340B Drug Pricing Program Database


CHC08238-21 CHANGE INC (Active) - information as of 4/28/2025 11:27:36 PM

Main Details
CHANGE INC
FMC - SBHC Indian Creek High School
HRSA-Funded Health Center
BPS-H80-038170
CHC08238-21
H80CS08238


Additional Details
Active
4/1/2024
7/1/2024
4/1/2024
2/11/2025

Contacts

CHANGE, Inc.
Lisa Mowry, CEO
(304) 797-7733 Ext: 1311

CHANGE, Inc.
James Boniey, Director of Program Operations
(304) 797-7733 Ext: 1309

Addresses

200 Park Dr
Wintersville, OH 43953-3944

CHANGE, Inc.
3158 West Street
Weirton, WV 26062-2606


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WV3810007536,3810008955,3810025567,39100064771063918472,1174074686,1245244367,1528275971,1912311705,1952716433
OH2733993,27642361063918472,1174074686,1245244367,1528275971,1912311705,1952716433
Shipping Addresses

CHANGE, Inc.
3136 West Street
Weirton, WV 26062
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailA & B SUNSET PHCY4201-A SUNSET BLVD
STEUBENVILLEOH4395204/11/202507/01/2025  04/11/2025
Contract DetailDIAMOND PHARMACY503 CADIZ RD
WINTERSVILLEOH43953-412604/11/202507/01/2025  04/11/2025
Contract DetailVILLAGE LONG TERM PHARMACY LLCVILLAGE LONG TERM CARE PHARMACY 204 THREE SPRINGS DR
SUITE B
WEIRTONWV2606204/11/202507/01/2025  04/11/2025
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC08238-00ActiveBPS-H80-000648CHANGE, INCORPORATEDFamily Medical Care Community Health Center - Hancock County3136 West St WeirtonWV
CHC08238-02ActiveBPS-H80-012164CHANGE, INCORPORATEDFamily Medical Care Community Health Center - Jefferson County200 Luray Drive WintersvilleOH
CHC08238-03ActiveBPS-H80-013884CHANGE, INCORPORATEDFMC SBHC - Weirton Elementary3428 Pennsylvania Ave WeirtonWV
CHC08238-04ActiveBPS-H80-017702CHANGE, INCORPORATEDFamily Medical Care Community Health Center - Newell1151 Washington St NewellWV
CHC08238-05ActiveBPS-H80-021757Change, IncorporatedFMC -SBHC Brooke Complex29 Bruin Drive WellsburgWV
CHC08238-06ActiveBPS-H80-022073Change, IncorporatedFMC - SBHC Toronto Complex1305 DENNIS WAY TORONTOOH
CHC08238-07ActiveBPS-H80-022349Change, IncorporatedFMC MAT114 Taylor Ave WeirtonWV
CHC08238-08ActiveBPS-H80-027259Change, IncorporatedFMC - SBHC Weir Complex100 Red Rider Rd WeirtonWV
CHC08238-09ActiveBPS-H80-027370Change, IncorporatedFMC - SBHC Oak Glen Complex39 Golden Bear Dr New CumberlandWV
CHC08238-10ActiveBPS-H80-029429Change, IncorporatedFMC - SBHC Garfield East Elementary School936 N 5th St SteubenvilleOH
CHC08238-11ActiveBPS-H80-029428Change, IncorporatedFMC - SBHC Harding Middle School2002 Sunset Blvd SteubenvilleOH
CHC08238-12ActiveBPS-H80-029426Change, IncorporatedFMC - SBHC McKinley STEM Academy1400 Adams St SteubenvilleOH
CHC08238-13ActiveBPS-H80-029425Change, IncorporatedFMC - SBHC Pugliese West Elementary School435 John Scott Hwy SteubenvilleOH
CHC08238-14ActiveBPS-H80-029427Change, IncorporatedFMC - SBHC Steubenville High School420 N 4th St SteubenvilleOH
CHC08238-15ActiveBPS-H80-031058Change, IncorporatedFMC SBHC Alternative Learning Center1447 Main St WellsburgWV
CHC08238-16ActiveBPS-H80-033012Change, IncorporatedFMC SBHC Brooke Intermediate North1098 Jefferson St FollansbeeWV
CHC08238-17ActiveBPS-H80-033010Change, IncorporatedFMC SBHC Brooke Intermediate South1305 Washington Pike WellsburgWV
CHC08238-18ActiveBPS-H80-033013Change, IncorporatedFMC SBHC Brooke Primary South1448 Main St WellsburgWV
CHC08238-19ActiveBPS-H80-033011Change, IncorporatedFMC SBHC Brooke Primary North200 Rockdale Rd FollansbeeWV
CHC08238-20ActiveBPS-H80-032123Change, IncorporatedMobile Van #11151 Washington St NewellWV
CHC08238-21ActiveBPS-H80-038170CHANGE INCFMC - SBHC Indian Creek High School200 Park Dr WintersvilleOH
