Covered Entity Details

RRC100157-02 LAKELAND REGIONAL MED CTR (Terminated) - information as of 5/10/2025 11:09:05 PM

Main Details

Name

LAKELAND REGIONAL MED CTR

Subdivision Name

Family Health Center

Type

Rural Referral Center

Rural

340B ID

RRC100157-02

Medicare Provider Number

100157

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

2/28/2018

Participating Start Date

2/28/2018

Participating Approval Date

2/28/2018

Last Recertification Date

8/27/2019

Termination Date
Termination Reason

1/1/2020
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

Lakeland Regional Medical Center, Inc.
Lance Green, EVP/Chief Financial Officer
(863) 687-1100 Ext: 5225

Primary Contact

Lakeland Regional Medical Center, Inc.
Jason Alan McNeil, AVP/Finance
(863) 687-1100 Ext: 1011

Addresses

Street Address

300 Parkview Place
Lakeland, FL 33805

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating from effective date (1/1/2017) until terminated effective date ( 7/1/2017), reinstatement date effective date (02/28/18)	02/28/2018

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	010164800
		1144228446

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC100157-01	Child	RRC	LAKELAND REGIONAL MED CTR	Grasslands Campus / Wound Care	3030 Harden Blvd	Lakeland	FL	Terminated
RRC100157-02	Child	RRC	LAKELAND REGIONAL MED CTR	Family Health Center	300 Parkview Place	Lakeland	FL	Terminated
RRC100157-03	Child	RRC	LAKELAND REGIONAL MED CTR	Grasslands Campus / Outpatient Rehab	3030 Harden Blvd	Lakeland	FL	Terminated
RRC100157-04	Child	RRC	LAKELAND REGIONAL MED CTR	Hollis Cancer Center	3525 Lakeland Hills Blvd	Lakeland	FL	Terminated
RRC100157-06	Child	RRC	LAKELAND REGIONAL MED CTR	Grasslands Campus - Infusion Therapy Center - Infusion Therapy	3030 Harden Blvd	Lakeland	FL	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Green, Lance SVP/Chief Financial Officer Lakeland Regional Medical Center, Inc. 8636871100-5225	Green, Lance EVP/Chief Financial Officer Lakeland Regional Medical Center, Inc. 8636871100-5225	9/2/2020 7:19 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Details	State	Update	OPA Edit Termination Info	Terminated	To Be Terminated	10/18/2019 1:23 PM
Terminations	Termination Date	Update	OPA Edit Termination Info	10/17/2019 12:00:00 AM	1/1/2020 12:00:00 AM	10/18/2019 1:23 PM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	10/17/2019 12:00:00 AM	12/31/2019 12:00:00 AM	10/18/2019 1:23 PM
Details	State	Update	OPA Edit Termination Info	To Be Terminated	Terminated	10/17/2019 3:08 PM
Terminations	Termination Date	Update	OPA Edit Termination Info	1/1/2020 12:00:00 AM	10/17/2019 12:00:00 AM	10/17/2019 3:08 PM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	12/31/2019 12:00:00 AM	10/17/2019 12:00:00 AM	10/17/2019 3:08 PM
Details	State	Update	Termination Request	Active	To Be Terminated	10/17/2019 3:05 PM
Terminations	Termination Comments	Update	Termination Request		Transitioning from RRC to DSH	10/17/2019 3:05 PM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	10/17/2019 3:05 PM
Terminations	Termination Effective Date	Update	Termination Request		12/31/2019 12:00:00 AM	10/17/2019 3:05 PM
Terminations	Termination Reason	Update	Termination Request		Change of covered entity type (non-hospital)	10/17/2019 3:05 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 5:02:49 PM	8/27/2019 10:32:48 AM	8/27/2019 10:32 AM
Contacts	Authorizing Official	Update	Profile Change Request	Green, Lance VP/Finance Lakeland Regional Medical Center, Inc. 8636871100-5225	Green, Lance SVP/Chief Financial Officer Lakeland Regional Medical Center, Inc. 8636871100-5225	6/12/2019 10:19 AM
Contacts	Primary Contact	Update	Change Request	Green, Lance VP/Finance Lakeland Regional Medical Center, Inc. 8636871100-5225	McNeil, Jason Alan AVP/Finance Lakeland Regional Medical Center, Inc. 8636871100-1011	6/12/2019 9:47 AM
Contacts	Authorizing Official	Update	Change Request	Jones, Evan EVP/Chief Financial Officer Lakeland Regional Medical Center 8636871062	Green, Lance VP/Finance Lakeland Regional Medical Center, Inc. 8636871100-5225	6/12/2019 9:46 AM
Details	Last Recertification Date	Update	Recertification		8/21/2018 5:02:49 PM	8/21/2018 5:02 PM
Contacts	Primary Contact	Update	Profile Change Request	Green, Lance AVP/Finance Lakeland Regional Medical Center, Inc. 8636871100-5225	Green, Lance VP/Finance Lakeland Regional Medical Center, Inc. 8636871100-5225	8/21/2018 9:53 AM
Terminations	Termination Reason	Update		Change of covered entity type		7/21/2018 12:21 PM
Details	State	Update	OPA Edit	Approved	Active	2/28/2018 3:20 PM
Dates	Start Date	Update	OPA Edit	4/1/2018 12:00:00 AM	2/28/2018 12:00:00 AM	2/28/2018 3:20 PM
