Covered Entity Details

DSH100006HR ORLANDO HEALTH (Active) - information as of 4/25/2025 9:20:21 PM

Main Details

Name

ORLANDO HEALTH

Subdivision Name

Orlando Health Cancer Institute / 6980 ONC DPH RADIATION ONCOLOGY

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100006HR

Medicare Provider Number

100006

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/8/2019

Participating Start Date

10/1/2019

Participating Approval Date

7/16/2019

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Orlando Health
John Enoch Miller, SVP Finance
(321) 843-3180

Primary Contact

Orlando Health
Lacey Jory, 340B Program Supervisor
(321) 843-9045

Addresses

Street Address

7472 Docs Grove Circle
Orlando, FL 32819

Billing Address
Same as Street Address

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	010133800,031882500	1184709057

Shipping Addresses

Same as Street Address

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
DSH100006A	Child	DSH	ORLANDO HEALTH	ARNOLD PALMER HOSPITAL FOR CHILDREN & WOMEN	92 W Miller Street	Orlando	FL	Terminated
DSH100006AA	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 8306 LH OP WOUND CARE MANAGEMENT	60 W Gore Street	Orlando	FL	Active
DSH100006AB	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6924 ONC THORACIC SURG CLIN STAFF	22 W Underwood Street	Orlando	FL	Active
DSH100006AC	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6926 HEAD/NECK/THOR MED CLIN ST	22 W Underwood Street	Orlando	FL	Active
DSH100006AD	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6921 ONC PLASTICS/RECON CLIN STAFF	125 W Copeland Street	Orlando	FL	Active
DSH100006AE	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6925 ONC HEAD/NECK SURG CLIN STAFF	22 W Underwood Street	Orlando	FL	Active
DSH100006AF	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6923 ONC BREAST CARE CTR CLIN STAFF	83 W Miller Street	Orlando	FL	Active
DSH100006AG	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 6512 ACC WOMENS IMAGING	22 W Underwood Street	Orlando	FL	Active
DSH100006AH	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 6212 ACC ANESTHESIA SUPPLIES	22 W Underwood Street	Orlando	FL	Active
DSH100006AJ	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 6500 ACC SURGERY	22 W Underwood Street	Orlando	FL	Active
DSH100006AK	Child	DSH	ORLANDO HEALTH	ACC ENDOSCOPY / Endoscopy	22 W Underwood Street	Orlando	FL	Terminated
DSH100006AL	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1476 WPH RESPIRATORY CARE	83 W Miller Street	Orlando	FL	Terminated
DSH100006AM	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1213 WPH ANESTHESIA L & D	83 W Miller Street	Orlando	FL	Terminated
DSH100006AN	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1212 WPH ANESTHESIA SUPPLIES	83 W Miller Street	Orlando	FL	Terminated
DSH100006AP	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1264 WPH L&D OR/PACU	83 W Miller Street	Orlando	FL	Terminated
DSH100006AQ	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1263 WPH LABOR AND DELIVERY	83 W Miller Street	Orlando	FL	Active
DSH100006AR	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1262 WPH WOMENS TRIAGE UNIT	83 W Miller Street	Orlando	FL	Active
DSH100006AS	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1464 WPH PAC UNIT	83 W Miller Street	Orlando	FL	Active
DSH100006AT	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1500 WPH SURGERY	83 W Miller Street	Orlando	FL	Active
DSH100006AU	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital / 1468 WPH PREADMISSION TESTING	83 W Miller Street	Orlando	FL	Active
DSH100006AV	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6906 ONC DENTAL CLINICAL STAFF	22 W Underwood Street	Orlando	FL	Active
DSH100006AW	Child	DSH	ORLANDO HEALTH	UF Health Cancer Center / 6803 ONC HC MED ONCOL CLIN STAFF	1111 Blackwood Avenue	Ocoee	FL	Terminated
DSH100006AX	Child	DSH	ORLANDO HEALTH	UF Health Cancer Center / 6804 ONC HC RADIATION ONCOLOGY	1111 Blackwood Avenue	Ocoee	FL	Terminated
DSH100006AY	Child	DSH	ORLANDO HEALTH	UF Health Cancer Center / 6844 ONC HC NURSING	1111 Blackwood Avenue	Ocoee	FL	Terminated
DSH100006AZ	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6992 ONC GYN ONCOLOGY CENTER	83 W Miller Street	Orlando	FL	Active
DSH100006B	Child	DSH	ORLANDO HEALTH	ORLANDO REGIONAL LUCERNE	818 MAIN LANE	ORLANDO	FL	Terminated
DSH100006BA	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital - 1054 WPH MOTHER/BABY UNIT 6th floor - Observation	83 W Miller Street	Orlando	FL	Terminated
DSH100006BB	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital - 1052 WPH ANTEPARTUM SPECIAL CARE - Observation	83 W Miller Street	Orlando	FL	Terminated
