Covered Entity Details

CH04690T MEDCURA HEALTH INC (Active) - information as of 5/27/2025 11:42:41 PM

Main Details

Name

MEDCURA HEALTH INC

Subdivision Name

MedCura McNair

Type

HRSA-Funded Health Center

Site ID

BPS-H80-037404

340B ID

CH04690T

Grant Number

H80CS00179

Additional Details

Current Program Status

Active

Registration Date

4/8/2024

Participating Start Date

7/1/2024

Participating Approval Date

4/9/2024

Last Recertification Date

2/16/2025

Contacts

Authorizing Official

Oakhurst Medical Centers, Inc.
Jeff Taylor, Chief Executive Officer
(404) 298-3250

Primary Contact

MedCura Health, Inc.
Matthew Corso, 340B Program Manager
(732) 618-0989

Addresses

Street Address

2162 Second Ave
Decatur, GA 30032-5259

Billing Address
Same as Street Address

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?
No

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH046900	Active	BPS-H80-011386	MEDCURA HEALTH, INC.	STONE MOUNTAIN	5582 MEMORIAL DRIVE	STONE MOUNTAIN	GA
CH04690D	Active	BPS-H80-004332	MedCura Health, Inc.	MedCura Candler	1760 CANDLER ROAD	DECATUR	GA
CH04690G	Active	BPS-H80-034177	MedCura Health, Inc.	MedCura Buckhead	2140 PEACHTREE RD NW	ATLANTA	GA
CH04690H	Active	BPS-H80-011649	MedCura Health, Inc.	MedCura Rockdale	977 Taylor St SW	Conyers	GA
CH04690J	Active	BPS-H80-017462	MedCura Health, Inc.	MedCura Midtown	550 Peachtree St. N.E.	Atlanta	GA
CH04690K	Active	BPS-H80-021830	MedCura Health, Inc.	MedCura Hillandale	5910 Hillandale Drive	Lithonia	GA
CH04690L	Active	BPS-H80-019025	MedCura Health, Inc.	MedCura Northlake	2295 Parklake Dr NE, Suite 500	ATLANTA	GA
CH04690M	Active	BPS-H80-031462	MedCura Health, Inc.	MedCura Decatur	1706 Candler Rd	Decatur	GA
CH04690N	Active	BPS-H80-033536	MedCura Health, Inc.	MedCura Doraville	3630 Shallowford Rd NE	Doraville	GA
CH04690P	Active	BPS-H80-036410	MEDCURA HEALTH	MedCura Cobb	3065 S Cobb Dr SE STE A	Smyrna	GA
CH04690Q	Active	BPS-H80-036409	MEDCURA HEALTH	MedCura Lithonia	5424 Hillandale Park Ct STE A	Lithonia	GA
CH04690R	Active	BPS-H80-036387	MEDCURA HEALTH	MedCura Clarkston	4112 E Ponce de Leon Ave	Clarkston	GA
CH04690S	Active	BPS-H80-037732	MEDCURA HEALTH INC	MedCura Atlanta	10 Park Place SE STE LLC	Atlanta	GA
CH04690T	Active	BPS-H80-037404	MEDCURA HEALTH INC	MedCura McNair	2162 Second Ave	Decatur	GA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH046900	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/01/2016	10/14/2016
CH046900	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2016	10/14/2016
CH046900	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	01/01/2016	10/14/2016
CH046900	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2017
CH046900	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	07/01/2017	06/21/2021
CH046900	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2017
CH046900	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2017
CH046900	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/01/2016	10/14/2016
CH046900	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2016	10/14/2016
CH046900	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/01/2016	10/14/2016
CH046900	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2017
CH046900	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2017
CH046900	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2017
CH046900	AVITA PHARMACY 1046	LONG'S DRUGS OF SANDERSVILLE, GEORGIA, I	2140 PEACHTREE RD NW STE 232	ATLANTA	GA	30309	01/09/2023
CH046900	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	04/01/2025
CH046900	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2017
CH046900	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	01/01/2025
CH046900	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	01/01/2025
CH046900	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/01/2025
CH046900	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2019
CH046900	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2019
CH046900	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2019
CH046900	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2021	01/21/2022
CH046900	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2021	01/21/2022
