Covered Entity Details

CH04023P Agape Community Health Center, Inc. (Terminated) - information as of 5/11/2025 11:30:44 PM

Main Details

Name

Agape Community Health Center, Inc.

Subdivision Name

AGAPE/Magnolia Jacksonville Community Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-032720

340B ID

CH04023P

Grant Number

H80CS29456

Additional Details

Current Program Status

Terminated

Registration Date

11/15/2021

Participating Start Date

1/1/2022

Participating Approval Date

11/30/2021

Last Recertification Date

2/20/2023

Termination Date
Termination Reason

4/1/2024
Site closure

Contacts

Authorizing Official

Agape Community Health Center, Inc.
Mia L. Jones, CEO
(904) 760-4910

Primary Contact

Agape Family Health
Candace Guyton, Director of Pharmacy
(904) 544-6089

Addresses

Street Address

5300 N Pearl St
Jacksonville, FL 32208-5119

Billing Address

Agape Community Health Center, Inc.
120 King Street
JACKSONVILLE, FL 32204

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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		1508437641

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH04023F	Active	BPS-H80-017699	AGAPE COMMUNITY HEALTH CENTER, INC.	AGAPE/WEST JACKSONVILLE COMMUNITY HEALTH CENTER	120 King Street	JACKSONVILLE	FL
CH04023G	Active	BPS-H80-019355	AGAPE COMMUNITY HEALTH CENTER, INC.	AGAPE/Wesconnett Community Health Center	5460 Blanding Blvd	Jacksonville	FL
CH04023H	Active	BPS-H80-017699	AGAPE COMMUNITY HEALTH CENTER, INC.	AGAPE/ West Jacksonville	120 King Street	Jacksonville	FL
CH04023J	Terminated	BPS-H80-017695	AGAPE COMMUNITY HEALTH CENTER, INC.	AGAPE/Magnolia Jacksonville Community Health Center	5300 N Pearl Street	Jacksonville	FL
CH04023K	Terminated	BPS-H80-017697	AGAPE COMMUNITY HEALTH CENTER, INC.	AGAPE/Northwest Jacksonville Community Health Center	3160 Edgewood Avenue W	Jacksonville	FL
CH04023L	Active	BPS-H80-022362	AGAPE COMMUNITY HEALTH CENTER South	Agape Community Health Center, Inc	3900 University Blvd S	Jacksonville	FL
CH04023M	Active	BPS-H80-030531	Agape Community Health Center, Inc.	Agape Dunn Avenue	1680 Dunn Ave Unit 35-37	Jacksonville	FL
CH04023N	Terminated	BPS-H80-030530	Agape Community Health Center, Inc.	Agape/Magnolia East	6024 Merrill Rd	Jacksonville	FL
CH04023P	Terminated	BPS-H80-032720	Agape Community Health Center, Inc.	AGAPE/Magnolia Jacksonville Community Health Center	5300 N Pearl St	Jacksonville	FL
CH04023Q	Active	BPS-H80-031635	Agape Community Health Center, Inc.	Agape Dunn Avenue Ste 38	1680 Dunn Ave Ste 38	Jacksonville	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH04023F	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/11/2017	01/01/2021
CH04023F	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/11/2017	01/01/2021
CH04023F	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/01/2017
CH04023L	AVITA PHARMACY 1047	AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR	1110 KEVSTIN DR	KISSIMMEE	FL	34744	07/01/2019
CH04023F	AVITA PHARMACY 1047	AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR	1110 KEVSTIN DR	KISSIMMEE	FL	34744	07/01/2019
