Covered Entity Details

CH041281AN Tampa Family Health Centers, Inc. (Active) - information as of 4/30/2025 10:58:55 PM

Main Details

Name

Tampa Family Health Centers, Inc.

Subdivision Name

TFHC MLK II (West Tampa)

Type

HRSA-Funded Health Center

Site ID

BPS-H80-035371

340B ID

CH041281AN

Grant Number

H80CS00407

Additional Details

Current Program Status

Active

Registration Date

11/21/2022

Participating Start Date

1/1/2023

Participating Approval Date

11/22/2022

Last Recertification Date

2/18/2025

Contacts

Authorizing Official

Tampa Family Health Centers, Inc.
Sherry Hoback, Chief Executive Officer
(813) 866-0930 Ext: 1319

Primary Contact

Tampa Family Health Centers, Inc
Lisa A Mazarik, Director of Pharmacy Affairs
(813) 557-9621

Addresses

Street Address

2727 W Dr Martin Luther King Jr Blvd STE 100
Tampa, FL 33607-6353

Billing Address

Tampa Family Health Centers, Inc
PO Box 82969
tampa, FL 33682

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		1417953571,1184352114

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
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03628	5632 GUNN HWY	TAMPA	FL	33624	01/15/2024	04/01/2024		02/28/2024	02/28/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03662	5357 EHRLICH RD	TAMPA	FL	33625	04/15/2024	07/01/2024		08/05/2024	08/06/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH0412810	Active	BPS-H80-032101	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #16 New Nebraska	12410 N Nebraska Ave		Tampa	FL
CH041281AA	Active	BPS-H80-011205	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC # 23 - North Nebraska	8108 N Nebraska Ave		Tampa	FL
CH041281AB	Active	BPS-H80-012786	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC#28 - South Tampa	7608 Causeway Blvd		Tampa	FL
CH041281AC	Active	BPS-H80-014258	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC#31 - Sligh Avenue	6216 E SLIGH AVE		TAMPA	FL
CH041281AD	Active	BPS-H80-014267	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC#30 - Fletcher Avenue	302 W FLETCHER AVE		TAMPA	FL
CH041281AE	Active	BPS-H80-015362	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #35 - MDV2	302 W FLETCHER AVE		TAMPA	FL
CH041281AF	Terminated	BPS-H80-015790	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #34 - GPHC	5707 N. 22nd Street		Tampa	FL
CH041281AG	Terminated	BPS-H80-017434	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC # 33 - FHHC	3100 East Fletcher Avenue		Tampa	FL
CH041281AH	Terminated	BPS-H80-027593	Tampa Family Health Centers, Inc.	TFHC # 40 - Harbourside at Tampa General	5 Tampa General Cir Ste 650		Tampa	FL
CH041281AJ	Active	BPS-H80-027956	Tampa Family Health Centers, Inc.	TFHC #37 - Hillsborough	12085 W Hillsborough Ave		Tampa	FL
CH041281AK	Active	BPS-H80-032780	Tampa Family Health Centers, Inc.	TFHC Bearss	1212 E Bearss Ave		Lutz	FL
CH041281AL	Active	BPS-H80-032506	Tampa Family Health Centers, Inc.	TFHC #12 - Mobile Dental Van	302 W Fletcher Ave		Tampa	FL
CH041281AM	Terminated	BPS-H80-032711	Tampa Family Health Centers, Inc.	TFHC - Baycare	2727 W Dr Martin Luther King Jr Blvd		Tampa	FL
CH041281AN	Active	BPS-H80-035371	Tampa Family Health Centers, Inc.	TFHC MLK II (West Tampa)	2727 W Dr Martin Luther King Jr Blvd STE 100		Tampa	FL
CH041281AP	Active	BPS-H80-035617	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC - BH	13018 N Dale Mabry Hwy		Tampa	FL
CH041281AQ	Active	BPS-H80-034859	TAMPA FAMILY HEALTH CENTERS, INC.	Lutz North Hillsborough	19203 N Dale Mabry Hwy		Lutz	FL
