Covered Entity Details

CH04172B CENTRAL FLORIDA FAMILY HEALTH CENTER, INC. (Active) - information as of 6/28/2025 12:18:46 AM

Main Details

Name

CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.

Subdivision Name

Hoffner Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-002909

340B ID

CH04172B

Grant Number

H80CS00178

Additional Details

Current Program Status

Active

Registration Date

1/1/2002

Participating Start Date

1/1/2002

Participating Approval Date

5/21/2004

Last Recertification Date

3/3/2025

Contacts

Authorizing Official

Central Florida Family Health Center dba True Health
Janelle A Dunn, CEO
(407) 322-8645 Ext: 1132

Primary Contact

Central Florida Family Health Center Inc, dba True Health
Sabrina Mussari, Pharm.D.
(407) 322-8645 Ext: 1023

Addresses

Street Address

5449 S Semoran Blvd
Suite 14
Orlando, FL 32822-1722

Billing Address

True Health
4930 E Lake Mary Blvd
SANFORD, FL 32771

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

Comments

Comment	Last Updated On
2/21/07 ADDED MEDICAID #; 11/30/06 UPDATED MEDICAID# (WAS CH04172D); 12/20/05 UPDATED ENTITY NAME;	01/21/2010

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	682960100,682960102,025306500	1477694826,1740251883,1396746988

Shipping Addresses

Shipping Address 1

Central Florida Family Health Center, Inc. dba True Health
5449 South Semoran Blvd
Suite 14
Orlando, FL 32822

Shipping Address 2

Central Florida Family Health Center, Inc. dba True Health
5449 South Semoran Blvd
Suite 15
Orlando, FL 32822

