Covered Entity Details

CAN100079-121 UNIVERSITY OF MIAMI HOSPITAL AND CLINICS (Terminated) - information as of 4/25/2025 12:01:54 AM

Main Details

Name

UNIVERSITY OF MIAMI HOSPITAL AND CLINICS

Subdivision Name

UMHC: Lennar Women's Center - Women's Center

Type

Free Standing Cancer Hospital

Rural

340B ID

CAN100079-121

Medicare Provider Number

100079

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/13/2018

Participating Start Date

7/1/2018

Participating Approval Date

4/19/2018

Last Recertification Date

9/1/2022

Termination Date
Termination Reason

10/1/2023
Business decision by the Covered Entity

Contacts

Authorizing Official

University of Miami Hospital and Clinics
Kymberlee Manni, CEO
(305) 689-4515

Primary Contact

University of Miami Hospital and Clinics
Blanca Rivera, Associate Vice President, UHealth Pharmacy Services
(305) 689-5630

Addresses

Street Address

5555 Ponce de Leon Boulevard
Coral Gables, FL 33146

Billing Address

University of Miami Hospital and Clinics-Lennar
5555 Ponce de Leon Boulevard
442
Coral Gables, FL 33146

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	100471	1679660617

Shipping Addresses

Shipping Address 1

University of Miami Hospital and Clinics-Lennar
5555 Ponce de Leon Boulevard
442
Coral Gables, FL 33146