DSH100006BC	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital - 1050 WPH WOMENS GYN - Observation	83 W Miller Street	Orlando	FL	Terminated
DSH100006BD	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital - 1032 WPH ICU/WOMANS ADV CARE UNIT - Observation	83 W Miller Street	Orlando	FL	Terminated
DSH100006BE	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital - 1022 WPH OP NURSING - Observation	83 W Miller Street	Orlando	FL	Terminated
DSH100006BF	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6984 ONC SSH MEDICAL ONCOLOGY	210 Rinehart Rd	Lake Mary	FL	Active
DSH100006BG	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6981 ONC DPH MEDICAL ONCOLOGY	7472 Docs Grove Cir	Orlando	FL	Active
DSH100006BH	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6244 ONC NURSING	22 W Underwood Street	Orlando	FL	Terminated
DSH100006BJ	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6989 ONC LM NURSING	210 Rinehart Road	Lake Mary	FL	Active
DSH100006BK	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6986 ONC LM RADIATION ONCOLOGY	210 Rinehart Road	Lake Mary	FL	Active
DSH100006BL	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital / 2473 DPH RENAL DIALYSIS	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006BM	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital / 1284 APH CHILDRENS EMERG & TRAUMA	92 W Miller Street	Orlando	FL	Active
DSH100006BN	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 6505 ACC SURGICAL SUPPLIES	22 W Underwood Street	Orlando	FL	Terminated
DSH100006BP	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6244 ONC NURSING	1400 S Orange Avenue	Orlando	FL	Active
DSH100006BQ	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 8231 OHHI CARDIAC REHAB	1222 S Orange Avenue	Orlando	FL	Terminated
DSH100006BR	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 3022 INFUSION THERAPY	52 W Underwood Street	Orlando	FL	Terminated
DSH100006BS	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 3305 IP WOUND MGMT CARE	52 W Underwood Street	Orlando	FL	Terminated
DSH100006BT	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 3284 EMERGENCY SERVICES	52 W Underwood Street	Orlando	FL	Terminated
DSH100006BU	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 6464 ACC PACU	22 W Underwood Street	Orlando	FL	Active
DSH100006BV	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital / 1125 NEONATAL FOLLOW UP CLINIC	50 W Sturtevant Street	Orlando	FL	Active
DSH100006BW	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6904 ONC MEDICAL CLINICAL STAFF	1400 S Orange Avenue	Orlando	FL	Active
DSH100006BX	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6922 ONC GI MEDICAL CLINICAL STAFF	1400 S Orange Avenue	Orlando	FL	Active
DSH100006BY	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 3473 RENAL DIALYSIS	52 W Underwood Street	Orlando	FL	Terminated
DSH100006BZ	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital / 1311 WPH MOBILE TRANSPORT	92 W Miller Street	Orlando	FL	Terminated
DSH100006C	Child	DSH	ORLANDO HEALTH	DR. P. PHILLIPS HOSPITAL	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006CA	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6903 ONC SURGICAL CLINICAL STAFF	1400 S Orange Avenue	Orlando	FL	Active
DSH100006CB	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital / 1301 APH BURN CENTER	92 W Miller Street	Orlando	FL	Active
DSH100006CC	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital / 1244 APH OP ONCOLOGY INFUSION	92 W Miller Street	Orlando	FL	Active
DSH100006CD	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital / 2305 DPH WOUND CARE MGMT	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006CE	Child	DSH	ORLANDO HEALTH	15022 LMH OP NURSING	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006CF	Child	DSH	ORLANDO HEALTH	15473 LMH RENAL DIALYSIS	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006CG	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital / 1313 APH MOBILE TRANSPORT	92 W Miller Street	Orlando	FL	Active
DSH100006CH	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital / 2284 DPH EMERGENCY SERVICES	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006CJ	Child	DSH	ORLANDO HEALTH	15170 LMH LW Emergency Services	575 W SR 434	Longwood	FL	Active
DSH100006CK	Child	DSH	ORLANDO HEALTH	15305 LMH IP WOUND CARE MANAGEMENT	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006CL	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6979 ONC DPH NURSING	7472 Docs Grove Circle	Orlando	FL	Active
DSH100006CM	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3240 ORMC CONGENITAL HEART CENTER	52 W Underwood Street	Orlando	FL	Terminated
