| Details | Last Recertification Date | Update | Recertification | 1/31/2024 8:22:22 AM | 2/14/2025 10:20:18 AM | 2/14/2025 10:20 AM |
| Contacts | Primary Contact | Update | Group Change Request | Leone, Natalie Kaye
Clinic Administrator
Suncoast Community Health Centers, Inc.
8133314921 | Peguero, Miosotis
Analyst – Finance & Pharmacy Compliance
Suncoast Community Health Centers, Inc.
8133497998 | 3/28/2024 10:03 AM |
| Contacts | Primary Contact | Update | Recertification | Leone, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Leone, Natalie Kaye
Clinic Administrator
Suncoast Community Health Centers, Inc.
8133314921 | 1/31/2024 8:22 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 9:52:57 AM | 1/31/2024 8:22:22 AM | 1/31/2024 8:22 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Wrightson, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Leone, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 5/23/2023 12:41 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 3:23:16 PM | 1/30/2023 9:52:57 AM | 1/30/2023 9:52 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Wrightson, Natalie Kaye
Pharmacy Compliance and Financial Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Wrightson, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 6/23/2022 9:54 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 9:24:48 AM | 2/1/2022 3:23:16 PM | 2/1/2022 3:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/3/2021 9:24 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 2:37:50 PM | 2/3/2021 9:24:48 AM | 2/3/2021 9:24 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 3:49:44 PM | 1/28/2020 2:37:50 PM | 1/28/2020 2:37 PM |
| Contacts | Primary Contact | Update | Change Request | Hunt, Jeff
Pharmacy Director
Suncoast Community Health Centers, Inc
8133497959 | Wrightson, Natalie Kaye
Pharmacy Compliance and Financial Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 9/25/2019 11:51 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 8/7/2019 2:25 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 029557424 | 8/7/2019 2:25 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | FL | 8/7/2019 2:25 PM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2018 2:25:18 PM | 1/30/2019 3:49:44 PM | 1/30/2019 3:49 PM |
| Details | Last Recertification Date | Update | Recertification | | 2/19/2018 2:25:18 PM | 2/19/2018 2:25 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/19/2018 2:25 PM |
| Contacts | Authorizing Official | Update | | Herremans, Bradley
CEO
8136536268 | Herremans, Bradley
CEO
Suncoast Community Health Centers, Inc.
8136536268 | 1/9/2018 11:45 AM |
| Contacts | Signed By | Update | | Herremans, Bradley
CEO
8136536268 | Herremans, Bradley
CEO
Suncoast Community Health Centers, Inc.
8136536268 | 1/9/2018 11:45 AM |
| Contacts | Primary Contact | Update | | Hunt, Jeff
Pharmacy Director
8133497959 | Hunt, Jeff
Pharmacy Director
Suncoast Community Health Centers, Inc
8133497959 | 1/9/2018 9:54 AM |
| Addresses | Main Address | Insert | | |
9555 E. Fowler Ave.
Thonotosassa, FL 33592 | 8/9/2017 11:03 AM |
| Addresses | Billing Address | Insert | | | Suncoast Community Health Centers, Inc.
P.O. Box 1349
Ruskin, FL 33575 | 8/9/2017 11:03 AM |
| Contacts | Primary Contact | Insert | | | Hunt, Jeff
Pharmacy Director
8133497959 | 8/9/2017 11:03 AM |
| Contacts | Authorizing Official | Insert | | | Herremans, Bradley
CEO
8136536268 | 8/9/2017 11:03 AM |
| Contacts | Signed By | Insert | | | Herremans, Bradley
CEO
8136536268 | 8/9/2017 11:03 AM |
| Details | State | Update | | Approved | Active | 8/9/2017 11:03 AM |
| Dates | Participating Approval Date | Update | | | 8/9/2017 12:00:00 AM | 8/9/2017 11:03 AM |
| Details | State | Update | | Pending | Approved | 8/9/2017 11:03 AM |
| Dates | Start Date | Update | | | 10/1/2017 12:00:00 AM | 8/9/2017 11:03 AM |
| Details | 340B ID | Update | | ONLINE_REG_79339 | CH04175R | 8/8/2017 2:48 PM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_79339 | 8/8/2017 9:11 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1609303734 | 8/8/2017 9:11 AM |
| Details | Last Recertification Date | Insert | | | | 8/8/2017 9:11 AM |
| Details | Grant Number | Insert | | | H80CS00541 | 8/8/2017 9:11 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 8/8/2017 9:11 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 8/8/2017 9:11 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/8/2017 9:11 AM |
| Details | Medicare Provider Number | Insert | | | | 8/8/2017 9:11 AM |
| Details | Entity Name | Insert | | | SUNCOAST COMMUNITY HEALTH CENTERS, INC. | 8/8/2017 9:11 AM |
| Details | Program Code | Insert | | | CH | 8/8/2017 9:11 AM |
| Details | Entity Subname | Insert | | | Thonotosassa Community Health Center | 8/8/2017 9:11 AM |
| Dates | Participating Approval Date | Insert | | | | 8/8/2017 9:11 AM |
| Details | State | Insert | | | Pending | 8/8/2017 9:11 AM |
| Dates | Registration Date | Insert | | | 8/8/2017 12:00:00 AM | 8/8/2017 9:11 AM |
| Dates | Signed By Date | Insert | | | 8/8/2017 12:00:00 AM | 8/8/2017 9:11 AM |
| Dates | Start Date | Insert | | | | 8/8/2017 9:11 AM |
| Terminations | Termination Comments | Insert | | | | 8/8/2017 9:11 AM |
| Terminations | Termination Date | Insert | | | | 8/8/2017 9:11 AM |
| Terminations | Termination Effective Date | Insert | | | | 8/8/2017 9:11 AM |
| Terminations | Termination Reason | Insert | | | | 8/8/2017 9:11 AM |