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
CAN100079-01	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: DEERFIELD BEACH CLINIC	1192 East Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-02	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Kendall Clinic	8932 SW 97th Avenue	Miami	FL	Active
CAN100079-03	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Oncology Clinic - Plantation	8100 SW 10th Street	Plantation	FL	Active
CAN100079-04	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Oncology Clinic Hollywood - Oncology Clinic	3850 Hollywood Boulevard	Hollywood	FL	Active
CAN100079-05	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: CTU - Hollywood	3850 Hollywood Boulevard	Hollywood	FL	Active
CAN100079-06	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation	8100 SW 10th Street	Plantation	FL	Active
CAN100079-07	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: MRI - Plantation	8100 SW 10th Street	Plantation	FL	Active
CAN100079-08	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: MRI - Deerfield Beach	1192 East Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-09	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: CT - Plantation	8100 SW 10th Street	Plantation	FL	Active
CAN100079-10	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: CT - Deerfield Beach	1192 East Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-100	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH West: Multispecialty Care - Multispecialty Care	1321 NW 14th Street	Miami	FL	Active
CAN100079-101	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Occupational Therapy- Occupational Therapy	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-102	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Interventional Radiology	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-103	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar MRI - MRI	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-104	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Ultrasound - Ultrasound	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-105	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar GI/Special Procedures	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-106	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Multi-Specialty Clinic - Multi-Specialty Clinic	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-107	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Mammography - Mammography	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-108	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Dialysis - Dialysis	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-109	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Surgery - Surgery	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-11	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Nuclear Medicine- Deerfield Beach	1192 East Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-110	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Anesthesia - Anesthesia	5555 Ponce de Leon Boulevard	Coral Gables	FL	Terminated
CAN100079-111	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Occupational Physical Therapy - Occupational Physical Therapy	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-112	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Recovery Room - Recovery Room	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-113	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Anesthesia - Anesthesia	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-114	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: MRI - MRI	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-115	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Cardiac Cath Lab- Cath Lab	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-116	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: PACU Unit - PACU Unit	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-117	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Preop Assessment Center - Preop Assessment Center	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-118	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Card Rehab - Cardiopulmonary Rehab	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-119	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Physical Therapy - Physical therapy	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-12	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: CTU - Plantation	8100 SW 10th Street	Plantation	FL	Active
CAN100079-120	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Respiratory Therapy - Respiratory Therapy	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-121	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Women's Center - Women's Center	5555 Ponce de Leon Boulevard	Coral Gables	FL	Terminated
CAN100079-122	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: PH North Observation-Hospitalist	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-123	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 9 South Psychology - Psychology Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-124	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 7 North Telemetry - Telemetry Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-125	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 11 South Orthopedics - Orthopedics Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-126	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 9 Floor Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-127	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 8 South Telemetry - Telemetry Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-128	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: CCU - CCU Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-129	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 7 South Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-13	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: CTU - Deerfield Beach	1192 East Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-130	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 11 North Oncology - Oncology Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-131	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 9 East ICU Observation - Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-132	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: SICU - Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-133	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: PH South (13 South) Observation- IMCU	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-134	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 6 North Stroke and Seizure - Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-135	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 10th Floor Psychology- Psychology	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-136	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 8 North Telemetry - Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-137	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: MICU - Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-138	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 6 South Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-139	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Gamma Knife - Gamma Knife	1321 NW 14th Street	Miami	FL	Terminated