DSH100006CN	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2500 DPH SURGERY	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006CP	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3389 MRI	52 W Underwood Street	Orlando	FL	Terminated
DSH100006CQ	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1239 APH CARDIOLOGY OP CENTER	1222 S Orange Ave	Orlando	FL	Active
DSH100006CR	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1269 APMC ECHOCARDIOLOGY	92 W Miller Street	Orlando	FL	Terminated
DSH100006CS	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital - 1505 WPH SURGICAL SUPPLIES	83 W Miller Street	Orlando	FL	Terminated
DSH100006CT	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1473 APH RENAL DIALYSIS	92 W Miller Street	Orlando	FL	Active
DSH100006CU	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3272 ELECTROCARDIOLOGY	52 W Underwood Street	Orlando	FL	Terminated
DSH100006CV	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2464 DPH PACU	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006CW	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1211 APH ANESTHESIA SUPPLIES	92 W Miller Street	Orlando	FL	Terminated
DSH100006CX	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9212 SSH ANESTHESIA SUPPLIES	555 W SR 434	Longwood	FL	Terminated
DSH100006CY	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1446 APMC RADIOLOGY	92 W Miller Street	Orlando	FL	Terminated
DSH100006CZ	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0027 ORMC CHEST PAIN CENTER	52 W Underwood Street	Orlando	FL	Terminated
DSH100006DA	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1272 APMC ELECTROCARDIOLOGY	92 W Miller Street	Orlando	FL	Active
DSH100006DB	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9480 SSH SLEEP LAB	555 W SR 434	Longwood	FL	Terminated
DSH100006DC	Child	DSH	ORLANDO HEALTH	15293 LMH ENDOSCOPY	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006DD	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3441 OHHI IMAGING	1222 S Orange Avenue	Orlando	FL	Active
DSH100006DE	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9512 SSH WOMENS IMAGING CENTER	555 W SR 434	Longwood	FL	Terminated
DSH100006DF	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6919 ONC PROTON THERAPY	1400 S Orange Avenue	Orlando	FL	Active
DSH100006DG	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2419 DPH NONINVASIVE VASCULAR LAB	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006DH	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1507 APH SURGICAL SUPPLIES	92 W Miller Street	Orlando	FL	Terminated
DSH100006DJ	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6927 ONC GENETICS AND HIGH RISK	44 Sturtevant St.	Orlando	FL	Active
DSH100006DK	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1502 CARDIO OR	92 W Miller Street	Orlando	FL	Terminated
DSH100006DL	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1463 APH PAC UNIT	92 W Miller Street	Orlando	FL	Active
DSH100006DM	Child	DSH	ORLANDO HEALTH	15446 LMH IMAGING - DIAG	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006DN	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2272 DPH CARDIOLOGY	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006DP	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2027 DPH CHEST PAIN CENTER	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006DQ	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1200 APMC NEURODIAGNOSTICS	92 W Miller Street	Orlando	FL	Active
DSH100006DR	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3462 PRE-POST PROCEDURAL UNIT	52 W Underwood Street	Orlando	FL	Terminated
DSH100006DS	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1305 APH WOUND CARE MGMT	92 W Miller Street	Orlando	FL	Terminated
DSH100006DT	Child	DSH	ORLANDO HEALTH	15476 LMH RESPIRATORY THERAPY	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006DU	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1467 APH PREADMISSION TESTING	92 W Miller Street	Orlando	FL	Active
DSH100006DV	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3471 ORMC PRE/POST CATH	52 W Underwood Street	Orlando	FL	Terminated
DSH100006DW	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3212 ANESTHESIA SUPPLIES	52 W Underwood Street	Orlando	FL	Terminated
DSH100006DX	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1392 APH NUCLEAR MEDICINE	92 W Miller Street	Orlando	FL	Active
DSH100006DY	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3392 NUCLEAR MEDICINE	52 W Underwood Street	Orlando	FL	Terminated
