Covered Entity Details

DSH100135M TALLAHASSEE MEMORIAL HEALTHCARE, INC (Active) - information as of 4/25/2025 8:32:48 PM

Main Details

Name

TALLAHASSEE MEMORIAL HEALTHCARE, INC

Subdivision Name

TALLAHASSEE MEMORIAL HEALTHCARE INC - Radiation Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH100135M

Medicare Provider Number

100135

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/13/2020

Participating Start Date

1/1/2021

Participating Approval Date

10/19/2020

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

Tallahassee Memorial HealthCare
Priscilla Needham, Chief Financial Officer
(850) 431-0630

Primary Contact

Tallahassee Memorial HealthCare
Louis Kynard, Director of Pharmacy
(850) 431-5030

Addresses

Street Address

1775 ONE HEALING PL
TALLAHASSEE, FL 32308-4600

Billing Address

Tallahassee Memorial Healthcare, Inc
1300 Miccosukee Road
Tallahassee, FL 32308

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	010113300	1437177664
GA	000100009A	1437177664

Shipping Addresses

Shipping Address 1

Tallahassee Memorial Healthcare, Inc
1300 Miccosukee Road
Tallahassee, FL 32308

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
DSH100135A	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Emergency Center - Northeast	1260 Metropolitan Boulevard	Tallahassee	FL	Active
DSH100135AA	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Cardiology HFC	1609 PHYSICIANS DR	TALLAHASSEE	FL	Active
DSH100135AB	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Urology Specialists	2619 Centennial Blvd	TALLAHASSEE	FL	Active
DSH100135AC	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Healthcare Cardiology SMG - TMHPP Cardiology	1300 Medical Drive	Tallahassee	FL	Active
DSH100135AD	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Family Medicine Residency - Primary Care	1301 HODGES DR	TALLAHASSEE	FL	Active
DSH100135AE	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMH Physician Partners - Heart Rhythm Clinic - Electrophysiology	2100 Centerville Road	Tallahassee	FL	Active
DSH100135AF	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMH Physician Partners - Primary Care in Carrabelle - TMHPP Franklin - Carrabelle	110Th NE 5th ST	Carabelle	FL	Terminated
DSH100135AG	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Metabolic Health Center - Bariatric Medical Center - Bariatric Medical Center	2633 Centennial Blvd	Tallahassee	FL	Active
DSH100135AH	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMH Physician Partners - Primary Care in Apalachicola - TMHPP Franklin - Apalachicola	137 12TH St	Apalachicola	FL	Terminated
DSH100135AJ	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Metabolic Health Center - Outpatient Diabetes Center - Outpatient Diabetes Center	2633 Centennial Blvd	Tallahassee	FL	Active
DSH100135AK	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Metabolic Health Center- Endocrinology - Physician Partners Endocrinology Specialists	2633 Centennial Blvd	Tallahassee	FL	Active
DSH100135AL	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Urgent Care Center in Southwood - Tallahassee Memorial Urgent Care Center- Southwood	3900 Esplanade Way	Tallahassee	FL	Active
DSH100135AM	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Metabolic Health Center- Lipids Center - Lipid Center	2633 Centennial Blvd	Tallahassee	FL	Active
DSH100135AN	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMH Physician Partners - Oral Maxillofacial Trauma Surgery - TMHPP Oral Maxillofacial Trauma Surgery	1401 Centerville Rd	Tallahassee	FL	Active
DSH100135AP	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMH PHYSICIAN PARTNERS PANAMA CITY - TMH Physician Partners - Primary Care in Panama City Beach	1002 N. Arnold Rd (Highway 79)	Panama City Beach	FL	Active
DSH100135AQ	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMH PHYSICIAN PARTNERS CARDIAC & INTERNAL MEDICINE SPECIALISTS-NORTHEAST - Physician Partners CIM-NE	1260 Metropolitan Blvd	Tallahassee	FL	Active
DSH100135AR	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMH PHYSICIAN PARTNERS RHEUMATOLOGY - TMH Physician Partners – Rheumatology	3900 Esplanade Way	Tallahassee	FL	Active
DSH100135B	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Physician Partners Southwood-Medical Specialists	3900 Esplanade Way	Tallahassee	FL	Active