CAN100079-14	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Xray - Plantation	8100 SW 10th Street	Plantation	FL	Active
CAN100079-140	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH EEG - EEG	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-141	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar-Gamma Knife- Gamma Knife	5555 Ponce de Leon Boulevard	Coral Gables	FL	Terminated
CAN100079-142	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	VIEW RAY KENDALL - Kendall CTU	8932 SW 97th Avenue	Miami	FL	Terminated
CAN100079-143	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Echography - Echography	900 NW 17th Street	Miami	FL	Active
CAN100079-144	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Med/Surg Nursing - Observation - Med/Surg Nursing - Observation	900 NW 17th Street	Miami	FL	Active
CAN100079-145	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Minor OR 4th Floor - Minor OR 4th Floor	900 NW 17th Street	Miami	FL	Active
CAN100079-146	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH West: Respiratory Therapy- Respiratory Therapy	1321 NW 14th Street	Miami	FL	Terminated
CAN100079-147	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH South: Ultrasound - Ultrasound	1295 NW 14th Street	Miami	FL	Terminated
CAN100079-148	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH South:GI Special Procedures	1295 NW 14th Street	Miami	FL	Active
CAN100079-149	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	Respiratory Therapy	1295 NW 14th Street	Miami	FL	Terminated
CAN100079-15	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Radiology Oncology - Deerfield Beach	1192 East Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-150	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Interventional Radiology- Interventional Radiology	1295 NW 14th Street	Miami	FL	Terminated
CAN100079-151	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH South: EKG - EKG	1295 NW 14th Street	Miami	FL	Terminated
CAN100079-152	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH South: Anesthesiology - Anesthesiology	1295 NW 14th Street	Miami	FL	Terminated
CAN100079-153	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH South: Nuclear Medicine - Nuclear Medicine	1295 NW 14th Street	Miami	FL	Terminated
CAN100079-154	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH South: Multi-Specialty Clinic - Multi-Specialty Clinic	1295 NW 14th Street	Miami	FL	Active
CAN100079-155	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH West: EKG - EKG	1321 NW 14th Street	Miami	FL	Terminated
CAN100079-156	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH West: Cardiac Clinic - Cardiac Clinic	1321 NW 14th Street	Miami	FL	Active
CAN100079-157	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH West: Multispecialty Care - Multispecialty Care	1321 NW 14th Street Suite 510	Miami	FL	Terminated
CAN100079-158	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Plantation Clinic - Opthalmology	8100 SW 10th Street	Plantation	FL	Active
CAN100079-159	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	Observation - UMH: Coronary Care Unit - Coronary Care Unit	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-16	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Hematology - Plantation	8100 SW 10th St.	Plantation	FL	Terminated
CAN100079-160	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: 12 Floor Observation	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-161	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Head & Neck Center - Head & Neck Center	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-162	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	Observation - UMH: Neuro ICU - Neuro ICU	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-163	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Plantation Ocular Surface Center - Ocular Surface Center	8100 SW 10th Street	Plantation	FL	Active
CAN100079-164	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Minor OR 2nd Floor - Minor OR 2nd Floor	900 NW 17th Street	Miami	FL	Active
CAN100079-165	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar University PreOperative Assessment center- UPAC	5555 Ponce de Leon Boulevard	Coral Gables	FL	Terminated
CAN100079-166	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Plantation Echography - Plantation Echography	8100 SW 10th Street	Plantation	FL	Active
CAN100079-167	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	Plantation: ABLE Procedure Room - ABLE Procedure Room	8100 SW 10th Street	Plantation	FL	Terminated
CAN100079-168	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Respiratory Therapy - Respiratory Therapy	900 NW 17th Street	Miami	FL	Terminated
CAN100079-169	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Aesthetic Center - Aesthetic Center	900 NW 17th Street	Miami	FL	Active
CAN100079-17	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Mammography - Deerfield Beach	1192 East Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-170	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Surgery - Surgery	900 NW 17th Street	Miami	FL	Active
CAN100079-171	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Cornea Services - Cornea Services	900 NW 17th Street	Miami	FL	Active
CAN100079-172	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Physical Therapy - Physical Therapy	900 NW 17th Street	Miami	FL	Terminated
CAN100079-173	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Anesthesiology - Anesthesiology	900 NW 17th Street	MIami	FL	Terminated
CAN100079-174	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: CT Scan - CT Scan	900 NW 17th Street	Miami	FL	Active
CAN100079-175	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Oculo-Plastic Service - Oculo-Plastic Service	900 NW 17th Street	Miami	FL	Active
CAN100079-176	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Recovery Room - Recovery Room	900 NW 17th Street	Miami	FL	Terminated
CAN100079-177	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Electrophysiology	900 NW 17th Street	Miami	FL	Active
CAN100079-178	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Audiology - Audiology	900 NW 17th Street	Miami	FL	Active
CAN100079-179	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Occupational Therapy- Occupational Therapy	900 NW 17th Street	Miami	FL	Terminated
CAN100079-18	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: CTU - Kendall	8932 SW 97th Avenue	Miami	FL	Active
CAN100079-180	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Retina Clinic - Retina Clinic	900 NW 17th Street	Miami	FL	Active
CAN100079-181	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Neuro Opthalmology - Neuro Opthalmology	900 NW 17th Street	Miami	FL	Active