DSH100006DZ	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2505 DPH SURGICAL SUPPLIES	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006E	Child	DSH	ORLANDO HEALTH	SOUTH SEMINOLE HOSPITAL	555 W SR 434	Longwood	FL	Terminated
DSH100006EA	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1293 APH ENDOSCOPY	92 W Miller Street	Orlando	FL	Active
DSH100006EB	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2212 DPH ANESTHESIA SUPPLIES	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006EC	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2468 DPH PREADMISSION TESTING	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006ED	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3234 ORMC - ELECTROPHYSIOLOGY	52 W Underwood Street	Orlando	FL	Terminated
DSH100006EE	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3269 ECHOCARDIOLOGY	52 W Underwood Street	Orlando	FL	Terminated
DSH100006EF	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1233 APH CARDIAC CATH LAB	92 W Miller Street	Orlando	FL	Active
DSH100006EG	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1480 APH SLEEP CENTER	92 W Miller Street	Orlando	FL	Terminated
DSH100006EH	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3287 INTRAOP NEURO MONITORING DEPT	52 W Underwood Street	Orlando	FL	Terminated
DSH100006EJ	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6440 ONC RADIATION ONCOLOGY	1400 S Orange Avenue	Orlando	FL	Active
DSH100006EK	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3419 NONINVASIVE VASCULAR LAB	52 W Underwood Street	Orlando	FL	Terminated
DSH100006EL	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3233 CARDIAC CATH LAB	52 W Underwood Street	Orlando	FL	Terminated
DSH100006EM	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2233 DPH CARDIAC CATH LAB	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006EN	Child	DSH	ORLANDO HEALTH	15500 LMH SURGERY	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006EP	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1466 APH PEDS PROCEDURE AREA	92 W Miller Street	Orlando	FL	Terminated
DSH100006EQ	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2293 DPH ENDOSCOPY	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006ER	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3500 SURGERY	52 W Underwood Street	Orlando	FL	Terminated
DSH100006ES	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3443 RAD ANGIOGRAPHY	52 W Underwood Street	Orlando	FL	Terminated
DSH100006ET	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3464 PAC UNIT	52 W Underwood Street	Orlando	FL	Terminated
DSH100006EU	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3461 RAD ULTRASOUND	52 W Underwood Street	Orlando	FL	Terminated
DSH100006EV	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2446 DPH RADIOLOGY	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006EW	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3488 PULMONARY WELLNESS	52 W Underwood Street	Orlando	FL	Terminated
DSH100006EX	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1482 APH RESPIRATORY CARE	92 W Miller Street	Orlando	FL	Terminated
DSH100006EY	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2476 DPH RESPIRATORY CARE	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006EZ	Child	DSH	ORLANDO HEALTH	15464 LMH PACU	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006F	Child	DSH	ORLANDO HEALTH	ORLANDO REGIONAL MEDICAL CENTER	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FA	Child	DSH	ORLANDO HEALTH	15272 LMH NON INVASIVE CARDIOLOGY	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006FB	Child	DSH	ORLANDO HEALTH	15233 LMH CARDIAC CATH LAB	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006FC	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3293 ORMC ENDOSCOPY	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FD	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3446 RAD DIAG	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FE	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3458 RAD CAT SCAN	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FF	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9389 SSH MRI	555 W SR 434	Longwood	FL	Terminated
DSH100006FG	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2022 DPH OP NURSING 2B	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006FH	Child	DSH	ORLANDO HEALTH	15392 LMH NUCLEAR MEDICINE	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006FJ	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3476 RESP THER ADULT ICU	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FK	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1419 APH NONINVASIVE VASCULAR LAB	92 W Miller Street	Orlando	FL	Active