CH046900	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2019
CH046900	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2021
CH046900	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2019
CH046900	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2021	01/21/2022
CH046900	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2021	01/21/2022
CH046900	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	01/01/2014
CH046900	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	01/01/2014
CH046900	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2022
CH046900	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2021
CH046900	ENCOMPASS RX, LLC	2700 NORTHEAST EXPRESSWAY	SUITE B-800	ATLANTA	GA	30345	10/01/2015	05/21/2018
CH04690D	ENCOMPASS RX, LLC	2700 NORTHEAST EXPRESSWAY	SUITE B-800	ATLANTA	GA	30345	10/01/2015	01/01/2017
CH04690G	ENCOMPASS RX, LLC	2700 NORTHEAST EXPRESSWAY	SUITE B-800	ATLANTA	GA	30345	10/01/2015	01/01/2017
CH04690H	ENCOMPASS RX, LLC	2700 NORTHEAST EXPRESSWAY	SUITE B-800	ATLANTA	GA	30345	10/01/2015	01/01/2017
CH046900	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2022
CH046900	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2022
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02116	7207 ROCKBRIDGE ROAD	STONE MOUNTAIN	GA	30087	01/01/2021	07/30/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02175	2738 NORTH DECATUR ROAD	DECATUR	GA	30033	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02504	2586 LAWRENCEVILLE HWY.	DECATUR	GA	30033	01/01/2021	09/15/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04178	895 RALPH ABERNATHY BLVD., SW	ATLANTA	GA	30310	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04513	2830 N. DRUID HILLS RD. NE	ATLANTA	GA	30329	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04530	2458 CANDLER ROAD	DECATUR	GA	30032	01/01/2021	09/15/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04595	7550 COVINGTON HWY.	LITHONIA	GA	30058	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04600	1144 S. INDIAN CREEK DR.	STONE MOUNTAIN	GA	30083	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04684	4037 GLENWOOD ROAD	DECATUR	GA	30032	01/01/2021	07/15/2022
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04698	5755 ROCKBRIDGE RD	STONE MOUNTAIN	GA	30087	01/01/2021	01/21/2022
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04717	2429 MARTIN LUTHER KING JR. DR.	ATLANTA	GA	30311	01/01/2021	07/30/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04720	1554 N DECATUR RD NE	ATLANTA	GA	30307	01/01/2021	07/15/2022
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04742	2444 WESLEY CHAPEL RD	DECATUR	GA	30035	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04747	1544 PIEDMONT AVE NE	ATLANTA	GA	30324	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05621	3030 HEADLAND DR.	ATLANTA	GA	30311	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07336	520 BOULEVARD SE	ATLANTA	GA	30312	01/01/2021
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07778	3820 NORTH DECATUR RD	DECATUR	GA	30032	01/01/2021	07/15/2022
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02186	2350 CHESHIRE BRIDGE ROAD	ATLANTA	GA	30324	07/01/2022
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02943	842 PEACHTREE STREET, NE	ATLANTA	GA	30308	07/01/2022
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02082	1943 PEACHTREE RD NE	ATLANTA	GA	30309	10/01/2022
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05376	2910 BUFORD HWY NE	BROOKHAVEN	GA	30329	04/01/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04661	2555 BOLTON RD NW	ATLANTA	GA	30318	07/01/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04424	2907 MAIN STREET	EAST POINT	GA	30344	07/01/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02236	1600 TOWNE LAKE PKWY	WOODSTOCK	GA	30189	10/01/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16874	3660 MARKETPLACE BLVD	EAST POINT	GA	30344	10/01/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04723	439 HIGLAND AVE. NE	ATLANTA	GA	30312	10/01/2023	09/15/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00081	1455 MORELAND AVE SE	ATLANTA	GA	30316	10/01/2023