CAN100079-182	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Pediatrics Clinic - Pediatrics Clinic	900 NW 17th Street	Miami	FL	Active
CAN100079-183	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Public Health Trust: Fellows Clinic - Public Health Trust: Fellows Clinic	900 NW 17th Street	Miami	FL	Active
CAN100079-184	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Laser Vision Center - Laser Vision Center	900 NW 17th Street	Miami	FL	Active
CAN100079-185	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Glaucoma Service - Glaucoma Service	900 NW 17th Street	Miami	FL	Active
CAN100079-186	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Optometry - Optometry	900 NW 17th Street	Miami	FL	Active
CAN100079-187	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Orthopedic Clinic - Orthopedic Clinic	900 NW 17th Street	Miami	FL	Terminated
CAN100079-188	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Pediatric ENT - Pediatric ENT	900 NW 17th Street	Miami	FL	Active
CAN100079-189	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Primary Opthalmology - Primary Opthalmology	900 NW 17th Street	Miami	FL	Active
CAN100079-19	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Ultrasound Deerfield - Ultrasound	1192 E Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-190	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Emergency Department - Emergency Department	900 NW 17th Street	Miami	FL	Active
CAN100079-191	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: MRI Center - MRI Center	900 NW 17th Street	Miami	FL	Active
CAN100079-192	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Radiology- Radiology	900 NW 17th Street	Miami	FL	Active
CAN100079-193	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH -Observation: Surgical Oncology Stepdown	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-194	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Sleep Center-Sleep Center	900 NW 17th Street	Miami	FL	Active
CAN100079-195	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: PSYCHOLOGY - PSYCHOLOGY	1121 NW 14th Street	Miami	FL	Active
CAN100079-196	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH UHealth Brain & Spine - UHT Brain & Spine	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-197	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Corneal Topography - Corneal Topography	900 NW 17th Street	Miami	FL	Active
CAN100079-198	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	ABLEH: Preoperative Services - Preoperative Services	900 NW 17th Street	Miami	FL	Active
CAN100079-199	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: PAC MOHS Clinic - MOHS Derm	1150 NW 14th Street	Miami	FL	Active
CAN100079-20	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Kendall X-Ray	8932 SW 97th Avenue	Miami	FL	Active
CAN100079-200	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH West: Oncology Care Clinic	1321 NW 14th Street	Miami	FL	Active
CAN100079-201	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC - AVENTURA - ONCOLOGY	2801 NE 213th Street	Aventura	FL	Active
CAN100079-202	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC - AVENTURA - CTU	2801 NE 213th Street	Aventura	FL	Active
CAN100079-203	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC- FT LAUDERDALE- ONCOLOGY - Hematology and Oncology	5700 N. Federal Highway	Ft. Lauderdale	FL	Active
CAN100079-204	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: West Pulmonology - Pulmonology	1321 NW 14th Street 1st Floor	Miami	FL	Active
CAN100079-205	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: SCCC Doral Clinic - Doral Clinic	8375 NW 53rd Terrace	Doral	FL	Active
CAN100079-206	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: South Thoracic Surgery Clinic - UHT Thoracic Surgical Clinic	1295 NW 14th Street	Miami	FL	Active
CAN100079-207	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: SCCC Doral Clinic- CTU - CTU	8375 NW 53rd Terrace	Doral	FL	Active
CAN100079-21	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Xray - Deerfield Beach	1192 East Newport Center Drive	Deerfield Beach	FL	Active
CAN100079-22	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH West: Radiation Oncology- UMH West	1321 NW 14th Street	Miami	FL	Active
CAN100079-23	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Audiology - CRB	1120 NW 14th Street	Miami	FL	Active
CAN100079-24	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Ear Institute - CRB	1120 NW 14th Street	Miami	FL	Active
CAN100079-25	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: UPain Center - CRB	1120 NW 14th Street	Miami	FL	Active
CAN100079-26	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Premium Care (Sayfie's Pavillion) - PAC	1150 NW 14th Street	Miami	FL	Terminated
CAN100079-27	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Interventional Radiology - PAC	1150 NW 14th Street	Miami	FL	Active
CAN100079-28	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Urology Oncology - Deerfield Beach	1192 E. Newport Center Dr.	Deerfield Beach	FL	Terminated
CAN100079-29	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Hem Oncology - Deerfield Beach	1192 E. Newport Center Dr.	Deerfield Beach	FL	Terminated
CAN100079-30	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: GYN Oncology - Deerfield Beach	1192 E. Newport Center Dr.	Deerfield Beach	FL	Terminated
CAN100079-31	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Head and Neck - Deerfield Beach	1192 E. Newport Center Dr.	Deerfield Beach	FL	Terminated
CAN100079-32	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: GYN Oncology - Kendall	8932 SW 97th Avenue	Miami	FL	Terminated
CAN100079-33	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Kendall- MRI- Kendall -MRI	8932 SW 97th Avenue	Miami	FL	Active
CAN100079-34	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: CT - Kendall	8932 SW 97th Avenue	Miami	FL	Terminated
CAN100079-35	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Josephn Applebaum MRI Center	1115 NW 14th Street	Miami	FL	Active
CAN100079-36	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: CTU - Coral Springs	8170 Royal Palm Boulevard	Coral Springs	FL	Active
CAN100079-37	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Coral Springs Clinic	8170 Royal Palm Boulevard	Coral Springs	FL	Active
CAN100079-38	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Physical Medicine and Rehabilitation	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-39	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Palliative Care	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-40	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Deerfield Beach Clinic / Nutrition	1192 East Newport Center Drive	Deerfield Beach	FL	Terminated
CAN100079-41	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	Ultrasound - Miami	1115 NW 14th Street	Miami	FL	Terminated
CAN100079-42	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Oncology Clinic - Hollywood / Acupuncture	3850 Hollywood BLVD	Hollywood	FL	Terminated
CAN100079-43	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	Joseph Applebaum MRI Center / CT-Radiology	1115 NW 14th Street	Miami	FL	Terminated