DSH100006FL	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2392 DPH NUCLEAR MEDICINE	9400 Turkey Lake Road	Orlando	FL	Active
DSH100006FM	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9275 SSH NEURODIAGNOSTICS	555 W SR 434	Longwood	FL	Terminated
DSH100006FN	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3505 SURGICAL SUPPLIES	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FP	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9263 SSH LABOR AND DELIVERY	555 W SR 434	Longwood	FL	Terminated
DSH100006FQ	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1504 APH SURGERY	92 W Miller Street	Orlando	FL	Active
DSH100006FR	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2275 DPH NEURODIAGNOSTICS	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006FS	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9505 SSH SURGICAL SUPPLIES	555 W SR 434	Longwood	FL	Terminated
DSH100006FT	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0026 CLINICAL OBSERVATION UNIT	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FU	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9162 SSH PSYCH CHILD & ADOL - Observation	555 W SR 434	Longwood	FL	Terminated
DSH100006FV	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0152 INTERMEDIATE CRITICAL CARE - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FW	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0076 ORTHOPEDICS - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FX	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0142 LP 9 SURGICAL ONCOLOGY - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006FY	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1149 APH ACUTE PEDIATRICS - Observation	92 W Miller Street	Orlando	FL	Terminated
DSH100006FZ	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 3307 DIRECT ADMIT UNITS - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006G	Child	DSH	ORLANDO HEALTH	UF HEALTH CANCER CENTER	1400 S Orange Avenue	Orlando	FL	Terminated
DSH100006GA	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0086 LP11 GENERAL/BARIATRIC SURGERY - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GB	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0028 PCU - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GC	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9163 SSH PSYCH ADULT - Observation	555 W SR 434	Longwood	FL	Terminated
DSH100006GD	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2032 DPH ICU - Observation	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006GE	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0018 CARDIOVASCULAR STEPDOWN - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GF	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0014 TRAUMA STEPDOWN - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GG	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2025 DPH CARDIAC INTERVENTIONAL - Observation	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006GH	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0024 ORMC MEDICINE UNIT - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GJ	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1145 APH SPECIAL CARE - Observation	92 W Miller Street	Orlando	FL	Terminated
DSH100006GK	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0035 NEURO STEPDOWN - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GL	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1148 APH PEDS ONCOLOGY - Observation	83 W Miller Street	Orlando	FL	Terminated
DSH100006GM	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9032 SSH ICU - Observation	555 W SR 434	Longwood	FL	Terminated
DSH100006GN	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2096 DPH M/S A4 - Observation	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006GP	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1088 APH PICU - Observation	92 W Miller Street	Orlando	FL	Terminated
DSH100006GQ	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0015 CARDIOVASCULAR ICU - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GR	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9026 SSH CLINICAL OBSERVATION UNIT	555 W SR 434	Longwood	FL	Terminated
DSH100006GS	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2152 DPH PCU - Observation	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006GT	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9156 SSH PSYCH ADULT ILOC - Observation	555 W SR 434	Longwood	FL	Terminated
DSH100006GU	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9024 SSH MED/SURG - Observation	555 W SR 434	Longwood	FL	Terminated