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	Address Cont.	City	State
CH041720	Active	BPS-H80-001131	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Sanford Health Center	4930 E Lake Mary Blvd		SANFORD	FL
CH04172A	Active	BPS-H80-003444	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Lake Underhill Health Center	5730 Lake Underhill Rd		Orlando	FL
CH04172B	Active	BPS-H80-002909	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Hoffner Health Center	5449 S Semoran Blvd	Suite 14	Orlando	FL
CH04172C	Active	BPS-H80-002172	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Alafaya Health Center	11881 E. COLONIAL DRIVE STE A		ORLANDO	FL
CH04172D	Active	BPS-H80-003779	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Southside Health Center	6101 Lake Ellenor Dr	Suite 105	Orlando	FL
CH04172E	Terminated	BPS-H80-012369	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Central FL Family Health Center - Cheney Elementary	2000 N Forsyth Rd		Orlando	FL
CH04172F	Terminated	BPS-H80-012863	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Evans High School Based Health Center	4949 Silver Star Rd		Orlando	FL
CH04172G	Active	BPS-H80-015549	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Casselberry Health Center	1120 SR 436		Casselberry	FL
CH04172H	Active	BPS-H80-017622	Central Florida Family Health Center, Inc.	Airport Health Center	400 W Airport Blvd		Sanford	FL
CH04172J	Terminated	BPS-H80-032255	Central Florida Family Health Center, Inc.	Temporary Site - True Health COVID Infusion Center	4240 N US Highway 17/92		Sanford	FL
CH04172K	Active	BPS-H80-032578	Central Florida Family Health Center, Inc.	Harvest Time International Health Center	225 Harvest Time Dr		Sanford	FL
CH04172L	Active	BPS-H80-036552	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Goldsboro Health Center	905 Historic Goldsboro Boulevard		Sanford	FL
CH04172M	Active	BPS-H80-037224	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Mobile Medical/Dental Unit	4930 E Lake Mary Blvd		Sanford	FL
CH04172N	Active	BPS-H80-037223	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Mobile Medical Unit	4930 E Lake Mary Blvd		Sanford	FL
CH04172P	Active	BPS-H80-038749	CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	Enterprise Wellness Cottage	105 Main Street		Enterprise	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03490	5650 RED BUG LAKE RD	WINTER SPRINGS	FL	32708	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03492	4315 CURRY FORD RD.	ORLANDO	FL	32806	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05853	13960 LANDSTAR BLVD.	ORLANDO	FL	32824	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01261	1510 SEMORAN BLVD	WINTER PARK	FL	32792	07/01/2020	03/13/2023
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00204	5899 ORANGE BLOSSOM TRL	ORLANDO	FL	32839	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05155	9975 LAKE UNDERHILL RD	ORLANDO	FL	32825	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07991	13300 E. COLONIAL DR.	ORLANDO	FL	32826	07/01/2020	04/12/2023
CH041720	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16886	325 N ALAFAYA TRL	ORLANDO	FL	32828	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04614	7451 E COLONIAL DR	ORLANDO	FL	32807	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05239	7496 UNIVERSITY BLVD	WINTER PARK	FL	32792	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05077	5300 S JOHN YOUNG PKWY	ORLANDO	FL	32839	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07889	8025 LEE VISTA BLVD	ORLANDO	FL	32829	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03251	130 E STATE RD 434	LONGWOOD	FL	32750	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03921	12077 SOUTH ORANGE BLOSSOM TRAIL	ORLANDO	FL	32837	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02291	6217 SILVER STAR RD	ORLANDO	FL	32808	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY #219	3798 ORLANDO DR	SANFORD	FL	32773	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03270	924 RINEHART RD.	LAKE MARY	FL	32746	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03657	1250 PROVIDENCE BLVD	DELTONA	FL	32725	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05216	2702 S ORANGE AVE	ORLANDO	FL	32806	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03748	65 E MAIN ST	APOPKA	FL	32703	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03141	5190 S CONWAY RD	ORLANDO	FL	32812	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY #5195	4639 W 1ST ST	SANFORD	FL	32771	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03351	7300 CURRY FORD RD.	ORLANDO	FL	32822	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05854	2187 HOWLAND BLVD.	DELTONA	FL	32738	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03132	10952 E COLONIAL DR	ORLANDO	FL	32817	07/01/2020
