Covered Entity Details

DSH100173 AdventHealth TAMPA (Active) - information as of 6/24/2025 3:05:49 AM

Main Details

Name

AdventHealth TAMPA

Subdivision Name

University Community dba Florida Hospital Tampa

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100173

Medicare Provider Number

100173

Additional Details

Current Program Status

Active

Registration Date

10/12/2016

Participating Start Date

1/1/2017

Participating Approval Date

10/26/2016

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

AdventHealth Tampa
Tyson Davis, Chief Financial Officer
(813) 615-7159

Primary Contact

AdventHealth Tampa
Rey Velez, 340B Program Coordinator
(813) 615-7244

Addresses

Street Address

3100 East FLETCHER Avenue
TAMPA, FL 33613

Billing Address

AdventHealth Tampa
c/o AdventHealth
902 Inspiration Avenue
Suite 9100
Altamonte Springs, FL 32714

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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	01 0102800	1053321919

Shipping Addresses

Shipping Address 1

AdventHealth Tampa
3100 East Fletcher Avenue
Tampa, FL 33613

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	04/08/2025	07/01/2025		04/08/2025
Contract Detail	AHSSHC	RX PLUS PHARMACY	5050 WESLEY RD STE 110	APOPKA	FL	32712	04/08/2025	07/01/2025		04/08/2025
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/15/2019	07/01/2019		07/01/2019
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/15/2019	07/01/2019	09/21/2023	09/21/2023
Contract Detail	PUBLIX PHARMACY #0524	3939 VAN DYKE ROAD		LUTZ	FL	33558	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0834	16560 N NEBRASKA AVE	LUTZ	FL	33549	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0618	5400 BRUCE B DOWNS BLVD	WESLEY CHAPEL	FL	33544	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0876	10928 CROSS CREEK BLVD	TAMPA	FL	33647	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0877	2121 COLLIER PKWY	LAND O'LAKES	FL	34639	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0006	1920 CR 581	WESLEY CHAPEL	FL	33543	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0685	5450 EAST BUSCH BLVD	TEMPLE TERRACE	FL	33617	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1578	11502 N 53RD ST	TEMPLE TERRACE	FL	33617-2245	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1441	13178 NORTH DALE MABRY HWY	TAMPA	FL	33618	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1742	30841 MIRADA BLVD.	SAN ANTONIO	FL	33576	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1142	7830 LAND O'LAKES BLVD.	LAND O'LAKES	FL	34638	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1373	16041 TAMPA PALMS BLVD WEST	TAMPA	FL	33647	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	01/11/2023	04/01/2023		04/01/2023
Contract Detail	PUBLIX SUPERMARKETS	PUBLIX PHARMACY #0584	19034 BRUCE B DOWNS BLVD.	TAMPA	FL	33647	01/11/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05576	7925 GUNN HIGHWAY	TAMPA	FL	33626	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #09297	10427 BIG BEND RD	RIVERVIEW	FL	33578	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09300	3890 VAN DYKE RD	LUTZ	FL	33548	04/15/2019	07/01/2019	11/11/2019	11/11/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01925	13317 N BOULEVARD	TAMPA	FL	33612-3317	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05604	6429 GALL BLVD	ZEPHYRHILLS	FL	33542	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05437	17511 BRUCE B DOWNS BLVD.	TAMPA	FL	33647	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09300	3890 VAN DYKE RD	LUTZ	FL	33548	04/15/2019	07/01/2019	11/11/2019	11/11/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06412	28115 WESLEY CHAPEL BLVD	WESLEY CHAPEL	FL	33543	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06494	22829 STATE ROAD 54	LAND O LAKES	FL	34639	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 13824	18511 N. US HWY 41	LUTZ	FL	33549	04/15/2019	07/01/2019	11/11/2019	11/11/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03459	2117 E HILLSBOROUGH AVE	TAMPA	FL	33610	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12673	2916 E. FLETCHER AVE.	