CH04023J	AVITA PHARMACY 1047	AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR	1110 KEVSTIN DR	KISSIMMEE	FL	34744	07/01/2019	01/01/2020
CH04023H	AVITA PHARMACY 1047	AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR	1110 KEVSTIN DR	KISSIMMEE	FL	34744	07/01/2019
CH04023G	AVITA PHARMACY 1047	AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR	1110 KEVSTIN DR	KISSIMMEE	FL	34744	07/01/2019
CH04023M	AVITA PHARMACY 1047	AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR	1110 KEVSTIN DR	KISSIMMEE	FL	34744	10/01/2021
CH04023F	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	10/10/2017	01/01/2021
CH04023G	WALGREEN CO	DBA: WALGREENS #11580	1215 DUNN AVENUE, SUITE #2	JACKSONVILLE	FL	32218	07/01/2020	06/24/2021
CH04023F	WALGREEN CO	DBA: WALGREENS #11580	1215 DUNN AVENUE, SUITE #2	JACKSONVILLE	FL	32218	07/01/2020	06/24/2021
CH04023H	WALGREEN CO	DBA: WALGREENS #11580	1215 DUNN AVENUE, SUITE #2	JACKSONVILLE	FL	32218	07/01/2020	06/24/2021
CH04023L	WALGREEN CO	DBA: WALGREENS #11580	1215 DUNN AVENUE, SUITE #2	JACKSONVILLE	FL	32218	07/01/2020	06/24/2021
CH04023F	WALGREEN CO.	DBA: WALGREENS # 03287	5108 NORWOOD AVENUE	JACKSONVILLE	FL	32208	04/01/2019
CH04023F	WALGREEN CO.	DBA: WALGREENS # 09528	11135 LEM TURNER RD	JACKSONVILLE	FL	32218-4571	04/01/2019
CH04023F	WALGREEN CO.	DBA: WALGREENS # 03172	7512 LEM TURNER ROAD	JACKSONVILLE	FL	32208	04/01/2019
CH04023G	WALGREEN CO.	DBA: WALGREENS # 03172	7512 LEM TURNER ROAD	JACKSONVILLE	FL	32208	04/01/2019
CH04023G	WALGREEN CO.	DBA: WALGREENS # 01986	5340 SOUTEL DRIVE	JACKSONVILLE	FL	32219	04/01/2019
CH04023J	WALGREEN CO.	DBA: WALGREENS # 03287	5108 NORWOOD AVENUE	JACKSONVILLE	FL	32208	04/01/2019	01/01/2020
CH04023J	WALGREEN CO.	DBA: WALGREENS # 09528	11135 LEM TURNER RD	JACKSONVILLE	FL	32218-4571	04/01/2019	01/01/2020
CH04023J	WALGREEN CO.	DBA: WALGREENS # 01986	5340 SOUTEL DRIVE	JACKSONVILLE	FL	32219	04/01/2019	01/01/2020
CH04023G	WALGREEN CO.	DBA: WALGREENS # 03287	5108 NORWOOD AVENUE	JACKSONVILLE	FL	32208	04/01/2019
CH04023H	WALGREEN CO.	DBA: WALGREENS # 03287	5108 NORWOOD AVENUE	JACKSONVILLE	FL	32208	04/01/2019
CH04023G	WALGREEN CO.	DBA: WALGREENS # 09528	11135 LEM TURNER RD	JACKSONVILLE	FL	32218-4571	04/01/2019
CH04023H	WALGREEN CO.	DBA: WALGREENS # 01986	5340 SOUTEL DRIVE	JACKSONVILLE	FL	32219	04/01/2019
CH04023H	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16527	1801 N MAIN ST	JACKSONVILLE	FL	32206	04/01/2019
CH04023H	WALGREEN CO.	DBA: WALGREENS # 09528	11135 LEM TURNER RD	JACKSONVILLE	FL	32218-4571	04/01/2019
CH04023J	WALGREEN CO.	DBA: WALGREENS # 03172	7512 LEM TURNER ROAD	JACKSONVILLE	FL	32208	04/01/2019	01/01/2020
CH04023H	WALGREEN CO.	DBA: WALGREENS # 03172	7512 LEM TURNER ROAD	JACKSONVILLE	FL	32208	04/01/2019
CH04023F	WALGREEN CO.	DBA: WALGREENS # 01986	5340 SOUTEL DRIVE	JACKSONVILLE	FL	32219	04/01/2019
CH04023J	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16527	1801 N MAIN ST	JACKSONVILLE	FL	32206	04/01/2019	01/01/2020
CH04023F	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16527	1801 N MAIN ST	JACKSONVILLE	FL	32206	04/01/2019
CH04023L	WALGREEN CO.	DBA: WALGREENS # 01986	5340 SOUTEL DRIVE	JACKSONVILLE	FL	32219	04/01/2019
CH04023L	WALGREEN CO.	DBA: WALGREENS # 03287	5108 NORWOOD AVENUE	JACKSONVILLE	FL	32208	04/01/2019
