Covered Entity Details

RRC060064-03 AdventHealth Porter (Active) - information as of 5/14/2025 10:50:53 PM

Main Details

Name

AdventHealth Porter

Subdivision Name

AdventHealth Wound Care at Porter

Type

Rural Referral Center

Rural

Yes

340B ID

RRC060064-03

Medicare Provider Number

060064

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/14/2023

Participating Start Date

7/1/2023

Participating Approval Date

5/1/2023

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

AdventHealth Porter
Andrew Nathan Whitlock, CFO
(303) 778-2474

Primary Contact

AdventHealth
Ely S Abrams, 340b Coordinator
(407) 770-9259

Addresses

Street Address

990 E Harvard Ave
Denver, CO 80210

Billing Address

AdventHealth Porter
c/o AdventHealth
902 Inspiration Ave
Suite 9100
Altamonte Springs, FL 32714

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
CO	05064001	1801800594

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC060064-01	Child	RRC	AdventHealth Porter	AdventHealth Transplant Institute at Porter	2535 S Downing St	Denver	CO	Active
RRC060064-02	Child	RRC	AdventHealth Porter	Mental Health Clinic - Mental Health	960 Harvard Avenue	Denver	CO	Active
RRC060064-03	Child	RRC	AdventHealth Porter	AdventHealth Wound Care at Porter	990 E Harvard Ave	Denver	CO	Active
RRC060064-04	Child	RRC	AdventHealth Porter	AdventHealth ECT Porter - ECT	2535 South Downing Street	Denver	CO	Active
RRC060064-05	Child	RRC	AdventHealth Porter	AdventHealth Advanced Therapeutic Endoscopy Center Porter - Endoscopy	2535 South Downing Street	Denver	CO	Active
RRC060064-06	Child	RRC	AdventHealth Porter	AdventHealth Radiation Oncology Porter - Radiation Oncology	2555 South Downing Street	Denver	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	PC Change Request	Becker, Jody 340B Program Director AdventHealth 3524344284	Abrams, Ely S 340b Coordinator AdventHealth 4077709259	3/12/2025 12:20 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 3:18:29 PM	8/14/2024 7:57:40 PM	8/14/2024 7:57 PM
Addresses	Billing Address	Update	Change Request	Centura Health PO Box 372660 Denver, CO 80237	AdventHealth Porter c/o AdventHealth 902 Inspiration Ave Suite 9100 Altamonte Springs, FL 32714	4/9/2024 10:59 AM
Details	Entity Subname	Update	Change Request	Wound Care Clinic - Wound Care	AdventHealth Wound Care at Porter	4/9/2024 10:59 AM
Details	Entity Name	Update	Change Request	CENTURA PORTER ADVENTIST HOSPITAL	AdventHealth Porter	4/9/2024 10:55 AM
Contacts	Authorizing Official	Update	AO Change Request	Whitlock, Andrew CFO Centura Health 3036731256	Whitlock, Andrew Nathan CFO AdventHealth Porter 3037782474	2/28/2024 12:35 PM
Details	Last Recertification Date	Update	Recertification		8/14/2023 3:18:29 PM	8/14/2023 3:18 PM
Contacts	Primary Contact	Update	Group Change Request	Morgan, Samantha Director, Enterprise 340B Program Centura Health 3036737380	Becker, Jody 340B Program Director AdventHealth 3524344284	8/10/2023 11:01 AM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Primary Contact	Update	Profile Change Request	Morgan, Samantha 340B Program Manager Centura Health 3036737380	Morgan, Samantha Director, Enterprise 340B Program Centura Health 3036737380	5/25/2023 12:41 PM
Contacts	Signed By	Insert	New Registration		Whitlock, Andrew CFO Centura Health 3036731256	5/1/2023 10:33 AM
Details	340B ID	Update	New Registration		RRC060064-03	5/1/2023 10:33 AM
Details	Entity Subname	Update	New Registration	Wound Care Clinic	Wound Care Clinic - Wound Care	5/1/2023 10:33 AM
Dates	Participating Approval Date	Update	New Registration		5/1/2023 10:33:59 AM	5/1/2023 10:33 AM
Details	State	Update	New Registration	Pending	Approved	5/1/2023 10:33 AM
Dates	Signed By Date	Update	New Registration		4/17/2023 7:42:40 PM	5/1/2023 10:33 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	5/1/2023 10:33 AM
Addresses	Main Address	Insert	New Registration		990 E Harvard Ave Denver, CO 80210	4/14/2023 1:22 PM
Addresses	Billing Address	Insert	New Registration		Centura Health PO Box 372660 Denver, CO 80237	4/14/2023 1:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2023 1:22 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		05064001	4/14/2023 1:22 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CO	4/14/2023 1:22 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1801800594	4/14/2023 1:22 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	4/14/2023 1:22 PM
Contacts	Primary Contact	Insert	New Registration		Morgan, Samantha 340B Program Manager Centura Health 3036737380	4/14/2023 1:22 PM
Contacts	Authorizing Official	Insert	New Registration		Whitlock, Andrew CFO Centura Health 3036731256	4/14/2023 1:22 PM
Details	Assistance Received From Date	Insert	New Registration			4/14/2023 1:22 PM
Details	Assistance Received To Date	Insert	New Registration			4/14/2023 1:22 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2023 1:22 PM
Details	Grant Number	Insert	New Registration			4/14/2023 1:22 PM
Details	340B ID	Insert	New Registration			4/14/2023 1:22 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2023 1:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2023 1:22 PM
Details	Medicare Provider Number	Insert	New Registration		060064	4/14/2023 1:22 PM
Details	Entity Name	Insert	New Registration		CENTURA PORTER ADVENTIST HOSPITAL	4/14/2023 1:22 PM
Details	NOFO Number	Insert	New Registration			4/14/2023 1:22 PM
Details	Program Code	Insert	New Registration		RRC	4/14/2023 1:22 PM
Details	Entity Subname	Insert	New Registration		Wound Care Clinic	4/14/2023 1:22 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2023 1:22 PM
Details	State	Insert	New Registration		Pending	4/14/2023 1:22 PM
Dates	Registration Date	Insert	New Registration		4/14/2023 1:22:07 PM	4/14/2023 1:22 PM
Dates	Signed By Date	Insert	New Registration			4/14/2023 1:22 PM
Dates	Start Date	Insert	New Registration			4/14/2023 1:22 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2023 1:22 PM
Terminations	Termination Date	Insert	New Registration			4/14/2023 1:22 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2023 1:22 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2023 1:22 PM