TH ST NW	WINTER HAVEN	FL	33881	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03127	99 MAGNOLIA AVE	AUBURNDALE	FL	33823	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03399	6105 US HWY 98 N	LAKELAND	FL	33809	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03155	2728 US HWY 27 S	SEBRING	FL	33870	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00511	35799 HWY 27	HAINES CITY	FL	33844	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03204	5010 S FLORIDA AVE	LAKELAND	FL	33813	01/01/2020
CH040210	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 06729	39902 HIGHWAY 27	DAVENPORT	FL	33837	04/01/2022
CH040210	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17430	5000 GRANDVIEW PKWY	DAVENPORT	FL	33837	04/01/2022
CH040210	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2021	10/11/2022
CH040210	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2020
CH040210	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2020
CH040210	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2020
CH040210	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0836	1395 6TH STREET, N.W.	WINTER HAVEN	FL	33881	07/01/2019
CH040210	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #1076	617 US HWY 17-92 WEST	HAINES CITY	FL	33844-5047	07/01/2019
CH040210	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0791	2040 SHEPHERD ROAD	MULBERRY	FL	33860	07/01/2019
CH040210	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	07/01/2019
CH040210	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	07/01/2019
CH040210	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1347	3610 U.S. HIGHWAY 27 NORTH	SEBRING	FL	33870	07/01/2019
CH040210	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1167	39883 HIGHWAY 27	DAVENPORT	FL	33837	04/01/2022
CH040210	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2024
CH040210	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2024
CH040210	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	07/01/2024
CH040210	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2019
CH040210	WAL-MART PHARMACY 10-0580	1050 E VAN FLEET DRIVE		BARTOW	FL	33830	10/01/2020
CH040210	WAL-MART PHARMACY 10-0666	3525 U.S. HWY 27 NORTH		SEBRING	FL	33870	10/01/2020
CH040210	WAL-MART PHARMACY 10-0718	2120 US HWY 92 WEST		AUBURNDALE	FL	33823	07/01/2019
CH040210	WAL-MART PHARMACY 10-0725	36205 US HIGHWAY 27		HAINES CITY	FL	33844	07/01/2019
CH040210	WAL-MART PHARMACY 10-0759	1480 HIGHWAY 17 NORTH		WAUCHULA	FL	33873	07/01/2019
CH040210	WAL-MART PHARMACY 10-0859	2000 STATE ROAD 60 EAST		LAKE WALES	FL	33898	07/01/2019
CH040210	WAL-MART PHARMACY 10-0968	355 CYPRESS GARDEN BLVD		WINTER HAVEN	FL	33880	07/01/2019
CH040210	WAL-MART PHARMACY 10-1245	5800 U.S. 98 NORTH		LAKELAND	FL	33809	07/01/2019
CH040210	WAL-MART PHARMACY 10-3347	7450 CYPRESS GARDENS BLVD.		WINTER HAVEN(E)	FL	33884	07/01/2019
CH040210	WAL-MART PHARMACY 10-3887	1041 US HWY. 27 NORTH		AVON PARK	FL	33825	07/01/2019
CH040210	WAL-MART PHARMACY 10-5035	6745 N CHURCH AVE		MULBERRY	FL	33860	07/01/2019
CH040210	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2020
CH040210	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2019
CH040210	WALGREEN CO	DBA: WALGREENS #09098	2 US 27 S	LAKE PLACID	FL	33852	01/01/2019	02/15/2020
CH040210	WALGREEN CO	DBA: WALGREENS #09573	3120 KATHLEEN RD	LAKELAND	FL	33810	04/01/2022