CH041281AR	Active	BPS-H80-036761	TAMPA FAMILY HEALTH CENTERS, INC.	Mobile Medical Trailer-Adult VINCA5457	302 W Fletcher Ave		Tampa	FL
CH041281F	Terminated	BPS-H80-005279	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #14 - Florida Avenue	1514 N Florida Ave STE 300		Tampa	FL
CH041281L	Active	BPS-H80-033508	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC West Tampa (MLK)	2808 W Dr Martin Luther King Jr Blvd	Bldg	Tampa	FL
CH041281P	Active	BPS-H80-002406	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #18 - West Waters	8213 W Waters Ave		Tampa	FL
CH041281Q	Active	BPS-H80-009270	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #21 - Dale Mabry	7814 N Dale Mabry Hwy		Tampa	FL
CH041281R	Active	BPS-H80-012813	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC#15 - OSHC	4620 N 22nd St		Tampa	FL
CH041281S	Terminated	BPS-H80-010683	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #24 - University Area	13601 N 22nd St		Tampa	FL
CH041281T	Active	BPS-H80-013320	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC # 29 - CBHC	5611 Sheldon Rd		Tampa	FL
CH041281V	Terminated	BPS-H80-010686	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #27 - Sheldon Road	9827 Sheldon Rd		Tampa	FL
CH041281W	Terminated	BPS-H80-008961	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #20 - Columbus Drive	4422 E Columbus Dr		Tampa	FL
CH041281X	Terminated	BPS-H80-010681	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #22 - West Shore	3901 S West Shore Blvd		Tampa	FL
CH041281Y	Terminated	BPS-H80-007699	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #12 - Mobil Dental Van	1502 E Fowler Ave		Tampa	FL
CH041281Z	Active	BPS-H80-007342	TAMPA FAMILY HEALTH CENTERS, INC.	TFHC #13 - Mobil Medical Van	302 W Fletcher Ave		Tampa	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0412810	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
CH0412810	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2023
CH0412810	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2023
CH0412810	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2023
CH0412810	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2023
CH0412810	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2023
CH0412810	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2023
CH0412810	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2023
CH0412810	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2023
CH0412810	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2023
CH0412810	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2023
CH0412810	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	07/01/2024
CH0412810	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	07/01/2024
CH0412810	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2023
CH0412810	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2023
CH0412810	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2023
CH041281AF	GENOA HEALTHCARE OF FLORIDA, LLC		5707 N 22ND ST	TAMPA	FL	33610	04/01/2016	04/01/2019
CH0412810	GENOA HEALTHCARE OF FLORIDA, LLC		5707 N 22ND ST	TAMPA	FL	33610	01/01/2018	04/01/2019