DSH100006GV	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2108 DPH CARDIAC PCU - Observation	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006GW	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0032 MULTISYSTEM ICU - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GX	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0029 MEDICAL PCU - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006GY	Child	DSH	ORLANDO HEALTH	Winnie Palmer Hospital - 1120 WPH NEONATAL LEVEL III - Observation	83 W Miller Street	Orlando	FL	Terminated
DSH100006GZ	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9152 SSH PCU - Observation	555 W SR 434	Longwood	FL	Terminated
DSH100006HA	Child	DSH	ORLANDO HEALTH	South Seminole Hospital - 9030 SSH MED/SURG 4TH FLOOR - Observation	555 W SR 434	Longwood	FL	Terminated
DSH100006HB	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1144 APH PEDS TOWER 3 - Observation	92 W Miller Street	Orlando	FL	Terminated
DSH100006HC	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1551 APH CARDIO ICU - Observation	92 W Miller Street	Orlando	FL	Terminated
DSH100006HD	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2030 DPH M/S B4 - Observation	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006HE	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2104 DPH M/S B6 - Observation	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006HF	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0140 LP 8 MEDICAL ONCOLOGY - Medical Oncology -Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006HG	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0084 LP 10 GENERAL SURGERY - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006HH	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0080 NEUROLOGY - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006HJ	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0023 VASCULAR STEPDOWN - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006HK	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0017 CARDIAC STEPDOWN - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006HL	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6908 ONC ACUTE CARE - Observation	1400 S Orange Avenue	Orlando	FL	Terminated
DSH100006HM	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0033 TRAUMA ICU - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006HN	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0025 CARDIAC INTERVENTIONAL UNIT-Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006HP	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 0031 NEURO ICU - Observation	52 W Underwood Street	Orlando	FL	Terminated
DSH100006HQ	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital - 2024 DPH M/S B5 - Observation	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006HR	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6980 ONC DPH RADIATION ONCOLOGY	7472 Docs Grove Circle	Orlando	FL	Active
DSH100006HS	Child	DSH	ORLANDO HEALTH	15284 LMH EMERGENCY SERVICES	380 RINEHART RD	LAKE MARY	FL	Active
DSH100006HT	Child	DSH	ORLANDO HEALTH	LAKE MARY FSED - 9176 LM RESPIRATORY CARE	380 RINEHART RD	LAKE MARY	FL	Terminated
DSH100006HU	Child	DSH	ORLANDO HEALTH	OSCEOLA FSED - 2176 DPO-OSCEOLA RESPIRATORY CARE	1001 E OSCEOLA PKWY	KISSIMMEE	FL	Terminated
DSH100006HV	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1146 APH STEM CELL UNIT	92 W MILLER ST	ORLANDO	FL	Terminated
DSH100006HW	Child	DSH	ORLANDO HEALTH	OSCEOLA FSED - 6974 ONC OSCEOLA ONCOLOGY CLINIC	1001 E OSCEOLA PKWY	KISSIMMEE	FL	Terminated
DSH100006HX	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1416 APMC PERFUSION	92 W MILLER ST	ORLANDO	FL	Terminated
DSH100006HY	Child	DSH	ORLANDO HEALTH	LAKE MARY FSED - 9173 LM IMAGING	380 RINEHART RD	LAKE MARY	FL	Terminated
DSH100006HZ	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center - 8468 ORMP PREADMISSION TESTING	32 W GORE ST	ORLANDO	FL	Active
DSH100006J	Child	DSH	ORLANDO HEALTH	Orlando Heart Center / 3219 LONGWOOD-DIAGNOSTIC HOSP BASED	521 W SR 434	Longwood	FL	Active
DSH100006JA	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital - 1249 APH OP ONCOLOGY CLINIC	92 W MILLER ST	ORLANDO	FL	Terminated
DSH100006JB	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute - 6803 ONC HC CLINIC	9900 W. Colonial Dr.	Ocoee	FL	Active
DSH100006JC	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute - 6804 ONC HC RADIATION ONCOLOGY	9900 W. Colonial Dr.	Ocoee	FL	Active
DSH100006JD	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute - 6844 ONC HC NURSING	9900 W. Colonial Dr.	Ocoee	FL	Active