CH040210	WALGREEN CO.	DBA: WALGREENS # 03093	311 E. MEMORIAL BLVD	LAKELAND	FL	33801	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS # 04005	705 1ST STREET SOUTH	WINTER HAVEN	FL	33880	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS #04023	501 HAVENDALE BLVD	AUBURNDALE	FL	33823	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS # 04380	1903 STATE ROAD 60 E	LAKE WALES	FL	33853	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS # 04708	35800 US HWY 27 N	HAINES CITY	FL	33844	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS # 05212	4445 US HWY 98 NORTH	LAKELAND	FL	33809	10/01/2016	02/15/2020
CH040210	WALGREEN CO.	DBA: WALGREENS # 05328	5545 CYPRESS GARDENS BLVD	WINTER HAVEN	FL	33884	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS # 05946	93 US HIGHWAY 27 S	AVON PARK	FL	33825	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS # 05947	3027 US HWY 27 SOUTH	SEBRING	FL	33870	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS # 07273	2590 E HIGHWAY 50	CLERMONT	FL	34711-6050	10/01/2016	02/15/2020
CH040210	WALGREEN CO.	DBA: WALGREENS # 07806	805 HAVENDALE BLVD NW	WINTER HAVEN	FL	33881	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS #09006	3619 US 27	SEBRING	FL	33870	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS #11190	24170 HWY 27	LAKE WALES	FL	33859	10/01/2016
CH040210	WALGREEN CO.	DBA: WALGREENS # 04700	4340 S. FLORIDA AVE.	LAKELAND	FL	33813	01/01/2017	02/15/2020
CH040210	WALGREEN CO.	DBA: WALGREENS # 05657	101 ARIANA STREET	LAKELAND	FL	33803	01/01/2017
CH040210	WALGREEN CO.	DBA: WALGREENS # 05979	6210 LAKELAND HIGHLANDS RD	LAKELAND	FL	33813	01/01/2017	02/15/2020
CH040210	WALGREEN CO.	DBA: WALGREENS # 13797	395 E. VAN FLEET DR	BARTOW	FL	33830	01/01/2017
CH04021E	WALGREEN CO.	DBA: WALGREENS # 05327	6985 S FLORIDA AVE	LAKELAND	FL	33813	04/01/2018	02/08/2022
CH04021E	WALGREEN CO.	DBA: WALGREENS # 04399	2425 US HWY 92 E	LAKELAND	FL	33801	04/01/2018	02/08/2022
CH040210	WALGREEN CO.	DBA: WALGREENS # 05327	6985 S FLORIDA AVE	LAKELAND	FL	33813	04/01/2018
CH040210	WALGREEN CO.	DBA: WALGREENS # 04399	2425 US HWY 92 E	LAKELAND	FL	33801	04/01/2018
CH040210	WALGREEN CO.	DBA: WALGREENS # 05854	6730 US HIGHWAY 98 N	LAKELAND	FL	33809	01/01/2019
CH040210	WALGREEN CO.	DBA: WALGREENS # 05855	410 OLD POLK CITY ROAD	LAKELAND	FL	33809	01/01/2019	02/15/2020
CH040210	WALGREEN CO.	DBA: WALGREENS #11104	40079 US HIGHWAY 27	DAVENPORT	FL	33837	04/01/2022
CH040210	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	01/01/2023
CH040210	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/01/2020	06/24/2020
CH040210	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2021
CH040210	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2023
CH040210	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2023
CH040210	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH040210	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	2/9/2024 11:14:08 AM	2/10/2025 4:16:45 PM	2/10/2025 4:16 PM
Details	Last Recertification Date	Update	Recertification	2/20/2023 11:20:55 AM	2/9/2024 11:14:08 AM	2/9/2024 11:14 AM
Contacts	Primary Contact	Update	Profile Change Request	Pickos, Ron M Pharmacy Director Central Florida Health Care 8632063710	Pickos, Ron M Chief Pharmacy Officer Central Florida Health Care 8632063710	4/12/2023 8:53 AM
Details	Last Recertification Date	Update	Recertification	2/9/2022 1:18:54 PM	2/20/2023 11:20:55 AM	2/20/2023 11:20 AM