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02898	813 W. BEARSS AVE.	TAMPA	FL	33613	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04701	6701 N. DALE MABRY HWY.	TAMPA	FL	33614	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05148	1904 W LUMSDEN RD	BRANDON	FL	33511	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03814	4120 HENDERSON BLVD	TAMPA	FL	33629	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 06007	6206 COMMERCE PALMS DR.	TAMPA	FL	33647	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02760	2911 E. FOWLER AVE.	TAMPA	FL	33612	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01771	2322 LAND O LAKES BLVD	LUTZ	FL	33549	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00538	7351 W HILLSBOROUGH AVE	TAMPA	FL	33634	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03662	5357 EHRLICH RD	TAMPA	FL	33625	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03650	625 W. DR. MARTIN LUTHER KING JR BLVD	TAMPA	FL	33603	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00613	9202 N FLORIDA AVE	TAMPA	FL	33612	01/01/2022	09/05/2023
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03638	10623 GIBSONTON DR	RIVERVIEW	FL	33578	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02825	715 W. BRANDON BLVD.	BRANDON	FL	33511	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00579	110 BULLARD PKWY	TEMPLE TERRACE	FL	33617	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01328	2513 US HWY 19	HOLIDAY	FL	34691	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00998	4401 W GANDY BLVD.	TAMPA	FL	33611	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05149	5502 E FOWLER AVE	TEMPLE TERRACE	FL	33617	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05815	102 S. DALE MABRY HIGHWAY	TAMPA	FL	33609	01/01/2022	02/28/2024
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00651	37943 EILAND BLVD	ZEPHYRHILLS	FL	33542	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03811	2502 W HILLSBOROUGH AVE	TAMPA	FL	33614	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05196	11670 COUNTRYWAY BLVD	TAMPA	FL	33626	01/01/2022	06/13/2023
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05251	8809 NEW TAMPA BLVD	TAMPA	FL	33647	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03257	704 W MARTIN LUTHER KING JR BLVD	SEFFNER	FL	33584	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05207	2725 N MACDILL AVE	TAMPA	FL	33607	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04640	15499 N DALE MABRY HWY	TAMPA	FL	33618	01/01/2022	01/26/2023
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 08396	1929 BRUCE B. DOWNS BLVD.	WESLEY CHAPEL	FL	33544	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05783	8603 WEST HILLSBOROUGH AVE	TAMPA	FL	33615	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03520	6202 US HWY 41 N	APOLLO BEACH	FL	33572	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17311	10150 BLOOMINGDALE AVE	RIVERVIEW	FL	33578	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07225	5905 US HWY. 301 S.	RIVERVIEW	FL	33578	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05110	105 S PEBBLE BEACH BLVD	SUN CITY CENTER	FL	33573	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03930	611 S HOWARD AVE	TAMPA	FL	33606	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16249	6295 W WATERS AVE	TAMPA	FL	33634	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03746	11115 SPRING HILL DR	SPRING HILL	FL	34609	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16260	187 BRANDON TOWN CENTER DR	BRANDON	FL	33511	01/01/2022	05/02/2024
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05253	8801 W LINEBAUGH AVE	TAMPA	FL	33626	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01527	5606 POST OAK BLVD.	WESLEY CHAPEL	FL	33544	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02802	3102 W. GANDY BLVD.	TAMPA	FL	33611	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03628	5632 GUNN HWY	TAMPA	FL	33624	01/01/2022	08/15/2023