DSH100135C	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Physician Partners Perry	555 N. Byron Butler Parkway	Perry	FL	Active
DSH100135D	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Transition Care Center	3333 Capital Oaks Drive	Tallahassee	FL	Active
DSH100135E	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMHPP Chronic Pain Management	1633 Physicians Drive	Tallahassee	FL	Active
DSH100135F	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Physician Partners Wakulla	15 Council Moore Road	Crawfordville	FL	Active
DSH100135G	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Physician Partners Quincy	178 Lasalle Leffall Drive	Quincy	FL	Active
DSH100135H	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Physician Partners Monticello	1549 S. Jefferson Street	Monticello	FL	Active
DSH100135J	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Physician Partners Blountstown	17808 NE Charlie Johns Street	Blountstown	FL	Active
DSH100135K	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Cancer Center	1775 ONE HEALING PLACE	TALLAHASSEE	FL	Active
DSH100135L	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	Tallahassee Memorial Wound Healing Center - Wound Healing Center	1505 Surgeons Drive	Tallahassee	FL	Terminated
DSH100135M	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Radiation Oncology	1775 ONE HEALING PL	TALLAHASSEE	FL	Active
DSH100135N	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - TMHPP Surgical Specialists with Services by Surgical Associates of Tallahassee	1405 CENTERVILLE RD	TALLAHASSEE	FL	Active
DSH100135P	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Surgical Specialist	1401 CENTERVILLE RD	TALLAHASSEE	FL	Active
DSH100135Q	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE - Primary Care	2888 MAHAN DR	TALLAHASSEE	FL	Terminated
DSH100135R	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Cancer Center Physicians	1775 ONE HEALING PL	TALLAHASSEE	FL	Active
DSH100135S	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Neurology Specialists	2473 Care Drive	TALLAHASSEE	FL	Active
DSH100135T	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMH Urgent Care Center - Urgent Care Center	1541 Medical Drive	Tallahassee	FL	Active
DSH100135U	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Internal Medicine SMG	1300 MEDICAL DR	TALLAHASSEE	FL	Active
DSH100135V	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMHPP SMG Cardiothoracic Surgery - Cardiothoracic Surgery	1405 Centerville Road	Tallahassee	FL	Active
DSH100135W	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMHPP Surgical Specialist - TMPP Surgical Specialists	1401 Centerville Road	Tallahassee	FL	Active
DSH100135X	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TMHPP Pulmonary, Critical Care, & Sleep Specialists - Intensivists Services	1607 Saint James Court	Tallahassee	FL	Active
DSH100135Y	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Primary Care	6721 THOMASVILLE RD	TALLAHASSEE	FL	Active
DSH100135Z	Child	DSH	TALLAHASSEE MEMORIAL HEALTHCARE, INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Cardiology/Internal Medicine - Nuclear Medicine	1300 MEDICAL DR	TALLAHASSEE	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/8/2023 11:18:51 AM	9/6/2024 1:36:08 PM	9/6/2024 1:36 PM
Details	Last Recertification Date	Update	Recertification	9/16/2022 4:36:29 PM	9/8/2023 11:18:51 AM	9/8/2023 11:18 AM
Contacts	Authorizing Official	Update	Change Request	GIUDICE, WILLIAM A. CHIEF FINANCIAL OFFICER Tallahassee Memorial HealthCare Inc 8504315238	Needham, Priscilla Chief Financial Officer Tallahassee Memorial HealthCare 8504310630	2/25/2023 8:18 AM
Details	Last Recertification Date	Update	Recertification	8/17/2021 11:21:01 AM	9/16/2022 4:36:29 PM	9/16/2022 4:36 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	010113300 (GA)		10/29/2021 4:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/29/2021 4:03 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000100009A	10/29/2021 4:03 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	10/29/2021 4:03 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1215207360 (FL)		10/29/2021 4:03 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1215207360 (GA)		10/29/2021 4:03 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437177664	10/29/2021 4:03 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	10/29/2021 4:03 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1437177664	10/29/2021 4:03 PM