DSH100006JE	Child	DSH	ORLANDO HEALTH	RANDAL PARK FSED - 2180 RANDAL PARK EMERGENCY SERVICES - Emergency Services	10155 Dowden Road	Orlando	FL	Active
DSH100006JF	Child	DSH	ORLANDO HEALTH	OSCEOLA FSED - 2170 DPO OSCEOLA EMERGENCY SERVICES - Emergency Services	1001 E OSCEOLA PKWY	KISSIMMEE	FL	Active
DSH100006JG	Child	DSH	ORLANDO HEALTH	Dr. Phillips Hospital / 2026 DPH Acute Respiratory Unit- Observation - Respiratory	9400 Turkey Lake Road	Orlando	FL	Terminated
DSH100006JH	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6930 ONC BMT CLINIC - Transplant	1400 S Orange Avenue	Orlando	FL	Active
DSH100006JJ	Child	DSH	ORLANDO HEALTH	RANDAL PARK FSED - 2183 RANDAL PARK IMAGING - Imaging	10155 Dowden Road	Orlando	FL	Terminated
DSH100006JK	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6806 ONC ORMC HC SURGICAL ONCOLOGY - Oncology	9900 W Colonial Dr	Ocoee	FL	Active
DSH100006JL	Child	DSH	ORLANDO HEALTH	Digestive Health Institute / 6294 DIGESTIVE HEALTH PROCEDURAL - Gastroenterology	22 W Underwood St	Orlando	FL	Active
DSH100006JM	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6975 ONC DPH OSCEOLA INFUSION - Oncology	1001 E Osceola Pkwy	Kissimmee	FL	Terminated
DSH100006JN	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital / 1126 APH FEEDING DIFFICULTIES CTR - Gastroenterology	92 W Miller St	Orlando	FL	Active
DSH100006JP	Child	DSH	ORLANDO HEALTH	2068 DPH STAR Center - Medication Therapy Management	9430 Turkey Lake Rd.	Orlando	FL	Active
DSH100006JQ	Child	DSH	ORLANDO HEALTH	2458 DPH Imaging - CT Scan	9400 Turkey Lake Rd.	Orlando	FL	Active
DSH100006JR	Child	DSH	ORLANDO HEALTH	2461 DPH Imaging - Ultrasound	9400 Turkey Lake Rd.	Orlando	FL	Active
DSH100006JS	Child	DSH	ORLANDO HEALTH	3277 ORMC OP Neurodiagnostics - Neurology	76 W Underwood St.	Orlando	FL	Active
DSH100006JT	Child	DSH	ORLANDO HEALTH	6972 ONC DPH STC Chemo - Oncology	1330 Budinger Ave.	St. Cloud	FL	Active
DSH100006JU	Child	DSH	ORLANDO HEALTH	6973 ONC DPH STC Clinic - Oncology	1330 Budinger Ave.	St. Cloud	FL	Active
DSH100006JV	Child	DSH	ORLANDO HEALTH	15458 LMH Imaging - CT	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006JW	Child	DSH	ORLANDO HEALTH	15461 LMH Imaging - Ultrasound	380 Rinehart Rd.	Lake Mary	FL	Active
DSH100006JX	Child	DSH	ORLANDO HEALTH	10020 OHJOI - Surgery	62 Columbia St.	Orlando	FL	Active
DSH100006JY	Child	DSH	ORLANDO HEALTH	10022 OHJOI Pre Op / PACU - Surgery	62 Columbia St.	Orlando	FL	Active
DSH100006JZ	Child	DSH	ORLANDO HEALTH	10023 OHJOI Pre-Surgical Evaluation - Surgery	62 Columbia St.	Orlando	FL	Active
DSH100006K	Child	DSH	ORLANDO HEALTH	DT Orange Hosp Based Cardio Sp	1222 South Orange Avenue	Orlando	FL	Terminated
DSH100006L	Child	DSH	ORLANDO HEALTH	Orlando Heart Center / 3217 OCOEE-DIAGNOSTIC HOSP BASED 2	10000 W Colonial Drive	Ocoee	FL	Terminated
DSH100006M	Child	DSH	ORLANDO HEALTH	Orlando Heart Center / 3218 CLERMONT-DIAGNOSTIC HOSP BASED	2080 Oakley Seaver Drive	Clermont	FL	Active
DSH100006N	Child	DSH	ORLANDO HEALTH	Orlando Regional Medical Center / 3275 NEURODIAGNOSTICS	32 W Gore Street	Orlando	FL	Active
DSH100006P	Child	DSH	ORLANDO HEALTH	Arnold Palmer Hospital / 1037 APH INFUSION CENTER	60 W Gore Street	Orlando	FL	Active
DSH100006R	Child	DSH	ORLANDO HEALTH	Orlando Heart Center / 2250 DPH-DIAGNOSTIC HOSPITAL BASED	7236 Stonerock Circle	Orlando	FL	Active
DSH100006S	Child	DSH	ORLANDO HEALTH	Orlando Heart Center / 2251 OCOEE-DIAGNOSTIC HOSP BASED 4	10000 W Colonial Drive	Ocoee	FL	Active
DSH100006T	Child	DSH	ORLANDO HEALTH	Orlando Heart Center / 3250 DOWNDOWN-DIAGNOSTIC HOSP BASED	1222 S Orange Avenue	Orlando	FL	Active
DSH100006U	Child	DSH	ORLANDO HEALTH	Orlando Heart Center / 3251 EAST ORL-DIAGNOSTIC HOSP BASED	100 N Dean Road	Orlando	FL	Active
DSH100006V	Child	DSH	ORLANDO HEALTH	Orlando Health Cancer Institute / 6993 ONC GYN ONCOLOGY CHEMO	83 W Miller Street	Orlando	FL	Active
DSH100006W	Child	DSH	ORLANDO HEALTH	ONC HC RAD ONCOL CLIN STAFF / Radiology-Therapeutic	1111 Blackwood Avenue	Ocoee	FL	Terminated
DSH100006X	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital / 2295 DPH OP ENDOSCOPY CENTER	7448 Doc's Grove Circle	Orlando	FL	Terminated
DSH100006Y	Child	DSH	ORLANDO HEALTH	Dr Phillips Hospital / 2306 DPH OP WOUND CARE	7339 Stonerock Circle	Orlando	FL	Active