CH0412810	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17360	11627 W HILLSBOROUGH AVE	TAMPA	FL	33635	01/01/2022
CH0412810	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03579	3771 TAMPA RD	OLDSMAR	FL	34677	10/01/2023
CH041281AN	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03628	5632 GUNN HWY	TAMPA	FL	33624	04/01/2024	02/28/2024
CH041281AN	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03662	5357 EHRLICH RD	TAMPA	FL	33625	07/01/2024	08/05/2024
CH0412810	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2023
CH0412810	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2023
CH0412810	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2023
CH0412810	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2023
CH0412810	PUBLIX PHARMACY #0399	7018 W WATERS AVE		TAMPA	FL	33634	07/01/2013	12/30/2016
CH0412810	PUBLIX PHARMACY #0399	7018 W WATERS AVE		TAMPA	FL	33634	07/01/2024
CH0412810	PUBLIX PHARMACY #0524	3939 VAN DYKE ROAD		LUTZ	FL	33558	07/01/2024
CH0412810	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0834	16560 N NEBRASKA AVE	LUTZ	FL	33549	07/01/2024
CH0412810	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0877	2121 COLLIER PKWY	LAND O'LAKES	FL	34639	07/01/2024
CH0412810	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #0398	15151 NORTH DALE MABRY HWY	TAMPA	FL	33618	07/01/2024
CH0412810	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1534	12024 ANDERSON RD	TAMPA	FL	33625	07/01/2024
CH0412810	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	07/01/2024
CH0412810	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1142	7830 LAND O'LAKES BLVD.	LAND O'LAKES	FL	34638	07/01/2024
CH0412810	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #0582	2724 W HILLSBOROUGH AVE	TAMPA	FL	33614	07/01/2024
CH0412810	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY 0611	1313 S DALE MABRY HWY	TAMPA	FL	33629-5010	07/01/2024
CH0412810	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1441	13178 NORTH DALE MABRY HWY	TAMPA	FL	33618	07/01/2024
CH0412810	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	07/01/2024
CH0412810	SAMSON MERGER SUB, LLC	WINN DIXIE #2474	61 ALEXANDER GRAHAM BELL BLVD. N.	LEHIGH ACRES	FL	33936	07/01/2020	07/20/2020
CH0412810	SAMSON MERGER SUB, LLC	WINN DIXIE #2441	8837 N. 56TH STREET	TEMPLE TERRACE	FL	33617	07/01/2020	06/27/2021
CH0412810	SAMSON MERGER SUB, LLC	WINN DIXIE #2415	13508 FLORIDA AVE N.	TAMPA	FL	33613	07/01/2020	09/18/2023
CH0412810	SAMSON MERGER SUB, LLC	WINN DIXIE #2461	2770 FOWLER AVE. EAST	TAMPA	FL	33612	07/01/2020	10/11/2023
CH0412810	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020	02/10/2020
CH0412810	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2020
CH0412810	WAL-MART PHARMACY #10-3197	15302 N. NEBRASKA AVE		TAMPA	FL	33613	04/01/2020	02/10/2020
CH0412810	WAL-MART PHARMACY #10-3197	15302 N. NEBRASKA AVE		TAMPA	FL	33613	07/01/2020	06/21/2021
CH0412810	WAL-MART PHARMACY #10-3197	15302 N. NEBRASKA AVE		TAMPA	FL	33613	04/01/2024
CH0412810	WAL-MART PHARMACY 10-1482	7011 WATERS AVE. WEST		TAMPA WEST	FL	33634	07/01/2015	06/21/2021
CH0412810	WAL-MART PHARMACY 10-1482	7011 WATERS AVE. WEST		TAMPA WEST	FL	33634	04/01/2024
CH0412810	WAL-MART PHARMACY 10-1501	14941 N. DALE MABRY HWY		TAMPA N	FL	33618	04/01/2020	02/10/2020
CH0412810	WAL-MART PHARMACY 10-1501	14941 N. DALE MABRY HWY		TAMPA N	FL	33618	07/01/2020	06/21/2021