CHC08238-22ActiveBPS-H80-037634CHANGE INCFMC - SBHC Indian Creek Middle School2379 Wilson Ave Mingo JunctionOH
CHC08238-23ToBeTerminatedBPS-H80-038794CHANGE INCFMC - SBHC Steubenville High School320 North 4th Street, Room 151 SteubenvilleOH
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC08238-00A & B SUNSET PHCY4201-A SUNSET BLVD
STEUBENVILLEOH4395207/01/2025  
CHC08238-21A & B SUNSET PHCY4201-A SUNSET BLVD
STEUBENVILLEOH4395207/01/2025  
CHC08238-22A & B SUNSET PHCY4201-A SUNSET BLVD
STEUBENVILLEOH4395207/01/2025  
CHC08238-00ACARIAHEALTH PHARMACY #11, INC1311 W SAM HOUSTON PKWY N STE 130
HOUSTONTX77043-401501/01/2023 12/31/2024
CHC08238-00ACARIAHEALTH PHARMACY #12, INC.5 SKYLINE DR STE 240
HAWTHORNENY10532-216601/01/2023 12/31/2024
CHC08238-00ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/01/2024  
CHC08238-00ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/01/2024  
CHC08238-00ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/01/2024  
CHC08238-00ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/01/2024  
CHC08238-00ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/01/2024  
CHC08238-00ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607510/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2024  
CHC08238-16BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CHC08238-17BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522610/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620310/01/2024  
CHC08238-00CITIZENS DRUG STR OF CHESTERLOUCAS/KARNOUPAKIS ENT 501 CAROLINA AVE
PO BOX 198
CHESTERWV2603404/01/2013  
CHC08238-15CITIZENS DRUG STR OF CHESTERLOUCAS/KARNOUPAKIS ENT 501 CAROLINA AVE
PO BOX 198
CHESTERWV2603404/01/2023  
CHC08238-00CYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503301/01/2023 10/14/2022
CHC08238-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/01/2018  
CHC08238-00DAVIS BROTHERS PHARMACYLEGAL BUSINESS NAME: DAVIS BROTHERS PHA 615 N CHESTER ST
NEW CUMBERLANDWV2604701/01/2016  
CHC08238-14DAVIS BROTHERS PHARMACYLEGAL BUSINESS NAME: DAVIS BROTHERS PHA 615 N CHESTER ST
NEW CUMBERLANDWV2604704/01/2023  
CHC08238-00DAVIS BROTHERS PHARMACY - CHESTER559 CAROLINA AVE STE B
CHESTERWV2603404/01/2017 07/01/2024
CHC08238-02DAVIS BROTHERS PHARMACY - CHESTER559 CAROLINA AVE STE B
CHESTERWV2603404/18/2023 07/02/2024
CHC08238-00DIAMOND PHARMACY503 CADIZ RD
WINTERSVILLEOH43953-412607/01/2025  
CHC08238-21DIAMOND PHARMACY503 CADIZ RD
WINTERSVILLEOH43953-412607/01/2025  
CHC08238-22DIAMOND PHARMACY503 CADIZ RD
WINTERSVILLEOH43953-412607/01/2025  
CHC08238-00DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654104/01/2024  
CHC08238-00ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111210/01/2024  
CHC08238-00EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313410/01/2024  
CHC08238-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801610/01/2024  
CHC08238-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607510/01/2024  
CHC08238-00FOLLANSBEE PHARMACY1415 MAIN ST
FOLLANSBEEWV26037-121706/22/2012  
CHC08238-13FOLLANSBEE PHARMACY1415 MAIN ST
FOLLANSBEEWV26037-121704/01/2023  
CHC08238-00FOUNDATION CARE LLC111 CHESTERFIELD INDUSTRIAL BLVD STE 115
CHESTERFIELDMO6300501/01/2023 12/31/2024
CHC08238-00GIANT EAGLE PHARMACY #147515937 STATE RT 170
EAST LIVERPOOLOH4392010/01/2017 10/01/2018
CHC08238-00GIANT EAGLE PHARMACY #1479619 BRADSHAW AVENUE
EAST LIVERPOOLOH4392010/01/2017 10/01/2018
CHC08238-00HERCHE BLOOR PHARMACY104 E 5TH ST
EAST LIVERPOOLOH4392001/01/2019  
CHC08238-12HERCHE BLOOR PHARMACY104 E 5TH ST
EAST LIVERPOOLOH4392004/01/2023  
CHC08238-00HOOD'S PHARMACY INCJOSEPH A.IERISE 971 MAIN ST
PO BOX 455