TAMPA	FL	33612	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13630	1301 SECOND AVE, S.W. SUITE 200	LARGO	FL	33770	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07177	705 N PEBBLE BEACH BLVD	SUN CITY CENTER	FL	33573-5350	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 13824	18511 N. US HWY 41	LUTZ	FL	33549	04/15/2019	07/01/2019	11/11/2019	11/11/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15236	13130 N DALE MABRY HWY	TAMPA	FL	33618-2406	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06029	11115 E DR MLK JR BLVD	SEFFNER	FL	33584	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03145	1860 E. FOWLER AVE.	TAMPA	FL	33612	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04573	9202 N. 56TH STREET	TEMPLE TERRACE	FL	33617	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09300	3890 VAN DYKE RD	LUTZ	FL	33548	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02959	2111 E BUSCH BLVD	TAMPA	FL	33612	04/15/2019	07/01/2019	01/04/2023	02/15/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 13824	18511 N. US HWY 41	LUTZ	FL	33549	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02975	15602 N. DALE MABRY	TAMPA	FL	33618	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07569	20741 BRUCE B DOWNS BLVD	TAMPA	FL	33647	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #12146	1200 KUHL AVE	ORLANDO	FL	32806	07/01/2019	10/01/2019		10/14/2019
Contract Detail	WALGREEN CO.	WALGREENS #16399	3100 E. FLETCHER AVE SUITE A165	TAMPA	FL	33613	07/01/2019	10/01/2019		10/01/2019
Contract Detail	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	01/11/2023	04/01/2023		04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/15/2019	07/01/2019	09/21/2023	09/21/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH100173A	Child	DSH	AdventHealth TAMPA	AdventHealth Wound Care Center Tampa	3000 MEDICAL PARK Drive	TAMPA	FL	Active
DSH100173B	Child	DSH	AdventHealth TAMPA	AdventHealth Kay Meyer Breast Care Center	3000 MEDICAL PARK DR	TAMPA	FL	Active
DSH100173C	Child	DSH	AdventHealth TAMPA	AdventHealth Brandon ER	305 East Brandon Boulevard	Brandon	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 2:30:51 PM	8/21/2024 2:39:32 PM	8/21/2024 2:39 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 12:19:52 PM	8/29/2023 2:30:51 PM	8/29/2023 2:30 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 3:03:02 PM	9/14/2022 12:19:52 PM	9/14/2022 12:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/13/2022 12:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01 0102800	3/13/2022 12:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	3/13/2022 12:51 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	01 0102808 (FL)		3/13/2022 12:51 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 9:36:50 AM	9/7/2021 3:03:02 PM	9/7/2021 3:03 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1053321919	9/4/2020 9:36 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/4/2020 9:36 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1053321919 ( )		9/4/2020 9:36 AM
Details	Last Recertification Date	Update	Recertification	9/8/2019 8:20:52 PM	9/4/2020 9:36:50 AM	9/4/2020 9:36 AM
Contacts	Authorizing Official	Update	Change Request	Coe, Jason Chief Operating Officer Advent Health Tampa 8136157129	Davis, Tyson Chief Financial Officer AdventHealth Tampa 8136157159	6/17/2020 10:57 AM
Contacts	Primary Contact	Update	Profile Change Request	Velez, Rey 340B Program Coordinator AdventHealth Tamnpa 8136157244	Velez, Rey 340B Program Coordinator AdventHealth Tampa 8136157244	4/7/2020 10:48 AM
Addresses	Shipping Address	Insert	Change Request		AdventHealth Tampa 3100 East Fletcher Avenue Tampa, FL 33613	10/29/2019 11:41 AM
Contacts	Primary Contact	Update	Profile Change Request	Velez, Rey 340B Program Coordinator Florida Hospital Tampa 8136157244	Velez, Rey 340B Program Coordinator AdventHealth Tamnpa 8136157244	10/24/2019 5:04 AM