Medicaid Billing	NPI: State	Insert	Change Request		GA	10/29/2021 4:03 PM
Contacts	Primary Contact	Update	Group Change Request	Brown, Bernadette Director of Pharmacy Tallahassee Memorial Healthcare, Inc 8504315030	Kynard, Louis Director of Pharmacy Tallahassee Memorial HealthCare 8504315030	10/15/2021 1:49 PM
Details	Last Recertification Date	Update	Recertification		8/17/2021 11:21:01 AM	8/17/2021 11:21 AM
Details	State	Update		Approved	Active	1/1/2021 12:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/19/2020 8:38 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010113300	10/19/2020 8:38 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	10/19/2020 8:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/19/2020 8:38 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010113300	10/19/2020 8:38 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	10/19/2020 8:38 AM
Contacts	Signed By	Insert	New Registration		GIUDICE, WILLIAM A. CHIEF FINANCIAL OFFICER Tallahassee Memorial HealthCare Inc 8504315238	10/19/2020 8:38 AM
Details	340B ID	Update	New Registration		DSH100135M	10/19/2020 8:38 AM
Details	Entity Name	Update	New Registration	TALLAHASSEE MEMORIAL HOSPITAL	TALLAHASSEE MEMORIAL HEALTHCARE, INC	10/19/2020 8:38 AM
Details	Entity Subname	Update	New Registration	TALLAHASSEE MEMORIAL HEALTHCARE INC	TALLAHASSEE MEMORIAL HEALTHCARE INC - Radiation Oncology	10/19/2020 8:38 AM
Dates	Participating Approval Date	Update	New Registration		10/19/2020 8:38:59 AM	10/19/2020 8:38 AM
Details	State	Update	New Registration	Pending	Approved	10/19/2020 8:38 AM
Dates	Signed By Date	Update	New Registration		10/15/2020 1:06:13 PM	10/19/2020 8:38 AM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	10/19/2020 8:38 AM
Addresses	Main Address	Insert	New Registration		1775 ONE HEALING PL TALLAHASSEE, FL 32308-4600	10/13/2020 5:20 PM
Addresses	Billing Address	Insert	New Registration		Tallahassee Memorial Healthcare, Inc 1300 Miccosukee Road Tallahassee, FL 32308	10/13/2020 5:20 PM
Addresses	Shipping Address	Insert	New Registration		Tallahassee Memorial Healthcare, Inc 1300 Miccosukee Road Tallahassee, FL 32308	10/13/2020 5:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1215207360	10/13/2020 5:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	10/13/2020 5:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1215207360	10/13/2020 5:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		GA	10/13/2020 5:20 PM
Contacts	Primary Contact	Insert	New Registration		Brown, Bernadette Director of Pharmacy Tallahassee Memorial Healthcare, Inc 8504315030	10/13/2020 5:20 PM
Contacts	Authorizing Official	Insert	New Registration		GIUDICE, WILLIAM A. CHIEF FINANCIAL OFFICER Tallahassee Memorial HealthCare Inc 8504315238	10/13/2020 5:20 PM
Details	Assistance Received From Date	Insert	New Registration			10/13/2020 5:20 PM
Details	Assistance Received To Date	Insert	New Registration			10/13/2020 5:20 PM
Details	Last Recertification Date	Insert	New Registration			10/13/2020 5:20 PM
Details	Grant Number	Insert	New Registration			10/13/2020 5:20 PM
Details	340B ID	Insert	New Registration			10/13/2020 5:20 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2020 5:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2020 5:20 PM
Details	Medicare Provider Number	Insert	New Registration		100135	10/13/2020 5:20 PM
Details	Entity Name	Insert	New Registration		TALLAHASSEE MEMORIAL HOSPITAL	10/13/2020 5:20 PM
Details	NOFO Number	Insert	New Registration			10/13/2020 5:20 PM
Details	Program Code	Insert	New Registration		DSH	10/13/2020 5:20 PM
Details	Entity Subname	Insert	New Registration		TALLAHASSEE MEMORIAL HEALTHCARE INC	10/13/2020 5:20 PM
Dates	Participating Approval Date	Insert	New Registration			10/13/2020 5:20 PM
Details	State	Insert	New Registration		Pending	10/13/2020 5:20 PM
Dates	Registration Date	Insert	New Registration		10/13/2020 5:20:48 PM	10/13/2020 5:20 PM
Dates	Signed By Date	Insert	New Registration			10/13/2020 5:20 PM
Dates	Start Date	Insert	New Registration			10/13/2020 5:20 PM
Terminations	Termination Comments	Insert	New Registration			10/13/2020 5:20 PM
Terminations	Termination Date	Insert	New Registration			10/13/2020 5:20 PM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2020 5:20 PM
Terminations	Termination Reason	Insert	New Registration			10/13/2020 5:20 PM