CH041720	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05214	12280 LAKE UNDERHILL RD	ORLANDO	FL	32825	07/01/2020
CH04172K	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03351	7300 CURRY FORD RD.	ORLANDO	FL	32822	10/01/2024
CH04172L	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07889	8025 LEE VISTA BLVD	ORLANDO	FL	32829	10/01/2024
CH04172H	HOLIDAY CVS, L.L.C.	DBA CVS/PHARMACY #219	3798 ORLANDO DR	SANFORD	FL	32773	10/01/2024
CH04172P	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00204	5899 ORANGE BLOSSOM TRL	ORLANDO	FL	32839	01/01/2025
CH041720	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020
CH041720	WAL-MART PHARMACY 10-0857	3653 ORLANDO DR		SANFORD	FL	32773	10/01/2020
CH041720	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2020
CH041720	WALGREEN CO	DBA: WALGREENS #10556	5903 S ORANGE BLOSSOM TRAIL	ORLANDO	FL	32809	10/01/2019
CH041720	WALGREEN CO	DBA: WALGREENS #11221	13989 LANDSTAR BLVD	ORLANDO	FL	32824	07/01/2020
CH041720	WALGREEN CO	DBA: WALGREENS #09484	7015 NARCOOSSEE RD	ORLANDO	FL	32822	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 05178	5205 RED BUG LAKE RD	WINTER SPRINGS	FL	32708	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 12672	1835 SAND LAKE RD	ORLANDO	FL	32809	10/01/2019	01/28/2025
CH041720	WALGREEN CO.	DBA: WALGREENS # 06922	113 MAITLAND AVE	ALTAMONTE SPRINGS	FL	32701-4901	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 04906	5280 S JOHN YOUNG PKWY	ORLANDO	FL	32839	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 03811	4502 S ORANGE BLOSSOM TRAIL	ORLANDO	FL	32839-1704	10/01/2019	03/20/2023
CH041720	WALGREEN CO.	DBA: WALGREENS # 03107	2501 S FRENCH AVE	SANFORD	FL	32773	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 03862	4774 S SEMORAN BLVD	ORLANDO	FL	32822-2412	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 04526	8000 LAKE UNDERHILL ROAD	ORLANDO	FL	32822	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 03161	401 W. STATE RD 434	WINTER SPRINGS	FL	32708	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS #10062	500 HOWLAND BLVD	DELTONA	FL	32738	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 06970	3803 S ORLANDO DRIVE	SANFORD	FL	32773	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS #21144	2300 S GOLDENROD RD	ORLANDO	FL	32822-7902	10/01/2019
CH041720	WALGREEN CO.	WALGREENS # 07819	7085 COUNTY ROAD 46A	LAKE MARY	FL	32746	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 05399	955 S WINTER PARK DR	CASSELBERRY	FL	32707	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 06030	13700 E COLONIAL DR	ORLANDO	FL	32826	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 05495	7403 ALOMA AVE.	WINTER PARK	FL	32792	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 07314	2000 HOWELL BRANCH RD	WINTER PARK	FL	32792	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS #11684	2251 N. SEMORAN BLVD.	ORLANDO	FL	32807	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 07090	3000 N ALAFAYA TRAIL	ORLANDO	FL	32826-3206	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 04554	12279 LAKE UNDERHILL RD	ORLANDO	FL	32825	10/01/2019
CH041720	WALGREEN CO.	WALGREENS #06997	785 LOCKWOOD BLVD.	OVIEDO	FL	32765	10/01/2019
CH041720	WALGREEN CO.	DBA: WALGREENS # 07694	16900 E COLONIAL DR	ORLANDO	FL	32820-1911	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 03577	1925 PROVIDENCE BLVD.	DELTONA	FL	32725	07/01/2020	04/21/2022