Details	Last Recertification Date	Update	Recertification	2/9/2021 3:01:42 PM	2/9/2022 1:18:54 PM	2/9/2022 1:18 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/13/2021 11:17 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		029549327	12/13/2021 11:17 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	12/13/2021 11:17 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	100322900 (FL)		9/21/2021 11:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/3/2021 3:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100382300	5/3/2021 3:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	5/3/2021 3:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1811577307	4/20/2021 10:52 AM
Medicaid Billing	NPI: State	Insert	Change Request		FL	4/20/2021 10:52 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1740786532 (FL)		4/20/2021 10:52 AM
Details	Entity Subname	Update	Change Request	CFHC Lakeland Pediatrics, Pharmacy and Dental	CFHC Lakeland Pediatrics and Dental	4/20/2021 10:52 AM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/9/2021 3:01 PM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/9/2021 3:01 PM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/9/2021 3:01 PM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/9/2021 3:01 PM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/9/2021 3:01 PM
Details	Last Recertification Date	Update	Recertification	2/12/2020 1:33:12 PM	2/9/2021 3:01:42 PM	2/9/2021 3:01 PM
Contacts	Primary Contact	Update	Profile Change Request	Pickos, Ron m Pharmacy Director Central Florida Health Care 8633331625	Pickos, Ron M Pharmacy Director Central Florida Health Care 8632063710	1/13/2021 11:29 AM
Addresses	Main Address	Update	Change Request	601 S. Florida Avenue Lakeland, FL 33801-5237	601 S Florida Ave Lakeland, FL 33801-5237	5/4/2020 4:27 PM
Details	Entity Subname	Update	Change Request	CFHC Lakeland Pharmacy and Dental	CFHC Lakeland Pediatrics, Pharmacy and Dental	5/4/2020 4:27 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1831232669	4/14/2020 5:12 PM
Details	Last Recertification Date	Update	Recertification	2/22/2019 8:38:04 AM	2/12/2020 1:33:12 PM	2/12/2020 1:33 PM
Addresses	Main Address	Update	Recertification	601 S. Florida Avenue, Suite 6 Lakeland, FL 33801	601 S. Florida Avenue Lakeland, FL 33801-5237	2/22/2019 8:38 AM
Addresses	Billing Address	Update	Recertification	CENTRAL FLORIDA HEALTH CARE, INC 47 5th Street Northwest Winter Haven, FL 33881	CFHC Administrative Office 47 5TH ST NW WINTER HAVEN, FL 33881-4672	2/22/2019 8:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2019 8:38 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100322900	2/22/2019 8:38 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/22/2019 8:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2019 8:38 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		029549324	2/22/2019 8:38 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	2/22/2019 8:38 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1740786532	2/22/2019 8:38 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1205336690	2/22/2019 8:38 AM
Details	Last Recertification Date	Update	Recertification	3/1/2018 9:24:02 AM	2/22/2019 8:38:04 AM	2/22/2019 8:38 AM
Details	Entity Subname	Update	Recertification	CFHC Lakeland Pediatrics	CFHC Lakeland Pharmacy and Dental	2/22/2019 8:38 AM