CH0412810	WAL-MART PHARMACY 10-1960	1505 NORTH DALE MABRY HWY		TAMPA	FL	33607	04/01/2024
CH0412810	WAL-MART PHARMACY 10-2387	11110 CAUSEWAY BLVD		BRANDON	FL	33511	04/01/2020	02/10/2020
CH0412810	WAL-MART PHARMACY 10-2627	2701 EAST FLETCHER AVENUE		TAMPA	FL	33612	07/01/2013	04/15/2015
CH0412810	WAL-MART PHARMACY 10-2627	2701 EAST FLETCHER AVENUE		TAMPA	FL	33612	01/01/2018	01/01/2018
CH0412810	WAL-MART PHARMACY 10-2627	2701 EAST FLETCHER AVENUE		TAMPA	FL	33612	07/01/2020
CH0412810	WAL-MART PHARMACY 10-4681	4302 W GANDY BLVD		TAMPA	FL	33611	04/01/2020	02/10/2020
CH0412810	WAL-MART PHARMACY 10-4681	4302 W GANDY BLVD		TAMPA	FL	33611	07/01/2020
CH0412810	WAL-MART PHARMACY 10-5036	6192 GUNN HWY		TAMPA	FL	33625	04/01/2020	02/10/2020
CH0412810	WAL-MART PHARMACY 10-5036	6192 GUNN HWY		TAMPA	FL	33625	07/01/2020
CH0412810	WAL-MART PHARMACY 10-5196	5255 ELVIS PERSLEY BLVD		MEMPHIS(ELVIS HOLMES)	TN	38116	07/01/2020	04/14/2020
CH0412810	WAL-MART PHARMACY 10-5220	8220 NORTH DALE MABRY HWY		TAMPA	FL	33614	07/01/2013	04/15/2015
CH0412810	WAL-MART PHARMACY 10-5220	8220 NORTH DALE MABRY HWY		TAMPA	FL	33614	01/01/2018	01/01/2018
CH0412810	WAL-MART PHARMACY 10-5220	8220 NORTH DALE MABRY HWY		TAMPA	FL	33614	04/01/2024
CH0412810	WAL-MART PHARMACY 10-5221	8885 N. FLORIDA AVE		TAMPA	FL	33604	04/01/2020	02/10/2020
CH0412810	WAL-MART PHARMACY 10-5221	8885 N. FLORIDA AVE		TAMPA	FL	33604	07/01/2020
CH0412810	WAL-MART PHARMACY 10-5255	6216 ELLIOT DR		TAMPA(ELLIOTT)	FL	33615	04/01/2020	02/10/2020
CH0412810	WAL-MART PHARMACY 10-5255	6216 ELLIOT DR		TAMPA(ELLIOTT)	FL	33615	07/01/2020
CH0412810	WAL-MART PHARMACY 10-5760	1601 WEST KENEDY BLVD.		TAMPA	FL	33606	07/01/2020	02/13/2022
CH0412810	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020	02/10/2020
CH0412810	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2020
CH0412810	WALGREEN CO		15998 WALGREENS DRIVE	JUPITER	FL	33478	01/01/2018	04/15/2018
CH0412810	WALGREEN CO	DBA: WALGREENS #10398	13911 NINE EAGLES DR	TAMPA	FL	33626	04/01/2020
CH0412810	WALGREEN CO.	DBA: WALGREENS # 03459	2117 E HILLSBOROUGH AVE	TAMPA	FL	33610	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 06674	8706 W HILLSBOROUGH AVE	TAMPA	FL	33615-3705	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 02818	2199 W BUSCH BLVD	TAMPA	FL	33612	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 01925	13317 N BOULEVARD	TAMPA	FL	33612-3317	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 03863	4141 W HILLSBOROUGH AVE	TAMPA	FL	33614	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 04573	9202 N. 56TH STREET	TEMPLE TERRACE	FL	33617	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 03829	8398 SHELDON ROAD	TAMPA	FL	33615	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS #15236	13130 N DALE MABRY HWY	TAMPA	FL	33618-2406	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 06029	11115 E DR MLK JR BLVD	SEFFNER	FL	33584	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 04523	930 PROVIDENCE ROAD	BRANDON	FL	33511	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 02887	1001 78TH ST SOUTH	TAMPA	FL	33619	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 02959	2111 E BUSCH BLVD	TAMPA	FL	33612	01/01/2013	01/04/2023
CH0412810	WALGREEN CO.	DBA: WALGREENS # 02975	15602 N. DALE MABRY	TAMPA	FL	33618	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 03128	5709 GUNN HIGHWAY	TAMPA	FL	33625	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 03145	1860 E. FOWLER AVE.	TAMPA	FL	33612	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 03744	4738 W. GANDY BLVD.	TAMPA	FL	33611	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 03351	6818 N. ARMENIA AVE.	TAMPA	FL	33604	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 04326	4319 N. ARMENIA AVE.	TAMPA	FL	33607	01/01/2013	04/18/2018