FOLLANSBEEWV26037-260310/01/2016  
CHC08238-11HOOD'S PHARMACY INCJOSEPH A.IERISE 971 MAIN ST
PO BOX 455
FOLLANSBEEWV26037-260304/01/2023  
CHC08238-00KROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321704/01/2017  
CHC08238-00KROGER PHARMACY100 ST THOMAS DRIVE
WEIRTONWV2606201/01/2014  
CHC08238-10KROGER PHARMACY100 ST THOMAS DRIVE
WEIRTONWV2606204/18/2023  
CHC08238-00KROGER PHARMACY #26891-27TH STREET
WELLSBURGWV2607001/01/2022  
CHC08238-00KROGER PHARMACY #51213201 RITTENHOUSE DRIVE
MIDLOTHIANVA2311201/01/2022 07/13/2022
CHC08238-00KROGER PHARMACY N-2153558 MAIN STREET
WEIRTONWV2606201/01/2014 08/20/2020
CHC08238-00KROGER PHARMACY N-512264 S HOLLYWOOD BLVD
STEUBENVILLEOH4395210/01/2022  
CHC08238-04KROGER PHARMACY N-512264 S HOLLYWOOD BLVD
STEUBENVILLEOH4395204/18/2023  
CHC08238-00KROGER SAV-ON PHARMACY N-963858 MAIN STREET
WINTERSVILLEOH4395310/01/2014  
CHC08238-10KROGER SAV-ON PHARMACY N-963858 MAIN STREET
WINTERSVILLEOH4395304/01/2023  
CHC08238-00NEW CUMBERLAND PRESCRIPTION107 LINCOLN ST
NEW CUMBERLANDWV26047-955304/01/2013 11/01/2024
CHC08238-09NEW CUMBERLAND PRESCRIPTION107 LINCOLN ST
NEW CUMBERLANDWV26047-955304/01/2023 11/01/2024
CHC08238-00OPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/01/2020 08/31/2020
CHC08238-00OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2020  
CHC08238-00OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/01/2020 09/01/2021
CHC08238-00PENN WAY PHARMACYPENN WAY PHARMACY 3159 MAIN ST
WEIRTONWV2606204/01/2017 01/08/2018
CHC08238-00PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999204/01/2018  
CHC08238-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255004/01/2024  
CHC08238-00RITE AID OF OHIO, INC.RITE AID #450 138 NORTH 5TH STREET
STEUBENVILLEOH4395201/01/2014 02/09/2018
CHC08238-00RITE AID OF OHIO, INC.RITE AID #875 4402 SUNSET BOULEVARD
STEUBENVILLEOH4395201/01/2014 02/09/2018
CHC08238-00RITE AID OF OHIO, INC.RITE AID #2565 1820 FRANKLIN STREET
TORONTOOH4396401/01/2014 02/09/2018
CHC08238-00RITE AID OF WEST VIRGINIA, INC.RITE AID #1949 1600 MAIN STREET
FOLLANSBEEWV2603701/01/2014 02/09/2018
CHC08238-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2024  
CHC08238-00ROSS PARK PHARMACY1 ROSS PARK BLVD
STEUBENVILLEOH43952-268110/01/2014 09/14/2015
CHC08238-00SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2024  
CHC08238-00THREE SPRINGS VILLAGE PHARMACY LLCDBA VILLAGE PHARMACY 204 THREE SPRINGS DR
SUITE A
WEIRTONWV2606207/01/2020  
CHC08238-00THRIFT DRUG, INC.RITE AID #11308 1360 COVE ROAD
WEIRTONWV2606201/01/2014 02/09/2018
CHC08238-00TRI-STATE PHARMACY651 COLLIERS WAY STE 204 JOHN J. BERNABEI, RPH
WEIRTONWV26062-505501/01/2014  
CHC08238-08TRI-STATE PHARMACY651 COLLIERS WAY STE 204 JOHN J. BERNABEI, RPH
WEIRTONWV26062-505504/01/2023  
CHC08238-00VALUE LEADER PHARMACYDBA VALUE LEADER PHARMACY 200 LURAY DR STE B
WINTERSVILLEOH4395310/01/2013  
CHC08238-07VALUE LEADER PHARMACYDBA VALUE LEADER PHARMACY 200 LURAY DR STE B
WINTERSVILLEOH4395304/01/2023  
CHC08238-11VALUE LEADER PHARMACYDBA VALUE LEADER PHARMACY 200 LURAY DR STE B
WINTERSVILLEOH4395304/18/2023  
CHC08238-00VILLAGE LONG TERM PHARMACY LLCVILLAGE LONG TERM CARE PHARMACY 204 THREE SPRINGS DR
SUITE B
WEIRTONWV2606207/01/2025  
CHC08238-22VILLAGE LONG TERM PHARMACY LLCVILLAGE LONG TERM CARE PHARMACY 204 THREE SPRINGS DR
SUITE B
WEIRTONWV2606207/01/2025  
CHC08238-21VILLAGE LONG TERM PHARMACY LLCVILLAGE LONG TERM CARE PHARMACY 204 THREE SPRINGS DR
SUITE B
WEIRTONWV2606207/01/2025  
CHC08238-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2019  
CHC08238-00WAL-MART PHARMACY 10-170716280 DRESDEN DR
EAST LIVERPOOLOH4392001/01/2019  
