| Details | State | Update | | To Be Terminated | Terminated | 7/1/2022 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 11/4/2020 12:00:00 AM | 5/26/2022 12:22 PM |
| Details | State | Update | Recertification | Active | To Be Terminated | 5/26/2022 12:22 PM |
| Terminations | Termination Date | Update | Recertification | | 7/1/2022 12:00:00 AM | 5/26/2022 12:22 PM |
| Terminations | Termination Effective Date | Update | Recertification | | 11/4/2020 12:00:00 AM | 5/26/2022 12:22 PM |
| Terminations | Termination Reason | Update | Recertification | | Business decision by the Covered Entity | 5/26/2022 12:22 PM |
| Addresses | Billing Address | Update | Recertification | Positive Health Alliance, Inc
730 W Hallandale Beach Blvd
109
Hallandale Beach, FL 33009 | Positive Health Alliance, Inc
501 Federal Highway 1
109
Lake Park, FL 33403 | 5/28/2021 8:25 AM |
| Addresses | Shipping Address | Insert | Recertification | | Positive Health Alliance, Inc.
501 Federal Highway 1
Lake Park, FL 33403 | 5/28/2021 8:25 AM |
| Details | Nature of Support: In Kind Support Description | Update | Recertification | | Condoms, Lubricants, 1628 forms, STD/HIV brochures, Rapid HIV test-kits and supplies, HIV 500/501 Trainings, State Lab access for Specimen analysis and testing results.
| 5/28/2021 8:25 AM |
| Details | Nature of Support: Support Received From Date | Update | Recertification | | 1/1/2021 12:00:00 AM | 5/28/2021 8:25 AM |
| Details | Nature of Support: Support Received To Date | Update | Recertification | | 12/31/2021 12:00:00 AM | 5/28/2021 8:25 AM |
| Details | Last Recertification Date | Update | Recertification | | 5/28/2021 8:25:23 AM | 5/28/2021 8:25 AM |
| Details | NOFO Number | Update | Recertification | | CDC-RFA-PS19-1901 | 5/28/2021 8:25 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Kogan, Gary G
Executive Director
Positive Health Alliance, Inc.
3055252975 | Kogan, Gary G
Executive Director
Positive Health Alliance, Inc.
8887522267 | 5/27/2021 4:35 PM |
| Contacts | Signed By | Update | Profile Change Request | Kogan, Gary G
Executive Director
Positive Health Alliance, Inc.
3055252975 | Kogan, Gary G
Executive Director
Positive Health Alliance, Inc.
8887522267 | 5/27/2021 4:35 PM |
| Contacts | Primary Contact | Update | | Mann, Cora
President
Positive Health Alliance, Inc.
7862291471 | Mann, Cora Lee
President
Positive Health Alliance, Inc.
7862291471 | 7/15/2020 11:48 AM |
| Details | State | Update | OPA Edit | Approved | Active | 5/8/2020 8:00 AM |
| Dates | Start Date | Update | OPA Edit | 7/1/2020 12:00:00 AM | 5/8/2020 12:00:00 AM | 5/8/2020 8:00 AM |
| Contacts | Signed By | Insert | New Registration | | Kogan, Gary G
Executive Director
Positive Health Alliance, Inc.
3055252975 | 5/6/2020 9:11 AM |
| Details | 340B ID | Update | New Registration | | STD322021 | 5/6/2020 9:11 AM |
| Dates | Participating Approval Date | Update | New Registration | | 5/6/2020 9:11:14 AM | 5/6/2020 9:11 AM |
| Details | State | Update | New Registration | Pending | Approved | 5/6/2020 9:11 AM |
| Dates | Signed By Date | Update | New Registration | | 4/14/2020 12:05:01 PM | 5/6/2020 9:11 AM |
| Dates | Start Date | Update | New Registration | | 7/1/2020 12:00:00 AM | 5/6/2020 9:11 AM |
| Addresses | Main Address | Insert | New Registration | |
720 N Ocean Street
Jacksonville, FL 32202 | 4/14/2020 12:04 PM |
| Addresses | Billing Address | Insert | New Registration | | Positive Health Alliance, Inc
730 W Hallandale Beach Blvd
109
Hallandale Beach, FL 33009 | 4/14/2020 12:04 PM |
| Details | Nature Of Support | Insert | New Registration | | In-Kind products or services (see note below; must have been purchased with section 318 funds) | 4/14/2020 12:04 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Kogan, Gary G
Executive Director
Positive Health Alliance, Inc.
3055252975 | 4/14/2020 12:04 PM |
| Contacts | Primary Contact | Insert | New Registration | | Mann, Cora
President
Positive Health Alliance, Inc.
7862291471 | 4/14/2020 12:04 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Details | Grant Number | Insert | New Registration | | NH25PS005131 | 4/14/2020 12:04 PM |
| Details | 340B ID | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Details | Entity Name | Insert | New Registration | | Positive Health Alliance, Inc | 4/14/2020 12:04 PM |
| Details | Program Code | Insert | New Registration | | STD | 4/14/2020 12:04 PM |
| Details | Entity Subname | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Details | State | Insert | New Registration | | Pending | 4/14/2020 12:04 PM |
| Dates | Registration Date | Insert | New Registration | | 4/14/2020 12:04:53 PM | 4/14/2020 12:04 PM |
| Dates | Signed By Date | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Dates | Start Date | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Terminations | Termination Date | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/14/2020 12:04 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/14/2020 12:04 PM |