CH041720	WALGREEN CO.	DBA: WALGREENS #12041	4024 W LAKE MARY BLVD	LAKE MARY	FL	32746	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 05245	1201 INTERNATIONAL PKWY S	LAKE MARY	FL	32746	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 03398	5501 S KIRKMAN RD	ORLANDO	FL	32819	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 04251	85 E. MITCHELL HAMMOCK RD.	OVIEDO	FL	32765	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 04646	11600 S ORANGE BLOSSOM	ORLANDO	FL	32837	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 07298	7815 S US HWY 17/92	FERN PARK	FL	32730	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 07938	10425 NARCOOSSEE ROAD	ORLANDO	FL	32832	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 09016	200 W STATE RD 436	ALTAMONTE SPRINGS	FL	32714-4202	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 07149	115 E STATE ROAD 434	LONGWOOD	FL	32750	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 06391	5702 LEE VISTA BLVD	ORLANDO	FL	32822	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 05658	408 E MICHIGAN STREET	ORLANDO	FL	32806	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 05240	3950 N DEAN RD	ORLANDO	FL	32817	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 03131	1920 ALOMA AVE.	WINTER PARK	FL	32792	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 15332	4720 S KIRKMAN RD	ORLANDO	FL	32811	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 06505	920 S KIRKMAN ROAD	ORLANDO	FL	32811	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS # 09074	1000 N AVALON PARK BLVD	ORLANDO	FL	32828	07/01/2020
CH041720	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #12146	1200 KUHL AVE	ORLANDO	FL	32806	10/01/2024
CH041720	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	04/01/2023
CH041720	WALGREENS.COM, INC.	WALGREENS #02445	8337 S PARK CIRCLE	ORLANDO	FL	32819	04/01/2020	07/14/2020
CH041720	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH041720	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/26/2024 12:29:37 PM	3/3/2025 11:48:05 AM	3/3/2025 11:48 AM
Details	Last Recertification Date	Update	Recertification	2/27/2023 11:40:53 AM	2/26/2024 12:29:37 PM	2/26/2024 12:29 PM
Details	Last Recertification Date	Update	Recertification	2/14/2022 3:20:42 PM	2/27/2023 11:40:53 AM	2/27/2023 11:40 AM
Details	Last Recertification Date	Update	Recertification	2/25/2021 5:15:22 PM	2/14/2022 3:20:42 PM	2/14/2022 3:20 PM
Addresses	Main Address	Update	Change Request	5449 S Semoran Blvd Orlando, FL 32822-1722	5449 S Semoran Blvd Suite 14 Orlando, FL 32822-1722	7/16/2021 10:24 AM
Addresses	Shipping Address	Insert	Change Request		Central Florida Family Health Center, Inc. dba True Health 5449 South Semoran Blvd Suite 15 Orlando, FL 32822	7/16/2021 10:24 AM
Details	Entity Subname	Update	Change Request	Central FL Family Health Center-Hoffner	Hoffner Health Center	7/16/2021 10:24 AM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/25/2021 5:15 PM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/25/2021 5:15 PM
Medicaid Billing	NPI: State	Update	Recertification		FL	2/25/2021 5:15 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 7:35:15 PM	2/25/2021 5:15:22 PM	2/25/2021 5:15 PM
Contacts	Authorizing Official	Update	AO Change Request	Stewart, Latrice CEO Central Florida Family Health Center, Inc. dba True Health 4073228645-1015	Dunn, Janelle A CEO Central Florida Family Health Center dba True Health 4073228645-1132	6/15/2020 5:07 PM
Addresses	Shipping Address	Insert	Change Request		Central Florida Family Health Center, Inc. dba True Health 5449 South Semoran Blvd Suite 14 Orlando, FL 32822	4/16/2020 1:55 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1396746988	4/16/2020 1:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/26/2020 10:58 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		682960100	2/26/2020 10:58 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	2/26/2020 10:58 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/26/2020 10:58 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		682960102	2/26/2020 10:58 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	2/26/2020 10:58 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1740251883	2/26/2020 10:58 AM