CHC08238-09WAL-MART PHARMACY 10-170716280 DRESDEN DR
EAST LIVERPOOLOH4392004/18/2023  
CHC08238-00WAL-MART PHARMACY 10-1948400 THREE SPRINGS DR
WEIRTONWV2606201/01/2019  
CHC08238-05WAL-MART PHARMACY 10-1948400 THREE SPRINGS DR
WEIRTONWV2606204/18/2023  
CHC08238-00WAL-MART PHARMACY 10-2193100 MALL DRIVE
STEUBENVILLEOH4395201/01/2019  
CHC08238-03WAL-MART PHARMACY 10-2193100 MALL DRIVE
STEUBENVILLEOH4395204/18/2023  
CHC08238-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2019  
CHC08238-00WALGREEN CO.DBA: WALGREENS #11695 2001 SUNSET BLVD.
STEUBENVILLEOH4395204/01/2015 04/15/2016
CHC08238-00WALGREEN CO.WALGREENS #19676 1360 COVE RD
WEIRTONWV26062-420502/27/2018  
CHC08238-00WALGREEN CO.WALGREENS #19743 1600 MAIN ST
FOLLANSBEEWV2603702/27/2018  
CHC08238-00WALGREEN CO.RITE AID #00450 138 N 5TH ST
STEUBENVILLEOH4395202/28/2018 08/23/2018
CHC08238-00WALGREEN CO.WALGREEN #19910 1820 FRANKLIN ST
TORONTOOH4396402/28/2018  
CHC08238-00WALGREEN CO.WALGREENS #17303 4402 SUNSET BLVD
STEUBENVILLEOH4395202/28/2018  
CHC08238-00WALGREEN CO.DBA: WALGREENS #11695 2001 SUNSET BLVD.
STEUBENVILLEOH4395201/01/2019 11/08/2023
CHC08238-00WALGREEN CO.WALGREENS #19991 126 12TH ST.
WELLSBURGWV26070-157207/01/2019  
CHC08238-00WALGREEN CO.WALGREENS #18289 400 PUBLIC RD
YORKVILLEOH4397101/01/2022 04/24/2025
CHC08238-06WALGREEN CO.WALGREENS #19743 1600 MAIN ST
FOLLANSBEEWV2603704/18/2023  
CHC08238-07WALGREEN CO.WALGREENS #19991 126 12TH ST.
WELLSBURGWV26070-157204/18/2023  
CHC08238-08WALGREEN CO.DBA: WALGREENS #11695 2001 SUNSET BLVD.
STEUBENVILLEOH4395204/18/2023  
CHC08238-00Walgreens #21423Walgreens Central Fill #21423 6275 Winchester Blvd
Canal WInchesterOH43110-653701/01/2024  
CHC08238-00WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528404/01/2015 07/06/2015
CHC08238-00WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904904/01/2015 07/06/2015
CHC08238-00WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/01/2018  
CHC08238-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/01/2018  
CHC08238-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/01/2018  
CHC08238-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/01/2018  
CHC08238-00WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275607/01/2023  
CHC08238-00Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/11/2025 11:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 38100075362/11/2025 11:23 AM
Medicaid BillingMedicaid: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/11/2025 11:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 38100089552/11/2025 11:23 AM
Medicaid BillingMedicaid: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/11/2025 11:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 38100255672/11/2025 11:23 AM
Medicaid BillingMedicaid: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/11/2025 11:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 39100064772/11/2025 11:23 AM
Medicaid BillingMedicaid: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/11/2025 11:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 27339932/11/2025 11:23 AM
Medicaid BillingMedicaid: StateInsertRecertification OH2/11/2025 11:23 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/11/2025 11:23 AM
Medicaid BillingMedicaid: NumberInsertRecertification 27642362/11/2025 11:23 AM