CH046900	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17220	375 18TH ST NW	ATLANTA	GA	30363	01/01/2024
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02569	3637 PEACHTREE ROAD, NE	ATLANTA	GA	30319	01/01/2024
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03878	680 PONCE DE LEON AVE. NE	ATLANTA	GA	30308	01/01/2024
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04542	3481 GEORGIA HWY 20	CONYERS	GA	30013	01/01/2024
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07312	1140 N HAIRSTON RD	STONE MOUNTAIN	GA	30083	01/01/2024
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04549	8139 TARA BLVD.	JONESBORO	GA	30236	01/01/2024
CH04690H	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02186	2350 CHESHIRE BRIDGE ROAD	ATLANTA	GA	30324	04/01/2024
CH04690H	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04530	2458 CANDLER ROAD	DECATUR	GA	30032	04/01/2024	04/01/2024
CH04690D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04595	7550 COVINGTON HWY.	LITHONIA	GA	30058	04/01/2024
CH04690D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07336	520 BOULEVARD SE	ATLANTA	GA	30312	04/01/2024
CH04690H	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04595	7550 COVINGTON HWY.	LITHONIA	GA	30058	04/01/2024
CH04690D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04600	1144 S. INDIAN CREEK DR.	STONE MOUNTAIN	GA	30083	04/01/2024
CH04690D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04747	1544 PIEDMONT AVE NE	ATLANTA	GA	30324	04/01/2024
CH046900	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17080	1275 CAROLINE ST NE	ATLANTA	GA	30307	01/01/2025
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05633	80 FAIRVIEW RD.	ELLENWOOD	GA	30294	01/01/2025
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04709	77 HUDSON PLAZA	FAIRBURN	GA	30213	01/01/2025
CH046900	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04147	5815 CAMPBELLTON RD SW	ATLANTA	GA	30331	01/01/2025
CH04690D	GLOBAL PHARMACY	926 MONTREAL RD STE B		CLARKSTON	GA	30021-3002	07/01/2005	01/01/2017
CH046900	KROGER DRUG STORE #482	4357 LAWRENCEVILLE HIGHWAY		TUCKER	GA	30084	10/01/2019	02/16/2023
CH046900	KROGER DRUGSTORE #298	1700 MONROE DR NE		ATLANTA	GA	30324-5033	10/01/2019
CH046900	KROGER DRUGSTORE #346	1715 HOWELL MILL RD NW		ATLANTA	GA	30318-3167	10/01/2019	02/16/2023
CH046900	KROGER DRUGSTORE #459	2875 NORTH DECATUR ROAD		DECATUR	GA	30033	10/01/2019	02/16/2023
CH046900	KROGER DRUGSTORE #652	2036 JOHNSON FERRY RD		ATLANTA	GA	30319	10/01/2019	05/06/2020
CH046900	KROGER PHARMACY #626	2452 MOROSGO WAY		ATLANTA	GA	30324	10/01/2019
CH046900	KROGER PHARMACY #672	800 GLENWOOD AVE SE		ATLANTA	GA	30316	10/01/2019	02/16/2023
CH046900	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	07/01/2024
CH046900	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/01/2023
CH046900	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CH046900	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/01/2023
CH046900	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	10/01/2023
CH046900	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	10/01/2023
CH046900	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/01/2023
CH046900	POLARIS PHARMACY SERVICES OF FT LAUDERDA	2900 NW 60TH ST		FT LAUDERDALE	FL	33309-1774	10/01/2024
CH046900	POLARIS SPECIALTY RX	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	10/01/2024
CH046900	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	07/01/2022	02/01/2023
CH046900	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2019
CH046900	PROCARE PHARMACY, L.L.C.	CVS/PHARMACY #48637	2700 NORTHEAST EXPY NE STE B800 BUILDING B	ATLANTA	GA	30345	07/06/2018	07/06/2019
CH046900	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2686	560 AMSTERDAM AVE, STE #E	ATLANTA	GA	30306	01/01/2021	08/09/2024
CH046900	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2021	01/21/2022
CH046900	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2021	01/21/2022
CH046900	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2021	01/21/2022
CH046900	SIGNIO SPECIALTY PHARMACY	711 ANDERSON AVE		CLIFFSIDE PARK	NJ	07010	07/01/2022	02/01/2023
CH046900	SIGNIO SPECIALTY PHARMACY	POLARIS SPECIALTY PHARMACY, LLC	100 ENTERPRISE DR, STE 501	ROCKAWAY	NJ	07866	10/01/2024
