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  5. THE BREVARD HEALTH ALLIANCE, INC.

THE BREVARD HEALTH ALLIANCE, INC.

Company Details

Entity Name: THE BREVARD HEALTH ALLIANCE, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 01 Apr 2003 (22 years ago)
Document Number: N03000002784
FEI/EIN Number 900068515
Address: 4315 Woodland Park Drive, West Melbourne, FL, 32904, US
Mail Address: 4315 Woodland Park Drive, West Melbourne, FL, 32904, US
ZIP code: 32904
County: Brevard
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1194589341 2024-02-08 2024-04-04 PO BOX 1137, MELBOURNE, FL, 329021137, US 1315 VALENTINE ST, MELBOURNE, FL, 329013127, US

Contacts
Phone +1 321-952-9696
Fax 3219527937
Phone +1 321-241-6800
Fax 3212416890

Authorized person
Name ANGELA CRAIG
Role DIRECTOR OF BILLING
Phone 3216983446

Taxonomy
Taxonomy Code 3336C0003X - Community/Retail Pharmacy
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THE BREVARD HEALTH ALLIANCE, INC. 401(K) PROFIT S ARING PLAN 2011 900068515 2012-07-02 THE BREVARD HEALTH ALLIANCE, INC. 105
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 3217225910
Plan sponsor’s address 3661 S. BABCOCK ST., MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 900068515
Plan administrator’s name THE BREVARD HEALTH ALLIANCE, INC.
Plan administrator’s address 3661 S. BABCOCK ST., MELBOURNE, FL, 32901
Administrator’s telephone number 3217225910

Signature of
Role Plan administrator
Date 2012-07-02
Name of individual signing LISA GURRI
Valid signature Filed with authorized/valid electronic signature
THE BREVARD HEALTH ALLIANCE, INC. 401(K) PROFIT S ARING PLAN 2010 900068515 2011-06-27 THE BREVARD HEALTH ALLIANCE, INC. 83
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621399
Sponsor’s telephone number 3217225910
Plan sponsor’s address 3661 S. BABCOCK ST., MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 900068515
Plan administrator’s name THE BREVARD HEALTH ALLIANCE, INC.
Plan administrator’s address 3661 S. BABCOCK ST., MELBOURNE, FL, 32901
Administrator’s telephone number 3217225910

Signature of
Role Plan administrator
Date 2011-06-27
Name of individual signing LISA GURRI
Valid signature Filed with authorized/valid electronic signature
THE BREVARD HEALTH ALLIANCE, INC. 401(K) PROFIT S ARING PLAN 2009 900068515 2010-07-27 THE BREVARD HEALTH ALLIANCE, INC. 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-01-01
Business code 621498
Sponsor’s telephone number 3217225910
Plan sponsor’s address 3661 S. BABCOCK ST., MELBOURNE, FL, 32901

Plan administrator’s name and address
Administrator’s EIN 900068515
Plan administrator’s name THE BREVARD HEALTH ALLIANCE, INC.
Plan administrator’s address 3661 S. BABCOCK ST., MELBOURNE, FL, 32901
Administrator’s telephone number 3217225910

Signature of
Role Plan administrator
Date 2010-07-27
Name of individual signing LISA GURRI
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Johnson Marcus Agent 4315 Woodland Park Drive, West Melbourne, FL, 32904

Vice President

Name Role Address
SHEA ERIN Vice President 4315 WOODLAND PARK DRIVE, WEST MELBOURNE, FL, 32904

Chief Executive Officer

Name Role Address
Helton Richard A Chief Executive Officer 4315 Woodland Park Drive, West Melbourne, FL, 32904

Chief Operating Officer

Name Role Address
Anderson Maegen Chief Operating Officer 2120 Sarno Road, MELBOURNE, FL, 32935

HEAL

Name Role Address
ESROCK BRETT HEAL 4315 WOODLAND PARK DRIVE, WEST MELBOURNE, FL, 32904

PUBL

Name Role Address
DONALD KEITH PUBL 4315 WOODLAND PARK DRIVE, WEST MELBOURNE, FL, 32904

Chairman

Name Role Address
SANTIAGO ROBERT Chairman 4315 WOODLAND PARK DRIVE, WEST MELBOURNE, FL, 32904

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2024-04-15 Johnson, Marcus No data
CHANGE OF PRINCIPAL ADDRESS 2020-01-15 4315 Woodland Park Drive, West Melbourne, FL 32904 No data
CHANGE OF MAILING ADDRESS 2020-01-15 4315 Woodland Park Drive, West Melbourne, FL 32904 No data
REGISTERED AGENT ADDRESS CHANGED 2020-01-15 4315 Woodland Park Drive, West Melbourne, FL 32904 No data

Documents

Name Date
AMENDED ANNUAL REPORT 2024-04-15
AMENDED ANNUAL REPORT 2024-02-15
ANNUAL REPORT 2024-01-29
ANNUAL REPORT 2023-03-01
ANNUAL REPORT 2022-02-04
ANNUAL REPORT 2021-02-17
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-01-30
ANNUAL REPORT 2018-01-30
ANNUAL REPORT 2017-01-05

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SANTIAGO ROBERT

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Johnson Marcus

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Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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