Addresses	Billing Address	Update	Change Request	AdventHealth Tampa c/o AdventHealth 902 Inspiration Avenue 9100 Altamonte Springs, FL 32714	AdventHealth Tampa c/o AdventHealth 902 Inspiration Avenue Suite 9100 Altamonte Springs, FL 32714	10/14/2019 10:23 AM
Addresses	Billing Address	Insert	Recertification		AdventHealth Tampa c/o AdventHealth 902 Inspiration Avenue 9100 Altamonte Springs, FL 32714	9/8/2019 8:20 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 11:43:18 AM	9/8/2019 8:20:52 PM	9/8/2019 8:20 PM
Contacts	Authorizing Official	Update	Change Request	Heinrich, William Chief Financial Officer Florida Hospital Tampa 8136157853	Coe, Jason Chief Operating Officer Advent Health Tampa 8136157129	8/13/2019 6:31 AM
Details	Entity Name	Update	Change Request	FLORIDA HOSPITAL TAMPA	AdventHealth TAMPA	2/20/2019 1:00 PM
Details	Last Recertification Date	Update	Recertification	11/21/2017 11:49:11 AM	8/28/2018 11:43:18 AM	8/28/2018 11:43 AM
Addresses	Main Address	Update	Change Request	3100 E FLETCHER AVE TAMPA, FL 33613	3100 East FLETCHER Avenue TAMPA, FL 33613	8/13/2018 5:57 AM
Details	Last Recertification Date	Update	Recertification		11/21/2017 11:49:11 AM	11/21/2017 11:49 AM
Contacts	Primary Contact	Update	Profile Change Request	Velez, Rey 340b Program Coordinator Florida Hospital Tampa 8136157244	Velez, Rey 340B Program Coordinator Florida Hospital Tampa 8136157244	11/6/2017 9:21 AM
Contacts	Authorizing Official	Update		Heinrich, William Chief Financial Officer 8136157853	Heinrich, William Chief Financial Officer Florida Hospital Tampa 8136157853	10/10/2017 10:01 AM
Contacts	Signed By	Update		Heinrich, William Chief Financial Officer 8136157853	Heinrich, William Chief Financial Officer Florida Hospital Tampa 8136157853	10/10/2017 10:01 AM
Contacts	Primary Contact	Update		Velez, Rey 340b Program Coordinator 8136157244	Velez, Rey 340b Program Coordinator Florida Hospital Tampa 8136157244	9/27/2017 1:15 PM
Addresses	Main Address	Insert			3100 E FLETCHER AVE TAMPA, FL 33613	11/22/2016 5:07 PM
Contacts	Primary Contact	Insert			Velez, Rey 340b Program Coordinator 8136157244	11/22/2016 5:07 PM
Contacts	Authorizing Official	Insert			Heinrich, William Chief Financial Officer 8136157853	11/22/2016 5:07 PM
Contacts	Signed By	Insert			Heinrich, William Chief Financial Officer 8136157853	11/22/2016 5:07 PM
Details	Entity Subname	Update			University Community dba Florida Hospital Tampa	11/22/2016 5:07 PM
Dates	Participating Approval Date	Update			10/26/2016 12:00:00 AM	10/26/2016 5:35 PM
Details	State	Update		Pending	Active	10/26/2016 5:35 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	10/26/2016 5:35 PM
Details	340B ID	Update		ONLINE_REG_72925	DSH100173	10/13/2016 1:32 PM
Details	340B ID	Update			ONLINE_REG_72925	10/12/2016 8:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/12/2016 8:45 AM
Medicaid Billing	Medicaid: Number	Insert			01 0102808	10/12/2016 8:45 AM
Medicaid Billing	Medicaid: State	Insert			FL	10/12/2016 8:45 AM
Medicaid Billing	NPI: Number	Insert			1053321919	10/12/2016 8:45 AM
Details	Last Recertification Date	Insert				10/12/2016 8:45 AM
Details	Grant Number	Insert				10/12/2016 8:45 AM
Details	340B ID	Insert				10/12/2016 8:45 AM
Details	Is Authorizing Official EHB Data	Insert				10/12/2016 8:45 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/12/2016 8:45 AM
Details	Medicare Provider Number	Insert			100173	10/12/2016 8:45 AM
Details	Entity Name	Insert			FLORIDA HOSPITAL TAMPA	10/12/2016 8:45 AM
Details	Program Code	Insert			DSH	10/12/2016 8:45 AM
Details	Entity Subname	Insert				10/12/2016 8:45 AM
Dates	Participating Approval Date	Insert				10/12/2016 8:45 AM
Details	State	Insert			Pending	10/12/2016 8:45 AM
Dates	Registration Date	Insert			10/12/2016 12:00:00 AM	10/12/2016 8:45 AM
Dates	Signed By Date	Insert			10/12/2016 12:00:00 AM	10/12/2016 8:45 AM
Dates	Start Date	Insert				10/12/2016 8:45 AM
Terminations	Termination Comments	Insert				10/12/2016 8:45 AM
Terminations	Termination Date	Insert				10/12/2016 8:45 AM
Terminations	Termination Effective Date	Insert				10/12/2016 8:45 AM
Terminations	Termination Reason	Insert				10/12/2016 8:45 AM