Contacts	Primary Contact	Update	Profile Change Request	Mussari, Sabrina Pharm.D. Central Florida Family Health Center 4073228645-1023	Mussari, Sabrina Pharm.D. Central Florida Family Health Center Inc, dba True Health 4073228645-1023	2/25/2020 4:36 PM
Details	Last Recertification Date	Update	Recertification	2/12/2019 10:08:30 AM	1/27/2020 7:35:15 PM	1/27/2020 7:35 PM
Contacts	Primary Contact	Update	Change Request	Boxer, Hylan Director of Pharmacy True Health 4073228653	Mussari, Sabrina Pharm.D. Central Florida Family Health Center 4073228645-1023	2/12/2019 4:08 PM
Details	Last Recertification Date	Update	Recertification	2/13/2018 12:42:09 PM	2/12/2019 10:08:30 AM	2/12/2019 10:08 AM
Details	Last Recertification Date	Update	Recertification	2/8/2017 12:00:00 AM	2/13/2018 12:42:09 PM	2/13/2018 12:42 PM
Contacts	Primary Contact	Update		Boxer, Hylan Director of Pharmacy 4073228653	Boxer, Hylan Director of Pharmacy True Health 4073228653	10/2/2017 8:12 AM
Contacts	Authorizing Official	Update		Stewart, Latrice CEO 4073228645-1015	Stewart, Latrice CEO Central Florida Family Health Center, Inc. dba True Health 4073228645-1015	9/21/2017 1:13 PM
Contacts	Authorizing Official	Update		Smith, Leslie CEO/CMO 4073228645-1034	Stewart, Latrice CEO 4073228645-1015	5/22/2017 12:40 PM
Contacts	Primary Contact	Insert			Boxer, Hylan Director of Pharmacy 4073228653	2/13/2017 6:51 AM
Addresses	Main Address	Insert			5449 S Semoran Blvd Orlando, FL 32822-1722	2/8/2017 5:19 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/8/2017 5:18 PM
Details	Last Recertification Date	Update		2/25/2016 12:00:00 AM	2/8/2017 12:00:00 AM	2/8/2017 5:18 PM
Addresses	Billing Address	Update		CENTRAL FLORIDA FAMILY HEALTH,INC. 2400 STATE ROAD 415 SANFORD, FL 32771	True Health 4930 E Lake Mary Blvd SANFORD, FL 32771	2/25/2016 9:34 AM
Details	Last Recertification Date	Update		2/12/2015 12:00:00 AM	2/25/2016 12:00:00 AM	2/25/2016 9:34 AM
Addresses	Billing Address	Insert			CENTRAL FLORIDA FAMILY HEALTH,INC. 2400 STATE ROAD 415 SANFORD, FL 32771	2/25/2016 9:34 AM
Contacts	Authorizing Official	Update		CAHILL, DENNIS W. CEO 4073228645-239	Smith, Leslie CEO/CMO 4073228645-1034	2/12/2015 12:48 PM
Details	Last Recertification Date	Update		3/20/2014 12:00:00 AM	2/12/2015 12:00:00 AM	2/12/2015 12:48 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/20/2014 12:00:00 AM	3/20/2014 2:53 PM
Details	Entity Subname	Update		HOFFNER CLINIC	Central FL Family Health Center-Hoffner	3/20/2014 2:53 PM
Medicaid Billing	NPI: Number	Insert			1477694826	2/25/2013 8:40 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/25/2013 8:40 AM
Contacts	Authorizing Official	Insert			CAHILL, DENNIS W. CEO 4073228645-239	1/21/2010 11:13 AM
Details	Last Recertification Date	Insert				1/21/2010 11:12 AM
Details	Grant Number	Insert			H80CS00178	1/21/2010 11:12 AM
Details	340B ID	Insert			CH04172B	1/21/2010 11:12 AM
Details	Is Authorizing Official EHB Data	Insert				1/21/2010 11:12 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/21/2010 11:12 AM
Details	Medicare Provider Number	Insert				1/21/2010 11:12 AM
Details	Entity Name	Insert			CENTRAL FLORIDA FAMILY HEALTH CENTER, INC.	1/21/2010 11:12 AM
Details	Program Code	Insert			CH	1/21/2010 11:12 AM
Details	Entity Subname	Insert			HOFFNER CLINIC	1/21/2010 11:12 AM
Dates	Participating Approval Date	Insert			5/21/2004 12:00:00 AM	1/21/2010 11:12 AM
Details	State	Insert			Active	1/21/2010 11:12 AM
Dates	Registration Date	Insert			1/1/2002 12:00:00 AM	1/21/2010 11:12 AM
Dates	Signed By Date	Insert				1/21/2010 11:12 AM
Dates	Start Date	Insert			1/1/2002 12:00:00 AM	1/21/2010 11:12 AM
Terminations	Termination Comments	Insert				1/21/2010 11:12 AM
Terminations	Termination Date	Insert				1/21/2010 11:12 AM
Terminations	Termination Effective Date	Insert				1/21/2010 11:12 AM
Terminations	Termination Reason	Insert				1/21/2010 11:12 AM
Details	Comments Public	Insert			2/21/07 ADDED MEDICAID #; 11/30/06 UPDATED MEDICAID# (WAS CH04172D); 12/20/05 UPDATED ENTITY NAME;	1/21/2010 11:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	1/1/2002 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			025306500	1/1/2002 12:00 AM
Medicaid Billing	Medicaid: State	Insert			FL	1/1/2002 12:00 AM

340B Drug Pricing Program Database