CAN100079-44	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Coral Springs Clinic / Acupuncture	8170 Royal Palm BLVD	Coral Springs	FL	Terminated
CAN100079-45	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Coral Springs Clinic / Nutrition	8170 Royal Palm BLVD	Coral Springs	FL	Terminated
CAN100079-46	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Nutrition	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-47	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Oncology Clinic - Hollywood / Nutrition	3850 Hollywood BLVD	Hollywood	FL	Terminated
CAN100079-48	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	Joseph Applebaum MRI Center / Urology	1115 NW 14th St	Miami	FL	Terminated
CAN100079-49	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Hepatology	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-50	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Kendall Clinic / Hepatology	8932 SW 97th Avenue	Miami	FL	Terminated
CAN100079-51	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Upain Center - CRB / Physical Medicine and Rehabilitation	1120 NW 14th St	Miami	FL	Terminated
CAN100079-52	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Upain Center - CRB / Pain Medicine	1120 NW 14th St	Miami	FL	Terminated
CAN100079-53	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Genetics	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-54	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Endocrine Surgery	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-55	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Acupuncture	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-56	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Gastroenterology	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-57	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Family Medicine	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-58	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Pain Medicine	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-59	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Surgical Oncology	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-60	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Breast Oncology	8100 SW 10th St	Plantation	FL	Terminated
CAN100079-61	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Kendall Clinic / Ortho Sports	8932 SW 97th Ave	Miami	FL	Terminated
CAN100079-62	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Kendall Clinic / Acupuncture	8932 SW 97th Ave	Miami	FL	Terminated
CAN100079-63	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinc - Plantation / Interventional Radiology	8100 SW 10th Street	Plantation	FL	Terminated
CAN100079-64	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic - Plantation / Ultrasound	8100 SW 10th Street	Plantation	FL	Active
CAN100079-65	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Multispecialty Clinic- Plantation / Mammography	8100 SW 10th Street	Plantation	FL	Active
CAN100079-66	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Kendall / Ultrasound	8932 SW 97th Avenue	Miami	FL	Active
CAN100079-67	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Ultrasound - Ultrasound	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-68	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: CT Scan- CT Scan	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-69	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Ambulatory Surgery - Ambulatory Surgery	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-70	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Radiology - Radiology	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-71	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: PT Plantation - Physical Therapy	8100 SW 10th Street	Plantation	FL	Active
CAN100079-72	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Digestive Health MSCC	1295 NW 14th Street	Miami	FL	Terminated
CAN100079-73	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Cardiac Clinic	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-74	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Ophthalmology - Opthalmology	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-75	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Pt Kendall - Physical Therapy	8980 SW 97th Avenue	Miami	FL	Active
CAN100079-76	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: EKG - EKG	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-77	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH : MRI Center- MRI Center	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-78	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar PACU - PACU	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-79	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Cardiology Lab - Cardiology Lab	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-80	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Nuclear Medicine - Nuclear Medicine	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-81	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Pt Marlins - Pt Marlins	501 Marlins Way	Miami	FL	Terminated
CAN100079-82	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Hyperbaric - Hyperbaric	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-83	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Wound Care Center - Wound Care Center	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-84	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Respiratory Therapy- Respiratory Therapy	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-85	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar CT - CT	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-86	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Emergency Room - Emergency Room	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-87	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: USBC - Spine And Brain Clinic - USBC-Spine And Brain Clinic	1295 NW 14th Street	Miami	FL	Active
CAN100079-88	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Radiation Oncology - Radiation Oncology	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-89	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Mammography- Miami	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-90	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: GI Special Procedures	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-91	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Nuclear Medicine - Nuclear Medicine	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-92	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Cardiac Surgery - Cardiac Surgery	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-93	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Radiology - Radiology	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-94	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar CTU - CTU	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-95	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar Interventional Radiology - Interventional Radiology	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active