Dates	Participating Approval Date	Update	Reinstatement		2/28/2018 3:18:13 PM	2/28/2018 3:18 PM
Details	State	Update	Reinstatement	Pending	Approved	2/28/2018 3:18 PM
Dates	Signed By Date	Update	Reinstatement	10/11/2016 12:00:00 AM	2/28/2018 12:08:25 PM	2/28/2018 3:18 PM
Dates	Start Date	Update	Reinstatement		4/1/2018 12:00:00 AM	2/28/2018 3:18 PM
Terminations	Termination Reason	Update	Reinstatement		Change of covered entity type	2/28/2018 3:18 PM
Details	Comments Public	Insert	Reinstatement		Participating from effective date (1/1/2017) until terminated effective date ( 7/1/2017), reinstatement date effective date (02/28/18)	2/28/2018 2:34 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	6/30/2017 12:00:00 AM		2/28/2018 12:08 PM
Dates	Participating Approval Date	Update	Reinstatement	11/14/2016 12:00:00 AM		2/28/2018 12:08 PM
Details	State	Update	Reinstatement	Terminated	Pending	2/28/2018 12:08 PM
Dates	Registration Date	Update	Reinstatement	10/11/2016 12:00:00 AM	2/28/2018 12:08:23 PM	2/28/2018 12:08 PM
Dates	Start Date	Update	Reinstatement	1/1/2017 12:00:00 AM		2/28/2018 12:08 PM
Terminations	Termination Comments	Update	Reinstatement	Change to DSH		2/28/2018 12:08 PM
Terminations	Termination Date	Update	Reinstatement	7/1/2017 12:00:00 AM		2/28/2018 12:08 PM
Terminations	Termination Effective Date	Update	Reinstatement	7/1/2017 12:00:00 AM		2/28/2018 12:08 PM
Terminations	Termination Reason	Update	Reinstatement	Change of covered entity type		2/28/2018 12:08 PM
Contacts	Authorizing Official	Update		Jones, Evan EVP/Chief Financial Officer 8636871062	Jones, Evan EVP/Chief Financial Officer Lakeland Regional Medical Center 8636871062	10/20/2017 9:52 AM
Contacts	Signed By	Update		Jones, Evan EVP/Chief Financial Officer 8636871062	Jones, Evan EVP/Chief Financial Officer Lakeland Regional Medical Center 8636871062	10/20/2017 9:52 AM
Contacts	Primary Contact	Update		Green, Lance AVP/Finance 8636871100-5225	Green, Lance AVP/Finance Lakeland Regional Medical Center, Inc. 8636871100-5225	10/20/2017 8:52 AM
Contacts	Authorizing Official	Insert			Jones, Evan EVP/Chief Financial Officer 8636871062	8/30/2017 12:44 PM
Contacts	Signed By	Insert			Jones, Evan EVP/Chief Financial Officer 8636871062	8/30/2017 12:44 PM
Contacts	Primary Contact	Insert			Green, Lance AVP/Finance 8636871100-5225	8/30/2017 12:44 PM
Addresses	Main Address	Insert			300 Parkview Place Lakeland, FL 33805	6/9/2017 2:20 PM
Dates	Last Date That 340B Drugs Purchased	Update			6/30/2017 12:00:00 AM	6/9/2017 2:20 PM
Details	State	Update		Active	Terminated	6/9/2017 2:20 PM
Terminations	Termination Comments	Update			Change to DSH	6/9/2017 2:20 PM
Terminations	Termination Date	Update			7/1/2017 12:00:00 AM	6/9/2017 2:20 PM
Terminations	Termination Effective Date	Update			7/1/2017 12:00:00 AM	6/9/2017 2:20 PM
Terminations	Termination Reason	Update			Change of covered entity type	6/9/2017 2:20 PM
Dates	Participating Approval Date	Update			11/14/2016 12:00:00 AM	11/14/2016 3:28 PM
Details	State	Update		Pending	Active	11/14/2016 3:28 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	11/14/2016 3:28 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72916	RRC100157-02	11/14/2016 12:24 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72916	10/11/2016 5:37 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/11/2016 5:37 PM
Medicaid Billing	Medicaid: Number	Insert			010164800	10/11/2016 5:37 PM
Medicaid Billing	Medicaid: State	Insert			FL	10/11/2016 5:37 PM
Medicaid Billing	NPI: Number	Insert			1144228446	10/11/2016 5:37 PM
Details	Last Recertification Date	Insert				10/11/2016 5:37 PM
Details	Grant Number	Insert				10/11/2016 5:37 PM
Details	340B ID	Insert				10/11/2016 5:37 PM
Details	Is Authorizing Official EHB Data	Insert				10/11/2016 5:37 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/11/2016 5:37 PM
Details	Medicare Provider Number	Insert			100157	10/11/2016 5:37 PM
Details	Entity Name	Insert			LAKELAND REGIONAL MED CTR	10/11/2016 5:37 PM
Details	Program Code	Insert			RRC	10/11/2016 5:37 PM
Details	Entity Subname	Insert			Family Health Center	10/11/2016 5:37 PM
Dates	Participating Approval Date	Insert				10/11/2016 5:37 PM
Details	State	Insert			Pending	10/11/2016 5:37 PM
Dates	Registration Date	Insert			10/11/2016 12:00:00 AM	10/11/2016 5:37 PM
Dates	Signed By Date	Insert			10/11/2016 12:00:00 AM	10/11/2016 5:37 PM
Dates	Start Date	Insert				10/11/2016 5:37 PM
Terminations	Termination Comments	Insert				10/11/2016 5:37 PM
Terminations	Termination Date	Insert				10/11/2016 5:37 PM
Terminations	Termination Effective Date	Insert				10/11/2016 5:37 PM
Terminations	Termination Reason	Insert				10/11/2016 5:37 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Parent/Child

History