CH046900	SOUTHSIDE INFUSION	7700 MAIN ST STE 210		HOUSTON	TX	77030-4457	07/01/2019	07/02/2021
CH046900	SOUTHSIDE PHARMACY	6330 WEST LOOP S STE 700D		BELLAIRE	TX	77401-2928	07/01/2019	07/02/2021
CH046900	SOUTHSIDE PHARMACY 3	6330 WEST LOOP S STE 700C		BELLAIRE	TX	77401-2928	07/01/2019	07/02/2021
CH046900	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2021	02/20/2025
CH046900	WAL-MART PHARMACY #10-3067	4975 JIMMY CARTER BLVD		NORCROSS	GA	30093	10/01/2023	12/02/2024
CH046900	WAL-MART PHARMACY #10-3188	5935 MEMORIAL DR.		STONE MOUNTAIN	GA	30083	07/01/2021	12/02/2024
CH046900	WAL-MART PHARMACY #10-6998	844 CLEVELAND AVENUE		EAST POINT	GA	30344	10/01/2023	12/02/2024
CH046900	WAL-MART PHARMACY 10-0459	10300 INDUSTRIAL BLVD NE		COVINGTON	GA	30014	10/01/2023	12/02/2024
CH046900	WAL-MART PHARMACY 10-0745	5600 N HENRY BLVD		STOCKBRIDGE	GA	30281	10/01/2023	02/20/2025
CH046900	WAL-MART PHARMACY 10-0787	7050 HIGHWAY 85		RIVERDALE	GA	30274	10/01/2023	12/02/2024
CH046900	WAL-MART PHARMACY 10-1181	1785 COBB PARKWAY SOUTH		MARIETTA	GA	30060	07/01/2021	12/02/2024
CH046900	WAL-MART PHARMACY 10-1340	5401 FAIRINGTON RD		LITHONIA	GA	30038	07/01/2021	02/20/2025
CH046900	WAL-MART PHARMACY 10-3401	6149 OLD NATIONAL HIGHWAY		COLLEGE PARK	GA	30349	10/01/2023	02/20/2025
CH046900	WAL-MART PHARMACY 10-3609	2940 ANVIL BLOCK ROAD		ELLENWOOD	GA	30294	10/01/2023	12/02/2024
CH046900	WAL-MART PHARMACY 10-5275	6435 BELLS FERRY ROAD		WOODSTOCK (W)	GA	30189	10/01/2023	12/02/2024
CH046900	WAL-MART PHARMACY 10-5390	210 COBB PARKWAY SOUTH		MARIETTA	GA	30060	10/01/2023	12/02/2024
CH046900	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2021	02/20/2025
CH046900	WALGREEN CO	DBA: WALGREENS # 05759	585 DEKALB INDUSTRIAL WAY	DECATUR	GA	30033	01/03/2012	12/19/2016
CH046900	WALGREEN CO	DBA: WALGREENS #10479	1783 HIGHWAY 138 SE	CONYERS	GA	30013	01/01/2015	12/19/2016
CH046900	WALGREEN CO	DBA: WALGREENS # 05759	585 DEKALB INDUSTRIAL WAY	DECATUR	GA	30033	07/01/2023
CH046900	WALGREEN CO.	DBA: WALGREENS # 05336	5320 MEMORIAL DR	STONE MOUNTAIN	GA	30083	01/03/2012
CH046900	WALGREEN CO.	DBA: WALGREENS # 05580	2035 CANDLER RD	DECATUR	GA	30032	01/03/2012
CH046900	WALGREEN CO.	DBA: WALGREENS # 06138	2065 S HAIRSTON RD	DECATUR	GA	30035	01/03/2012
CH046900	WALGREEN CO.	DBA: WALGREENS # 06205	2945 PANOLA ROAD	STONECREST	GA	30038	01/03/2012	12/19/2016
CH046900	WALGREEN CO.	DBA: WALGREENS # 06481	3584 WESLEY CHAPEL ROAD	DECATUR	GA	30034-5215	01/03/2012	12/19/2016
CH046900	WALGREEN CO.	DBA: WALGREENS # 07995	4765 REDAN RD	STONE MOUNTAIN	GA	30088	01/03/2012
CH046900	WALGREEN CO.	DBA: WALGREENS # 07742	1510 MILSTEAD AVE NE	CONYERS	GA	30012-3877	07/01/2013	12/19/2016
CH046900	WALGREEN CO.	DBA: WALGREENS # 06202	6671 COVINGTON HWY	STONECREST	GA	30058	01/01/2015	09/15/2015
CH046900	WALGREEN CO.	WALGREENS #17037	2020 HOWELL MILL RD NW	ATLANTA	GA	30318-1732	07/01/2023
CH046900	WALGREEN CO.	DBA: WALGREENS # 06032	595 PIEDMONT AVE NE STE 100	ATLANTA	GA	30308-2480	07/01/2023
CH046900	WALGREEN CO.	DBA: WALGREENS #12262	2320 N DRUID HILLS RD NE	BROOKHAVEN	GA	30329	07/01/2023
CH046900	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21146	565 PEACHTREE ST NE STE B	ATLANTA	GA	30308	07/01/2023
CH046900	WALGREEN CO.	DBA: WALGREENS # 09303	2893 PEACHTREE RD NE	ATLANTA	GA	30305-2929	07/01/2023
CH046900	WALGREEN CO.	DBA: WALGREENS # 09620	3800 PRINCETON LAKES PKWY SW	ATLANTA	GA	30331	07/01/2023
CH046900	WALGREEN CO.	DBA: WALGREENS # 07394	3740 CASCADE RD SW	ATLANTA	GA	30331	07/01/2023	11/07/2024
CH046900	WALGREEN CO.	DBA: WALGREENS # 07337	590 THORNTON ROAD	LITHIA SPRINGS	GA	30122	07/01/2023	11/07/2024
CH046900	WALGREEN CO.	WALGREENS #19047	2345 PEACHTREE RD NE	ATLANTA	GA	30305	07/01/2023
CH046900	WALGREEN CO.	COMMUNITY A WALGREENS PHARMACY #15304	1874 PIEDMONT AVE NE STE 100A	ATLANTA	GA	30324	07/01/2024
CH046900	WALMART PHARMACY 10-5010	1030 DELTA BOULEVARD		ATLANTA	GA	30354	10/01/2023	12/02/2024
CH046900	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2023	02/20/2025
CH046900	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024	02/20/2025
CH046900	YOUR PHARMACY SOLUTION	2140 PEACHTREE RD NW STE 232		ATLANTA	GA	30309-1316	02/26/2008