CH0412810	WALGREEN CO.	DBA: WALGREENS # 05451	315 W. PLATT STREET	TAMPA	FL	33606	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 05806	3917 NORTH NEBRASKA AVE	TAMPA	FL	33603	01/01/2013	11/09/2022
CH0412810	WALGREEN CO.	DBA: WALGREENS # 06611	1704 W HILLSBOROUGH AVE	TAMPA	FL	33603	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 06192	6503 W WATERS AVE	TAMPA	FL	33634-2207	01/01/2013
CH0412810	WALGREEN CO.	DBA: WALGREENS # 04962	128 E. BRANDON BLVD.	BRANDON	FL	33511	04/01/2015
CH0412810	WALGREEN CO.	DBA: WALGREENS # 05437	17511 BRUCE B DOWNS BLVD.	TAMPA	FL	33647	04/01/2015
CH0412810	WALGREEN CO.	DBA: WALGREENS # 05576	7925 GUNN HIGHWAY	TAMPA	FL	33626	04/01/2015
CH0412810	WALGREEN CO.	DBA: WALGREENS # 09300	3890 VAN DYKE RD	LUTZ	FL	33548	04/01/2015
CH0412810	WALGREEN CO.	DBA: WALGREENS #12673	2916 E. FLETCHER AVE.	TAMPA	FL	33612	04/01/2015
CH0412810	WALGREEN CO.	DBA: WALGREENS # 13031	3863 S DALE MABRY HWY	TAMPA	FL	33611	04/01/2015
CH0412810	WALGREEN CO.	DBA: WALGREENS # 13824	18511 N. US HWY 41	LUTZ	FL	33549	04/01/2015
CH0412810	WALGREEN CO.	DBA: WALGREENS # 02230	5420 DR MARTIN LUTHER KING JR ST N	ST PETERSBURG	FL	33703	10/01/2017	04/18/2018
CH0412810	WALGREEN CO.	DBA: WALGREENS # 05695	12211 W HILLSBOROUGH	TAMPA	FL	33635	04/01/2020
CH0412810	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21226	1506 W KENNEDY BLVD STE A	TAMPA	FL	33606	04/01/2020
CH0412810	WALGREEN CO.	DBA: WALGREENS # 15129	3518 HENDERSON BLVD	TAMPA	FL	33609	04/01/2020
CH0412810	WALGREEN CO.	DBA: WALGREENS # 03743	4651 W. KENNEDY BLVD.	TAMPA	FL	33609	04/01/2020
CH0412810	WALGREEN CO.	DBA: WALGREENS # 04480	3770 TAMPA ROAD	OLDSMAR	FL	34677	04/01/2020
CH0412810	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	07/01/2023
CH0412810	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	01/01/2013	06/25/2015
CH0412810	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	06/25/2015
CH0412810	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2018	04/15/2018
CH0412810	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	01/01/2018	04/15/2018
CH0412810	WALMART PHARMACY #10-5654	3671 W. HILLSBOROUGH AVE		TAMPA	FL	33614	04/01/2024
CH0412810	WALMART PHARMACY #10-5964	1720 E. HILLSBOROUGH AVE.		TAMPA	FL	33610	04/01/2020	02/10/2020
CH0412810	WALMART PHARMACY #10-5964	1720 E. HILLSBOROUGH AVE.		TAMPA	FL	33610	07/01/2020
CH0412810	WALMART PHARMACY #10-6548	4525 GUNN HWY		TAMPA	FL	33624	04/01/2020	02/10/2020
CH0412810	WALMART PHARMACY #10-6548	4525 GUNN HWY		TAMPA	FL	33624	07/01/2020
CH0412810	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH0412810	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH0412810	WINN DIXIE STORES, INC.	WINN-DIXIE PHARMACY#639	8438 NORTH ARMENIA AVENUE	TAMPA	FL	33604	07/01/2020	06/27/2021
CH0412810	WINN-DIXIE STORES, INC.	FRESCO Y MAS #697	8424 SHELDON ROAD	TAMPA	FL	33615	07/01/2020	06/27/2021
CH0412810	WINN-DIXIE STORES, INC.	PATHSTONE HEALTH SERVICES	5244 EDGEWOOD COURT, SUITE 2	JACKSONVILLE	FL	32254	07/01/2020	03/28/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 12:43:35 PM	2/18/2025 1:55:13 PM	2/18/2025 1:55 PM
Details	Entity Subname	Update	Change Request	TFHC Silver Blossoms	TFHC MLK II (West Tampa)	1/23/2025 10:32 AM
