Covered Entity Details

DSH100173A AdventHealth TAMPA (Active) - information as of 5/7/2025 10:49:12 PM

Main Details

Name

AdventHealth TAMPA

Subdivision Name

AdventHealth Wound Care Center Tampa

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100173A

Medicare Provider Number

100173

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/14/2016

Participating Start Date

1/1/2017

Participating Approval Date

11/10/2016

Last Recertification Date

8/14/2024

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

3000 MEDICAL PARK Drive
Suite 430
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	010102800	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	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
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	8/14/2023 8:15:35 AM	8/14/2024 9:48:23 AM	8/14/2024 9:48 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 12:18:49 PM	8/14/2023 8:15:35 AM	8/14/2023 8:15 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 10:33:12 AM	9/14/2022 12:18:49 PM	9/14/2022 12:18 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	010102808 (FL)		3/13/2022 12:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/13/2022 12:52 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010102800	3/13/2022 12:52 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	3/13/2022 12:52 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 9:37:21 AM	8/19/2021 10:33:12 AM	8/19/2021 10:33 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1053321919	9/4/2020 9:37 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/4/2020 9:37 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1053321919 ( )		9/4/2020 9:37 AM
Details	Last Recertification Date	Update	Recertification	9/6/2019 1:13:24 PM	9/4/2020 9:37:21 AM	9/4/2020 9:37 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
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	Shipping Address	Insert	Change Request		AdventHealth Tampa 3100 East Fletcher Avenue Tampa, FL 33613	10/15/2019 10:20 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	10/8/2019 7:31 AM
Addresses	Main Address	Update	Change Request	3000 MEDICAL PARK Drive Suite 430 TAMPA, FL 33613-4681	3000 MEDICAL PARK Drive Suite 430 TAMPA, FL 33613	10/8/2019 7:31 AM
Addresses	Billing Address	Update	Recertification	Adventist Health System 902 Inspiration Ave 9100 Altamonte Springs, FL 32714-1519	AdventHealth Tampa c/o AdventHealth 902 Inspiration Avenue 9100 Altamonte Springs, FL 32714	9/6/2019 1:13 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 8:10:56 AM	9/6/2019 1:13:24 PM	9/6/2019 1:13 PM
Addresses	Billing Address	Insert	Change Request		Adventist Health System 902 Inspiration Ave 9100 Altamonte Springs, FL 32714-1519	8/13/2019 3:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/13/2019 3:27 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		010102808	8/13/2019 3:27 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	8/13/2019 3:27 PM
Details	Entity Subname	Update	Change Request	AdventHealth Tampa Wound Healing Center	AdventHealth Wound Care Center Tampa	8/13/2019 3:27 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 Subname	Update	Change Request	Florida Hospital Tampa Wound Healing Center	AdventHealth Tampa Wound Healing Center	2/20/2019 1:00 PM
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 11:05:24 AM	8/17/2018 8:10:56 AM	8/17/2018 8:10 AM
Addresses	Main Address	Update	Change Request	3000 MEDICAL PARK DR 430 FHT WOUND HEALING INSTITUTE TAMPA, FL 33613-4681	3000 MEDICAL PARK Drive Suite 430 TAMPA, FL 33613-4681	8/13/2018 5:57 AM
Details	Entity Subname	Update	Change Request	Wound Healing Institute	Florida Hospital Tampa Wound Healing Center	8/13/2018 5:57 AM
Contacts	Primary Contact	Insert	Recertification		Velez, Rey 340B Program Coordinator Florida Hospital Tampa 8136157244	11/21/2017 11:05 AM
Details	Last Recertification Date	Update	Recertification		11/21/2017 11:05:24 AM	11/21/2017 11:05 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	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
Addresses	Main Address	Insert			3000 MEDICAL PARK DR 430 FHT WOUND HEALING INSTITUTE TAMPA, FL 33613-4681	11/10/2016 5:09 PM
Dates	Participating Approval Date	Update			11/10/2016 12:00:00 AM	11/10/2016 5:09 PM
Details	State	Update		Pending	Active	11/10/2016 5:09 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	11/10/2016 5:09 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_73231	DSH100173A	11/10/2016 1:25 PM
Details	Entity Subname	Update		UNIVERSITY COMMUNITY HOSPITAL INC	Wound Healing Institute	11/10/2016 1:25 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_73231	10/14/2016 12:29 PM
Medicaid Billing	NPI: Number	Insert			1053321919	10/14/2016 12:29 PM
Details	Last Recertification Date	Insert				10/14/2016 12:29 PM
Details	Grant Number	Insert				10/14/2016 12:29 PM
Details	340B ID	Insert				10/14/2016 12:29 PM
Details	Is Authorizing Official EHB Data	Insert				10/14/2016 12:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2016 12:29 PM
Details	Medicare Provider Number	Insert			100173	10/14/2016 12:29 PM
Details	Entity Name	Insert			FLORIDA HOSPITAL TAMPA	10/14/2016 12:29 PM
Details	Program Code	Insert			DSH	10/14/2016 12:29 PM
Details	Entity Subname	Insert			UNIVERSITY COMMUNITY HOSPITAL INC	10/14/2016 12:29 PM
Dates	Participating Approval Date	Insert				10/14/2016 12:29 PM
Details	State	Insert			Pending	10/14/2016 12:29 PM
Dates	Registration Date	Insert			10/14/2016 12:00:00 AM	10/14/2016 12:29 PM
Dates	Signed By Date	Insert			10/14/2016 12:00:00 AM	10/14/2016 12:29 PM
Dates	Start Date	Insert				10/14/2016 12:29 PM
Terminations	Termination Comments	Insert				10/14/2016 12:29 PM
Terminations	Termination Date	Insert				10/14/2016 12:29 PM
Terminations	Termination Effective Date	Insert				10/14/2016 12:29 PM
Terminations	Termination Reason	Insert				10/14/2016 12:29 PM