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/16/2025 6:47:12 PM	2/16/2025 6:47 PM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Taylor, Jeff Chief Executive Officer Oakhurst Medical Centers, Inc. 4042983250	4/9/2024 9:12 AM
Details	340B ID	Update	New Registration		CH04690T	4/9/2024 9:12 AM
Dates	Participating Approval Date	Update	New Registration		4/9/2024 9:12:21 AM	4/9/2024 9:12 AM
Details	State	Update	New Registration	Pending	Approved	4/9/2024 9:12 AM
Dates	Signed By Date	Update	New Registration		4/8/2024 7:46:08 PM	4/9/2024 9:12 AM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	4/9/2024 9:12 AM
Addresses	Main Address	Insert	New Registration		2162 Second Ave Decatur, GA 30032-5259	4/8/2024 3:16 PM
Contacts	Primary Contact	Insert	New Registration		Corso, Matthew 340B Program Manager MedCura Health, Inc. 7326180989	4/8/2024 3:16 PM
Contacts	Authorizing Official	Insert	New Registration		Taylor, Jeff Chief Executive Officer Oakhurst Medical Centers, Inc. 4042983250	4/8/2024 3:16 PM
Details	Assistance Received From Date	Insert	New Registration			4/8/2024 3:16 PM
Details	Assistance Received To Date	Insert	New Registration			4/8/2024 3:16 PM
Details	Last Recertification Date	Insert	New Registration			4/8/2024 3:16 PM
Details	Grant Number	Insert	New Registration		H80CS00179	4/8/2024 3:16 PM
Details	340B ID	Insert	New Registration			4/8/2024 3:16 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/8/2024 3:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/8/2024 3:16 PM
Details	Medicare Provider Number	Insert	New Registration			4/8/2024 3:16 PM
Details	Entity Name	Insert	New Registration		MEDCURA HEALTH INC	4/8/2024 3:16 PM
Details	NOFO Number	Insert	New Registration			4/8/2024 3:16 PM
Details	Program Code	Insert	New Registration		CH	4/8/2024 3:16 PM
Details	Entity Subname	Insert	New Registration		MedCura McNair	4/8/2024 3:16 PM
Dates	Participating Approval Date	Insert	New Registration			4/8/2024 3:16 PM
Details	State	Insert	New Registration		Pending	4/8/2024 3:16 PM
Dates	Registration Date	Insert	New Registration		4/8/2024 3:16:23 PM	4/8/2024 3:16 PM
Dates	Signed By Date	Insert	New Registration			4/8/2024 3:16 PM
Dates	Start Date	Insert	New Registration			4/8/2024 3:16 PM
Terminations	Termination Comments	Insert	New Registration			4/8/2024 3:16 PM
Terminations	Termination Date	Insert	New Registration			4/8/2024 3:16 PM
Terminations	Termination Effective Date	Insert	New Registration			4/8/2024 3:16 PM
Terminations	Termination Reason	Insert	New Registration			4/8/2024 3:16 PM

340B Drug Pricing Program Database