Contacts	Primary Contact	Update	Group Change Request	mazarik, lisa a Director of pharmacy affairs Tampa Family 8135579621	Mazarik, Lisa A Director of Pharmacy Affairs Tampa Family Health Centers, Inc 8135579621	5/6/2024 1:13 PM
Details	Last Recertification Date	Update	Recertification	2/13/2023 1:17:10 PM	1/29/2024 12:43:35 PM	1/29/2024 12:43 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1184352114	5/8/2023 1:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		FL	5/8/2023 1:39 PM
Details	Last Recertification Date	Update	Recertification		2/13/2023 1:17:10 PM	2/13/2023 1:17 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Hoback, Sherry Chief Executive Officer Tampa Family Health Centers, Inc. 8138660930-1319	11/22/2022 9:34 AM
Details	340B ID	Update	New Registration		CH041281AN	11/22/2022 9:34 AM
Dates	Participating Approval Date	Update	New Registration		11/22/2022 9:34:57 AM	11/22/2022 9:34 AM
Details	State	Update	New Registration	Pending	Approved	11/22/2022 9:34 AM
Dates	Signed By Date	Update	New Registration		11/21/2022 12:40:19 PM	11/22/2022 9:34 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	11/22/2022 9:34 AM
Addresses	Main Address	Insert	New Registration		2727 W Dr Martin Luther King Jr Blvd STE 100 Tampa, FL 33607-6353	11/21/2022 11:50 AM
Addresses	Billing Address	Insert	New Registration		Tampa Family Health Centers, Inc PO Box 82969 tampa, FL 33682	11/21/2022 11:50 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1417953571	11/21/2022 11:50 AM
Medicaid Billing	NPI: State	Insert	New Registration		FL	11/21/2022 11:50 AM
Contacts	Authorizing Official	Insert	New Registration		Hoback, Sherry Chief Executive Officer Tampa Family Health Centers, Inc. 8138660930-1319	11/21/2022 11:50 AM
Contacts	Primary Contact	Insert	New Registration		mazarik, lisa a Director of pharmacy affairs Tampa Family 8135579621	11/21/2022 11:50 AM
Details	Assistance Received From Date	Insert	New Registration			11/21/2022 11:50 AM
Details	Assistance Received To Date	Insert	New Registration			11/21/2022 11:50 AM
Details	Last Recertification Date	Insert	New Registration			11/21/2022 11:50 AM
Details	Grant Number	Insert	New Registration		H80CS00407	11/21/2022 11:50 AM
Details	340B ID	Insert	New Registration			11/21/2022 11:50 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			11/21/2022 11:50 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			11/21/2022 11:50 AM
Details	Medicare Provider Number	Insert	New Registration			11/21/2022 11:50 AM
Details	Entity Name	Insert	New Registration		Tampa Family Health Centers, Inc.	11/21/2022 11:50 AM
Details	NOFO Number	Insert	New Registration			11/21/2022 11:50 AM
Details	Program Code	Insert	New Registration		CH	11/21/2022 11:50 AM
Details	Entity Subname	Insert	New Registration		TFHC Silver Blossoms	11/21/2022 11:50 AM
Dates	Participating Approval Date	Insert	New Registration			11/21/2022 11:50 AM
Details	State	Insert	New Registration		Pending	11/21/2022 11:50 AM
Dates	Registration Date	Insert	New Registration		11/21/2022 11:50:41 AM	11/21/2022 11:50 AM
Dates	Signed By Date	Insert	New Registration			11/21/2022 11:50 AM
Dates	Start Date	Insert	New Registration			11/21/2022 11:50 AM
Terminations	Termination Comments	Insert	New Registration			11/21/2022 11:50 AM
Terminations	Termination Date	Insert	New Registration			11/21/2022 11:50 AM
Terminations	Termination Effective Date	Insert	New Registration			11/21/2022 11:50 AM
Terminations	Termination Reason	Insert	New Registration			11/21/2022 11:50 AM

340B Drug Pricing Program Database