Covered Entity Details

HV040330 JESSIE TRICE COMMUNITY HEALTH CENTER, INC (Terminated) - information as of 6/2/2025 8:31:52 AM

Main Details

Name

JESSIE TRICE COMMUNITY HEALTH CENTER, INC

Subdivision Name

Type

Ryan White Part C

340B ID

HV040330

Grant Number

H76HA00097

Additional Details

Current Program Status

Terminated

Registration Date

12/1/1992

Participating Start Date

12/1/1992

Participating Approval Date

12/1/1992

Last Recertification Date

2/2/2017

Time Period the Assistance was Received

Termination Date
Termination Reason

4/1/2018
Failure to recertify

Contacts

Authorizing Official

Annie Neasman, CEO
(305) 805-1700 Ext: 23151

Primary Contact

Ruth Duval, Vice President
(305) 805-1700 Ext: 1000

Addresses

Street Address

5361 NW 22ND AVENUE
MIAMI, FL 33142

Billing Address

Jessie Trice Community Health Center, Inc.
5601 NW 27th Avenue
Suite 1
Miami, FL 33142

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
7/9/08 UPDATED NAME (WAS ECONOMIC OPPORTUNITY FAMILY HEALTH CTR.)	07/09/2008

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	COMMCARE PHARMACY-FTL, LLC	855 SW 78TH AVE STE C100		PLANTATION	FL	33324-3223	07/14/2016	10/01/2016	04/01/2018	04/01/2018
Contract Detail	COMMCARE PHARMACY-MIA, LLC		1801 CORAL WAY SUITE 115	MIAMI	FL	33145-2784	07/14/2016	10/01/2016	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 00748	12295 BISCAYNE BLVD	NORTH MIAMI	FL	33181	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01532	6700 COLLINS AVE	MIAMI BEACH	FL	33141	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02443	3705 HOLLYWOOD BLVD	HOLLYWOOD	FL	33021	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02489	3007 AVENTURA BLVD., #4	AVENTURA	FL	33180	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02545	1480 NE MIAMI GARDENS DR	NORTH MIAMI BEACH	FL	33179	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02719	791 NE 167TH ST	NORTH MIAMI BEACH	FL	33162	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02790	3103 BISCAYNE BLVD	MIAMI	FL	33137	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	WALGREENS #16354	1780 N. UNIVERSITY DR.	PLANTATION	FL	33322	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03105	11920 NW 27TH AVENUE	MIAMI	FL	33167	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03173	9020 BISCAYNE BLVD	MIAMI SHORES	FL	33138	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03211	9675 NW 41ST STREET	DORAL	FL	33178-2974	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03239	1 SE 3RD AVE STE 100	MIAMI	FL	33131	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03250	18300 NW 37TH AVE.	MIAMI GARDENS	FL	33056-5101	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03301	1695 NW 20TH STREET	MIAMI	FL	33142	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03371	7910 NW 27TH AVENUE	MIAMI	FL	33147	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03493	9498 NW 7TH AVE	MIAMI	FL	33150	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03525	6817 TAFT STREET	HOLLYWOOD	FL	33024	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03527	567 NE 125TH STREET	NORTH MIAMI	FL	33161	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03566	4451 W. 12TH AVE.	HIALEAH	FL	33012	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03626	1800 N NOB HILL ROAD	PLANTATION	FL	33322	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03678	1501 NE 163RD STREET	NORTH MIAMI BEACH	FL	33162	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03679	161 NE 54TH STREET	MIAMI	FL	33137	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03782	5701 NW 183RD ST	HIALEAH	FL	33015	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03835	19935 NW 2ND AVE	MIAMI	FL	33169	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03854	15900 NW 27TH AVE	OPA LOCKA	FL	33054	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03905	1751 BONAVENTURE BLVD	WESTON	FL	33326	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03943	200 SW 13TH ST	MIAMI	FL	33130	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04141	3099 N. STATE ROAD 7	LAUDERDALE LAKES	FL	33313-1913	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04324	15911 PINES BLVD.	PEMBROKE PINES	FL	33027	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04384	400 HIALEAH DRIVE	HIALEAH	FL	33010	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04385	770 W 29TH ST	HIALEAH	FL	33012	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04386	5999 PEMBROKE ROAD	HOLLYWOOD	FL	33023	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04402	1300 E HALLANDALE BEACH BLVD	HALLANDALE BEACH	FL	33009	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04694	6105 W SUNRISE BLVD	PLANTATION	FL	33313	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04728	6200 NW 7TH AVE	MIAMI	FL	33150	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04766	9005 PINES BLVD	PEMBROKE PINES	FL	33024	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04808	20340 OLD CUTLER RD	CUTLER BAY	FL	33189	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04915	750 NW 119TH ST.	