Contacts	Primary Contact	Update	Change Request	FULSE, MISILENE DIRECTOR OF PHARMACY CENTRAL FLORIDA HEALTH CARE INC 8634490751	Pickos, Ron m Pharmacy Director Central Florida Health Care 8633331625	9/18/2018 6:17 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		9/18/2018 6:17 PM
Details	Last Recertification Date	Update	Recertification	2/17/2017 12:00:00 AM	3/1/2018 9:24:02 AM	3/1/2018 9:24 AM
Contacts	Authorizing Official	Update		CLAUSSEN, ANN CEO 8632915115	CLAUSSEN, ANN CEO CENTRAL FLORIDA HEALTH CARE INC 8632915115	10/23/2017 8:40 AM
Contacts	Signed By	Update		CLAUSSEN, ANN CEO 8632915115	CLAUSSEN, ANN CEO CENTRAL FLORIDA HEALTH CARE INC 8632915115	10/23/2017 8:40 AM
Contacts	Primary Contact	Update		FULSE, MISILENE DIRECTOR OF PHARMACY 8634490751	FULSE, MISILENE DIRECTOR OF PHARMACY CENTRAL FLORIDA HEALTH CARE INC 8634490751	10/16/2017 2:25 PM
Contacts	Primary Contact	Insert			FULSE, MISILENE DIRECTOR OF PHARMACY 8634490751	5/1/2017 5:51 PM
Contacts	Authorizing Official	Insert			CLAUSSEN, ANN CEO 8632915115	5/1/2017 5:51 PM
Contacts	Signed By	Insert			CLAUSSEN, ANN CEO 8632915115	5/1/2017 5:51 PM
Addresses	Main Address	Insert			601 S. Florida Avenue, Suite 6 Lakeland, FL 33801	2/17/2017 7:39 AM
Addresses	Billing Address	Insert			CENTRAL FLORIDA HEALTH CARE, INC 47 5th Street Northwest Winter Haven, FL 33881	2/17/2017 7:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/17/2017 7:39 AM
Medicaid Billing	Medicaid: Number	Insert			029549312	2/17/2017 7:39 AM
Medicaid Billing	Medicaid: State	Insert			FL	2/17/2017 7:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/17/2017 7:39 AM
Medicaid Billing	Medicaid: Number	Insert			029549311	2/17/2017 7:39 AM
Medicaid Billing	Medicaid: State	Insert			FL	2/17/2017 7:39 AM
Medicaid Billing	NPI: Number	Insert			1811358757	2/17/2017 7:39 AM
Details	Last Recertification Date	Update			2/17/2017 12:00:00 AM	2/17/2017 7:39 AM
Dates	Participating Approval Date	Update			4/18/2016 12:00:00 AM	4/18/2016 6:05 PM
Details	State	Update		Pending	Active	4/18/2016 6:05 PM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	4/18/2016 6:05 PM
Details	340B ID	Update		ONLINE_REG_60658	CH04021K	4/18/2016 2:49 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_60658	4/15/2016 4:39 PM
Medicaid Billing	NPI: Number	Insert			1851751549	4/15/2016 4:39 PM
Details	Last Recertification Date	Insert				4/15/2016 4:39 PM
Details	Grant Number	Insert			H80CS00423	4/15/2016 4:39 PM
Details	340B ID	Insert			ONLINE_REG	4/15/2016 4:39 PM
Details	Is Authorizing Official EHB Data	Insert			False	4/15/2016 4:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2016 4:39 PM
Details	Medicare Provider Number	Insert				4/15/2016 4:39 PM
Details	Entity Name	Insert			CENTRAL FLORIDA HEALTH CARE, INC.	4/15/2016 4:39 PM
Details	Program Code	Insert			CH	4/15/2016 4:39 PM
Details	Entity Subname	Insert			CFHC Lakeland Pediatrics	4/15/2016 4:39 PM
Dates	Participating Approval Date	Insert				4/15/2016 4:39 PM
Details	State	Insert			Pending	4/15/2016 4:39 PM
Dates	Registration Date	Insert			4/15/2016 12:00:00 AM	4/15/2016 4:39 PM
Dates	Signed By Date	Insert			4/15/2016 12:00:00 AM	4/15/2016 4:39 PM
Dates	Start Date	Insert				4/15/2016 4:39 PM
Terminations	Termination Comments	Insert				4/15/2016 4:39 PM
Terminations	Termination Date	Insert				4/15/2016 4:39 PM
Terminations	Termination Effective Date	Insert				4/15/2016 4:39 PM
Terminations	Termination Reason	Insert				4/15/2016 4:39 PM

340B Drug Pricing Program Database