CH04023L	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16527	1801 N MAIN ST	JACKSONVILLE	FL	32206	04/01/2019
CH04023L	WALGREEN CO.	DBA: WALGREENS # 09528	11135 LEM TURNER RD	JACKSONVILLE	FL	32218-4571	04/01/2019
CH04023L	WALGREEN CO.	DBA: WALGREENS # 03172	7512 LEM TURNER ROAD	JACKSONVILLE	FL	32208	04/01/2019
CH04023F	WALGREEN CO.	DBA: WALGREENS # 04327	6006 BEACH BLVD.	JACKSONVILLE	FL	32216	10/01/2019
CH04023J	WALGREEN CO.	DBA: WALGREENS # 04327	6006 BEACH BLVD.	JACKSONVILLE	FL	32216	10/01/2019	01/01/2020
CH04023G	WALGREEN CO.	DBA: WALGREENS # 04327	6006 BEACH BLVD.	JACKSONVILLE	FL	32216	10/01/2019
CH04023H	WALGREEN CO.	DBA: WALGREENS # 04327	6006 BEACH BLVD.	JACKSONVILLE	FL	32216	10/01/2019
CH04023L	WALGREEN CO.	DBA: WALGREENS # 04327	6006 BEACH BLVD.	JACKSONVILLE	FL	32216	10/01/2019
CH04023M	WALGREEN CO.	DBA: WALGREENS # 04327	6006 BEACH BLVD.	JACKSONVILLE	FL	32216	10/01/2021
CH04023M	WALGREEN CO.	DBA: WALGREENS # 03172	7512 LEM TURNER ROAD	JACKSONVILLE	FL	32208	10/01/2021
CH04023M	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16527	1801 N MAIN ST	JACKSONVILLE	FL	32206	10/01/2021
CH04023M	WALGREEN CO.	DBA: WALGREENS # 09528	11135 LEM TURNER RD	JACKSONVILLE	FL	32218-4571	10/01/2021
CH04023M	WALGREEN CO.	DBA: WALGREENS # 03287	5108 NORWOOD AVENUE	JACKSONVILLE	FL	32208	10/01/2021
CH04023M	WALGREEN CO.	DBA: WALGREENS # 01986	5340 SOUTEL DRIVE	JACKSONVILLE	FL	32219	10/01/2021
CH04023J	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2019	01/01/2020
CH04023G	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2019
CH04023F	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2019
CH04023H	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2019
CH04023L	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2019
CH04023M	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2021
CH04023F	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2019
CH04023H	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2019
CH04023J	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2019	01/01/2020
CH04023G	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2019
CH04023G	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2019
CH04023L	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2019
CH04023M	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		10/1/2023 12:00:00 AM	2/16/2024 11:15 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/16/2024 11:15 AM
Terminations	Termination Date	Update	Recertification		4/1/2024 12:00:00 AM	2/16/2024 11:15 AM
Terminations	Termination Effective Date	Update	Recertification		10/1/2023 12:00:00 AM	2/16/2024 11:15 AM
Terminations	Termination Reason	Update	Recertification		Site closure	2/16/2024 11:15 AM
Details	Last Recertification Date	Update	Recertification	2/3/2022 1:47:31 PM	2/20/2023 2:30:55 PM	2/20/2023 2:30 PM
Contacts	Authorizing Official	Update	Group Change Request	Ball, Tabatha COO Agape Community Health Center, Inc 9047604904	Jones, Mia L. CEO Agape Community Health Center, Inc. 9047604910	11/29/2022 6:25 AM