DSH100006Z	Child	DSH	ORLANDO HEALTH	15306 LMH OP WOUND CARE MANAGEMENT	380 Rinehart Rd.	Lake Mary	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 7:28:20 AM	8/20/2024 9:53:10 AM	8/20/2024 9:53 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	0101338-00 (FL)		7/23/2024 2:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	7/23/2024 2:06 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		010133800	7/23/2024 2:06 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		FL	7/23/2024 2:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	7/23/2024 2:06 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		031882500	7/23/2024 2:06 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		FL	7/23/2024 2:06 PM
Contacts	Authorizing Official	Update	Change Request	Flake, Leslie Flake CFO Orlando Health 3218415078	Miller, John Enoch SVP Finance Orlando Health 3218433180	7/15/2024 7:34 AM
Contacts	Primary Contact	Update	Profile Change Request	Jory, Lacey 340B Program Coordinator Orlando Health 3218439045	Jory, Lacey 340B Program Supervisor Orlando Health 3218439045	5/3/2024 2:44 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 4:37:05 PM	8/21/2023 7:28:20 AM	8/21/2023 7:28 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 2:52:06 PM	9/14/2022 4:37:05 PM	9/14/2022 4:37 PM
Contacts	Authorizing Official	Update	AO Change Request	SPONG, BERNADETTE CFO orlando health 3218415078	Flake, Leslie Flake CFO Orlando Health 3218415078	8/30/2022 6:07 AM
Details	Last Recertification Date	Update	Recertification	9/2/2020 8:38:33 AM	9/10/2021 2:52:06 PM	9/10/2021 2:52 PM
Contacts	Primary Contact	Update	Change Request	Richardson, Lacey 340B Program Coordinator Orlando Health Inc. 3218439045	Jory, Lacey 340B Program Coordinator Orlando Health 3218439045	1/12/2021 8:22 AM
Details	Entity Subname	Update	Change Request	UF Health Cancer Center - 6980 ONC DPH RADIATION ONCOLOGY	Orlando Health Cancer Institute / 6980 ONC DPH RADIATION ONCOLOGY	1/12/2021 8:22 AM
Medicaid Billing	NPI: State	Update	Recertification		FL	9/2/2020 8:38 AM
Details	Last Recertification Date	Update	Recertification		9/2/2020 8:38:33 AM	9/2/2020 8:38 AM
Contacts	Primary Contact	Update	Change Request	Moye II, James 340B Program Coordinator Orlando Health 3218416656	Richardson, Lacey 340B Program Coordinator Orlando Health Inc. 3218439045	8/14/2020 10:52 AM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		SPONG, BERNADETTE CFO orlando health 3218415078	7/16/2019 2:20 PM
Details	340B ID	Update	New Registration		DSH100006HR	7/16/2019 2:20 PM
Details	Entity Subname	Update	New Registration	UF Health Cancer Center	UF Health Cancer Center - 6980 ONC DPH RADIATION ONCOLOGY	7/16/2019 2:20 PM
Dates	Participating Approval Date	Update	New Registration		7/16/2019 2:20:09 PM	7/16/2019 2:20 PM
Details	State	Update	New Registration	Pending	Approved	7/16/2019 2:20 PM
Dates	Signed By Date	Update	New Registration		7/12/2019 3:46:15 PM	7/16/2019 2:20 PM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	7/16/2019 2:20 PM
Addresses	Main Address	Insert	New Registration		7472 Docs Grove Circle Orlando, FL 32819	7/8/2019 1:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/8/2019 1:28 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0101338-00	7/8/2019 1:28 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	7/8/2019 1:28 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1184709057	7/8/2019 1:28 PM
Contacts	Authorizing Official	Insert	New Registration		SPONG, BERNADETTE CFO orlando health 3218415078	7/8/2019 1:28 PM
Contacts	Primary Contact	Insert	New Registration		Moye II, James 340B Program Coordinator Orlando Health 3218416656	7/8/2019 1:28 PM
Details	Last Recertification Date	Insert	New Registration			7/8/2019 1:28 PM
Details	Grant Number	Insert	New Registration			7/8/2019 1:28 PM
Details	340B ID	Insert	New Registration			7/8/2019 1:28 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/8/2019 1:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/8/2019 1:28 PM
Details	Medicare Provider Number	Insert	New Registration		100006	7/8/2019 1:28 PM
Details	Entity Name	Insert	New Registration		ORLANDO HEALTH	7/8/2019 1:28 PM
Details	Program Code	Insert	New Registration		DSH	7/8/2019 1:28 PM
Details	Entity Subname	Insert	New Registration		UF Health Cancer Center	7/8/2019 1:28 PM
Dates	Participating Approval Date	Insert	New Registration			7/8/2019 1:28 PM
Details	State	Insert	New Registration		Pending	7/8/2019 1:28 PM
Dates	Registration Date	Insert	New Registration		7/8/2019 1:28:23 PM	7/8/2019 1:28 PM
Dates	Signed By Date	Insert	New Registration			7/8/2019 1:28 PM
Dates	Start Date	Insert	New Registration			7/8/2019 1:28 PM
Terminations	Termination Comments	Insert	New Registration			7/8/2019 1:28 PM
Terminations	Termination Date	Insert	New Registration			7/8/2019 1:28 PM
Terminations	Termination Effective Date	Insert	New Registration			7/8/2019 1:28 PM
Terminations	Termination Reason	Insert	New Registration			7/8/2019 1:28 PM