CAN100079-96	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Radiation Oncology - Radiation Oncology	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-97	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Physical Therapy - Physical Therapy	1400 NW 12th Avenue	Miami	FL	Active
CAN100079-98	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMH: Speech Therapy - Speech Therapy	1400 NW 12th Avenue	Miami	FL	Terminated
CAN100079-99	Child	CAN	UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	UMHC: Lennar - Surgery - Surgery	5555 Ponce de Leon Boulevard	Coral Gables	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2023 12:01 AM
Contacts	Primary Contact	Update	Profile Change Request	Rivera, Blanca Executive Director of Pharmacy University of Miami Hospital and Clinics 3056895630	Rivera, Blanca Associate Vice President, UHealth Pharmacy Services University of Miami Hospital and Clinics 3056895630	8/23/2023 11:09 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/12/2023 12:00:00 AM	7/13/2023 6:53 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/13/2023 6:53 AM
Terminations	Termination Date	Update	Termination Request		10/1/2023 12:00:00 AM	7/13/2023 6:53 AM
Terminations	Termination Effective Date	Update	Termination Request		7/12/2023 12:00:00 AM	7/13/2023 6:53 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	7/13/2023 6:53 AM
Details	Last Recertification Date	Update	Recertification	8/26/2021 12:06:25 PM	9/1/2022 10:18:29 AM	9/1/2022 10:18 AM
Addresses	Shipping Address	Delete	Recertification	University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard Coral Gables, FL 33146		8/26/2021 12:06 PM
Addresses	Billing Address	Update	Recertification	University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard Coral Gables, FL 33146	University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard 442 Coral Gables, FL 33146	8/26/2021 12:06 PM
Addresses	Shipping Address	Insert	Recertification		University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard 442 Coral Gables, FL 33146	8/26/2021 12:06 PM
Details	Last Recertification Date	Update	Recertification	8/31/2020 12:06:52 PM	8/26/2021 12:06:25 PM	8/26/2021 12:06 PM
Addresses	Shipping Address	Delete	Recertification	University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard Suite 442 Coral Gables, FL 33146		8/31/2020 12:06 PM
Addresses	Billing Address	Update	Recertification	University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard Suite 442 Coral Gables, FL 33146	University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard Coral Gables, FL 33146	8/31/2020 12:06 PM
Addresses	Shipping Address	Insert	Recertification		University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard Coral Gables, FL 33146	8/31/2020 12:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1679660617	8/31/2020 12:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/31/2020 12:06 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679660617 ( )		8/31/2020 12:06 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 11:38:41 AM	8/31/2020 12:06:52 PM	8/31/2020 12:06 PM
Contacts	Authorizing Official	Update	Change Request	Demers, Stephen L CEO University of Miami Hospital and Clinics 3056894515-67907	Manni, Kymberlee CEO University of Miami Hospital and Clinics 3056894515	4/15/2020 10:01 AM
Details	Last Recertification Date	Update	Recertification	9/6/2018 1:16:56 PM	8/28/2019 11:38:41 AM	8/28/2019 11:38 AM
Contacts	Authorizing Official	Update	AO Change Request	Gittelman, Michael CEO University of Miami Hospital & Clinics 3053266111	Demers, Stephen L CEO University of Miami Hospital and Clinics 3056894515-67907	7/23/2019 8:45 AM
Addresses	Main Address	Update	Recertification	5555 Ponce de Leon Blvd Coral Gables, FL 33146	5555 Ponce de Leon Boulevard Coral Gables, FL 33146	9/6/2018 1:16 PM
Addresses	Billing Address	Insert	Recertification		University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard Suite 442 Coral Gables, FL 33146	9/6/2018 1:16 PM
Addresses	Shipping Address	Insert	Recertification		University of Miami Hospital and Clinics-Lennar 5555 Ponce de Leon Boulevard Suite 442 Coral Gables, FL 33146	9/6/2018 1:16 PM
Details	Last Recertification Date	Update	Recertification		9/6/2018 1:16:56 PM	9/6/2018 1:16 PM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Gittelman, Michael CEO University of Miami Hospital & Clinics 3053266111	4/19/2018 11:49 AM
Details	340B ID	Update	New Registration		CAN100079-121	4/19/2018 11:49 AM
Details	Entity Subname	Update	New Registration	UMHC: Lennar Women's Center	UMHC: Lennar Women's Center - Women's Center	4/19/2018 11:49 AM
Dates	Participating Approval Date	Update	New Registration		4/19/2018 11:49:20 AM	4/19/2018 11:49 AM
Details	State	Update	New Registration	Pending	Approved	4/19/2018 11:49 AM
Dates	Signed By Date	Update	New Registration		4/16/2018 12:33:15 PM	4/19/2018 11:49 AM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	4/19/2018 11:49 AM
Addresses	Main Address	Insert	New Registration		5555 Ponce de Leon Blvd Coral Gables, FL 33146	4/13/2018 10:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/13/2018 10:46 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100471	4/13/2018 10:46 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	4/13/2018 10:46 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1679660617	4/13/2018 10:46 AM
Contacts	Authorizing Official	Insert	New Registration		Gittelman, Michael CEO University of Miami Hospital & Clinics 3053266111	4/13/2018 10:46 AM
Contacts	Primary Contact	Insert	New Registration		Rivera, Blanca Executive Director of Pharmacy University of Miami Hospital and Clinics 3056895630	4/13/2018 10:46 AM
Details	Last Recertification Date	Insert	New Registration			4/13/2018 10:46 AM
Details	Grant Number	Insert	New Registration			4/13/2018 10:46 AM
Details	340B ID	Insert	New Registration			4/13/2018 10:46 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2018 10:46 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2018 10:46 AM
Details	Medicare Provider Number	Insert	New Registration		100079	4/13/2018 10:46 AM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF MIAMI HOSPITAL AND CLINICS	4/13/2018 10:46 AM
Details	Program Code	Insert	New Registration		CAN	4/13/2018 10:46 AM
Details	Entity Subname	Insert	New Registration		UMHC: Lennar Women's Center	4/13/2018 10:46 AM
Dates	Participating Approval Date	Insert	New Registration			4/13/2018 10:46 AM
Details	State	Insert	New Registration		Pending	4/13/2018 10:46 AM
Dates	Registration Date	Insert	New Registration		4/13/2018 10:46:35 AM	4/13/2018 10:46 AM
Dates	Signed By Date	Insert	New Registration			4/13/2018 10:46 AM
Dates	Start Date	Insert	New Registration			4/13/2018 10:46 AM
Terminations	Termination Comments	Insert	New Registration			4/13/2018 10:46 AM
Terminations	Termination Date	Insert	New Registration			4/13/2018 10:46 AM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2018 10:46 AM
Terminations	Termination Reason	Insert	New Registration			4/13/2018 10:46 AM