Details	Last Recertification Date	Update	Recertification		2/3/2022 1:47:31 PM	2/3/2022 1:47 PM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Primary Contact	Update	Profile Change Request	Guyton, Candace Yvette Director of Pharmacy Agape Family Health 9048006343	Guyton, Candace Director of Pharmacy Agape Family Health 9045446089	12/2/2021 9:21 AM
Contacts	Signed By	Insert	New Registration		Ball, Tabatha COO Agape Community Health Center, Inc 9047604904	11/30/2021 4:54 PM
Details	340B ID	Update	New Registration		CH04023P	11/30/2021 4:54 PM
Dates	Participating Approval Date	Update	New Registration		11/30/2021 4:54:33 PM	11/30/2021 4:54 PM
Details	State	Update	New Registration	Pending	Approved	11/30/2021 4:54 PM
Dates	Signed By Date	Update	New Registration		11/18/2021 3:59:07 PM	11/30/2021 4:54 PM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	11/30/2021 4:54 PM
Addresses	Main Address	Insert	New Registration		5300 N Pearl St Jacksonville, FL 32208-5119	11/15/2021 10:55 AM
Addresses	Billing Address	Insert	New Registration		Agape Community Health Center, Inc. 120 King Street JACKSONVILLE, FL 32204	11/15/2021 10:55 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1508437641	11/15/2021 10:55 AM
Medicaid Billing	NPI: State	Insert	New Registration		FL	11/15/2021 10:55 AM
Contacts	Authorizing Official	Insert	New Registration		Ball, Tabatha COO Agape Community Health Center, Inc 9047604904	11/15/2021 10:55 AM
Contacts	Primary Contact	Insert	New Registration		Guyton, Candace Yvette Director of Pharmacy Agape Family Health 9048006343	11/15/2021 10:55 AM
Details	Assistance Received From Date	Insert	New Registration			11/15/2021 10:55 AM
Details	Assistance Received To Date	Insert	New Registration			11/15/2021 10:55 AM
Details	Last Recertification Date	Insert	New Registration			11/15/2021 10:55 AM
Details	Grant Number	Insert	New Registration		H80CS29456	11/15/2021 10:55 AM
Details	340B ID	Insert	New Registration			11/15/2021 10:55 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			11/15/2021 10:55 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			11/15/2021 10:55 AM
Details	Medicare Provider Number	Insert	New Registration			11/15/2021 10:55 AM
Details	Entity Name	Insert	New Registration		Agape Community Health Center, Inc.	11/15/2021 10:55 AM
Details	NOFO Number	Insert	New Registration			11/15/2021 10:55 AM
Details	Program Code	Insert	New Registration		CH	11/15/2021 10:55 AM
Details	Entity Subname	Insert	New Registration		AGAPE/Magnolia Jacksonville Community Health Center	11/15/2021 10:55 AM
Dates	Participating Approval Date	Insert	New Registration			11/15/2021 10:55 AM
Details	State	Insert	New Registration		Pending	11/15/2021 10:55 AM
Dates	Registration Date	Insert	New Registration		11/15/2021 10:55:01 AM	11/15/2021 10:55 AM
Dates	Signed By Date	Insert	New Registration			11/15/2021 10:55 AM
Dates	Start Date	Insert	New Registration			11/15/2021 10:55 AM
Terminations	Termination Comments	Insert	New Registration			11/15/2021 10:55 AM
Terminations	Termination Date	Insert	New Registration			11/15/2021 10:55 AM
Terminations	Termination Effective Date	Insert	New Registration			11/15/2021 10:55 AM
Terminations	Termination Reason	Insert	New Registration			11/15/2021 10:55 AM

340B Drug Pricing Program Database