Medicaid BillingMedicaid: StateInsertRecertification OH2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 10639184722/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 11740746862/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 12452443672/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 15282759712/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 19123117052/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 19527164332/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification WV2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 10639184722/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification OH2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 11740746862/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification OH2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 12452443672/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification OH2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 15282759712/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification OH2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 19123117052/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification OH2/11/2025 11:23 AM
Medicaid BillingNPI: NumberInsertRecertification 19527164332/11/2025 11:23 AM
Medicaid BillingNPI: StateInsertRecertification OH2/11/2025 11:23 AM
DetailsLast Recertification DateUpdateRecertification 2/11/2025 11:23:56 AM2/11/2025 11:23 AM
DetailsStateUpdate ApprovedActive7/1/2024 12:01 AM
ContactsSigned ByInsertNew Registration Mowry, Lisa CEO CHANGE, Inc. 3047977733-13114/1/2024 12:41 PM
Details340B IDUpdateNew Registration CHC08238-214/1/2024 12:41 PM
DatesParticipating Approval DateUpdateNew Registration 4/1/2024 12:41:15 PM4/1/2024 12:41 PM
DetailsStateUpdateNew RegistrationPendingApproved4/1/2024 12:41 PM
DatesSigned By DateUpdateNew Registration 4/1/2024 11:15:49 AM4/1/2024 12:41 PM
DatesStart DateUpdateNew Registration 7/1/2024 12:00:00 AM4/1/2024 12:41 PM
AddressesMain AddressInsertNew Registration  200 Park Dr Wintersville, OH 43953-39444/1/2024 11:15 AM
AddressesBilling AddressInsertNew Registration CHANGE, Inc. 3158 West Street Weirton, WV 26062-26064/1/2024 11:15 AM
AddressesShipping AddressInsertNew Registration CHANGE, Inc. 3136 West Street Weirton, WV 260624/1/2024 11:15 AM
ContactsPrimary ContactInsertNew Registration Boniey, James Director of Program Operations CHANGE, Inc. 3047977733-13094/1/2024 11:15 AM
ContactsAuthorizing OfficialInsertNew Registration Mowry, Lisa CEO CHANGE, Inc. 3047977733-13114/1/2024 11:15 AM
DetailsAssistance Received From DateInsertNew Registration  4/1/2024 11:15 AM
DetailsAssistance Received To DateInsertNew Registration  4/1/2024 11:15 AM
DetailsLast Recertification DateInsertNew Registration  4/1/2024 11:15 AM
DetailsGrant NumberInsertNew Registration H80CS082384/1/2024 11:15 AM
Details340B IDInsertNew Registration  4/1/2024 11:15 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/1/2024 11:15 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/1/2024 11:15 AM
DetailsMedicare Provider NumberInsertNew Registration  4/1/2024 11:15 AM
DetailsEntity NameInsertNew Registration CHANGE INC4/1/2024 11:15 AM
DetailsNOFO NumberInsertNew Registration  4/1/2024 11:15 AM
DetailsProgram CodeInsertNew Registration CH4/1/2024 11:15 AM
DetailsEntity SubnameInsertNew Registration FMC - SBHC Indian Creek High School4/1/2024 11:15 AM
DatesParticipating Approval DateInsertNew Registration  4/1/2024 11:15 AM
DetailsStateInsertNew Registration Pending4/1/2024 11:15 AM
DatesRegistration DateInsertNew Registration 4/1/2024 11:15:46 AM4/1/2024 11:15 AM
DatesSigned By DateInsertNew Registration  4/1/2024 11:15 AM
DatesStart DateInsertNew Registration  4/1/2024 11:15 AM
TerminationsTermination CommentsInsertNew Registration  4/1/2024 11:15 AM
TerminationsTermination DateInsertNew Registration  4/1/2024 11:15 AM
TerminationsTermination Effective DateInsertNew Registration  4/1/2024 11:15 AM
TerminationsTermination ReasonInsertNew Registration  4/1/2024 11:15 AM