MIAMI	FL	33168	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04917	690 NW 183RD ST	MIAMI GARDENS	FL	33169	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04955	18665 BISCAYNE BLVD	AVENTURA	FL	33180	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05050	1610 W 49TH ST	HIALEAH	FL	33012	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05130	6800 W 28TH AVE	HIALEAH	FL	33018	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05198	7340 COLLINS AVE	MIAMI BEACH	FL	33141	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05250	1699 NW 7TH ST	MIAMI	FL	33125	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05251	1 E FLAGLER ST	MIAMI	FL	33131	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05293	4895 PALM AVENUE	HIALEAH	FL	33012	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05521	12400 PEMBROKE RD	MIRAMAR	FL	33027	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05696	14501 MIRAMAR PARKWAY	MIRAMAR	FL	33027	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05845	14901 NE 6TH AVE	MIAMI	FL	33161	04/08/2013	07/01/2013	06/27/2017	08/09/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06011	8001 MIRAMAR PKWY	MIRAMAR	FL	33025-3004	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06012	655 NW 57TH AVE	MIAMI	FL	33126	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06403	199 WESTON ROAD	WESTON	FL	33326	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06512	6812 MIRAMAR PKWY	MIRAMAR	FL	33023-6003	04/08/2013	07/01/2013	07/27/2017	08/09/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06949	2499 S PALM AVE	MIRAMAR	FL	33025	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07322	2710 N UNIVERSITY DR	HOLLYWOOD	FL	33024	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07844	7605 W 33RD CT	HIALEAH	FL	33018	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10984	3914 W. COMMERCIAL BLVD	TAMARAC	FL	33309	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11638	15050 BISCAYNE BLVD	NORTH MIAMI	FL	33181	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11657	2000 NORMANDY DR.	MIAMI BEACH	FL	33141	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 11939	8450 CORAL WAY	MIAMI	FL	33155	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 12285	780 EAST 9TH STREET	HIALEAH	FL	33010	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 12724	1251 SOUTH STATE ROAD 7	DAVIE	FL	33317	04/08/2013	07/01/2013	05/12/2017	05/12/2017
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16331	5361 NW 22ND AVE STE 2	MIAMI	FL	33142	04/26/2016	07/01/2016	04/01/2018	04/01/2018
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/08/2013	07/01/2013	04/01/2018	04/01/2018
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/08/2013	07/01/2013	04/01/2018	04/01/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 1:27 PM
Details	State	Update	Recertification	Active	To Be Terminated	3/8/2018 1:27 PM
Terminations	Termination Date	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 1:27 PM
Terminations	Termination Effective Date	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 1:27 PM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	3/8/2018 1:27 PM
Contacts	Authorizing Official	Insert			Neasman, Annie CEO 3058051700-23151	8/9/2017 2:50 PM
Addresses	Main Address	Insert			5361 NW 22ND AVENUE MIAMI, FL 33142	2/2/2017 2:49 PM
Contacts	Primary Contact	Update		LULL, TOM PURCHASING AGENT 3054991932	Duval, Ruth Vice President 3058051700-1000	2/2/2017 2:49 PM
Details	Last Recertification Date	Update		3/4/2016 12:00:00 AM	2/2/2017 12:00:00 AM	2/2/2017 2:49 PM
Details	Last Recertification Date	Update		2/16/2015 12:00:00 AM	3/4/2016 12:00:00 AM	3/4/2016 4:03 PM
Details	Last Recertification Date	Update		2/19/2014 12:00:00 AM	2/16/2015 12:00:00 AM	2/16/2015 10:10 PM
Details	Last Recertification Date	Update		1/1/2013 12:00:00 AM	2/19/2014 12:00:00 AM	2/19/2014 2:32 PM
Addresses	Billing Address	Insert			Jessie Trice Community Health Center, Inc. 5601 NW 27th Avenue Suite 1 Miami, FL 33142	6/11/2013 9:51 AM
Contacts	Primary Contact	Update		GARY, LORRIANE HIV PROGRAM COORDINATOR 3058351578	LULL, TOM PURCHASING AGENT 3054991932	12/19/2012 9:45 AM
Details	Last Recertification Date	Update		10/1/2006 12:00:00 AM	1/1/2013 12:00:00 AM	12/19/2012 9:45 AM
Contacts	Primary Contact	Insert			GARY, LORRIANE HIV PROGRAM COORDINATOR 3058351578	3/21/2012 10:12 AM
Details	Last Recertification Date	Insert			10/1/2006 12:00:00 AM	7/9/2008 3:40 PM
Details	Grant Number	Insert			H76HA00097	7/9/2008 3:40 PM
Details	340B ID	Insert			HV040330	7/9/2008 3:40 PM
Details	Is Authorizing Official EHB Data	Insert				7/9/2008 3:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/9/2008 3:40 PM
Details	Medicare Provider Number	Insert				7/9/2008 3:40 PM
Details	Entity Name	Insert			JESSIE TRICE COMMUNITY HEALTH CENTER, INC	7/9/2008 3:40 PM
Details	Program Code	Insert			HV	7/9/2008 3:40 PM
Details	Entity Subname	Insert				7/9/2008 3:40 PM
Dates	Participating Approval Date	Insert			12/1/1992 12:00:00 AM	7/9/2008 3:40 PM
Details	State	Insert			Active	7/9/2008 3:40 PM
Dates	Registration Date	Insert			12/1/1992 12:00:00 AM	7/9/2008 3:40 PM
Dates	Signed By Date	Insert				7/9/2008 3:40 PM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	7/9/2008 3:40 PM
Terminations	Termination Comments	Insert				7/9/2008 3:40 PM
Terminations	Termination Date	Insert				7/9/2008 3:40 PM
Terminations	Termination Effective Date	Insert				7/9/2008 3:40 PM
Terminations	Termination Reason	Insert				7/9/2008 3:40 PM
Details	Comments Public	Insert			7/9/08 UPDATED NAME (WAS ECONOMIC OPPORTUNITY FAMILY HEALTH CTR.)	7/9/2008 3:40 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History