Covered Entity Details

FQHCLA464 SOLVERA HEALTHCARE CENTER INC (Active) - information as of 5/2/2025 10:17:30 PM

Main Details

Name

SOLVERA HEALTHCARE CENTER INC

Subdivision Name

Solvera Healthcare Center Inc

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-038595

340B ID

FQHCLA464

Grant Number

LALCS53029

Additional Details

Current Program Status

Active

Registration Date

5/9/2024

Participating Start Date

7/1/2024

Participating Approval Date

5/14/2024

Last Recertification Date

2/27/2025

Contacts

Authorizing Official

Solvera Healthcare Center, Inc.
Patrick Joseph Caplis, CEO
(309) 453-9052

Primary Contact

Solvera Healthcare Center Inc
Matthew Caplis, Director of Administration
(309) 922-8166

Addresses

Street Address

3525 N University St
Peoria, IL 61604-1324

Billing Address

Solvera Healthcare Center Inc
PO BOX 9727
Peoria, IL 61612-9727

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?
Yes

State	Medicaid Number	NPI Number
IL	119981425001,036128585,036077426,326804693001,359604238001,862788917001,862788917002,036076326,372026721001	1881442770,1457846834,1881891240,1215021100,1124304407,1780231969,1164099198,1225011307,1649216789

Shipping Addresses

Shipping Address 1

Solvera Healthcare Center Inc
3525 N University St
Rm 33
Peoria, IL 61604-1324

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06450	603 S. FOURTH ST.	CHILLICOTHE	IL	61523	04/09/2025	07/01/2025	04/09/2025
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06455	1200 W. MAIN ST.	PEORIA	IL	61606	04/09/2025	07/01/2025	04/09/2025
Contract Detail	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16324	1071 W CARL SANDBURG DR	GALESBURG	IL	61401	04/09/2025	07/01/2025	04/09/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
FQHCLA464	Active	BPS-LAL-038595	SOLVERA HEALTHCARE CENTER INC	Solvera Healthcare Center Inc	3525 N University St	Peoria	IL
FQHCLA464A	Active	BPS-LAL-038935	SOLVERA HEALTHCARE CENTER INC	Solvera Health Carbondale	2250 Reed Station Pkwy, Ste 305	Carbondale	IL
FQHCLA464B	Active	BPS-LAL-038934	SOLVERA HEALTHCARE CENTER INC	Solvera Health Galesburg	256 S Soangetaha Rd	Galesburg	IL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
FQHCLA464	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06450	603 S. FOURTH ST.	CHILLICOTHE	IL	61523	07/01/2025
FQHCLA464	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06455	1200 W. MAIN ST.	PEORIA	IL	61606	07/01/2025
FQHCLA464	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16324	1071 W CARL SANDBURG DR	GALESBURG	IL	61401	07/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Delete	Recertification	Safecor Health, LLC 317 New Boston Street Suite 100 Woburn, MA 01801		2/27/2025 9:56 AM
Addresses	Shipping Address	Delete	Recertification	Safecor Health, LLC 4060 Business Park Drive Columbus, OH 43204		2/27/2025 9:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/27/2025 9:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		036076326	2/27/2025 9:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	2/27/2025 9:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/27/2025 9:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		372026721001	2/27/2025 9:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	2/27/2025 9:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1225011307	2/27/2025 9:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	2/27/2025 9:56 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649216789	2/27/2025 9:56 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	2/27/2025 9:56 AM
Details	Last Recertification Date	Update	Recertification		2/27/2025 9:56:14 AM	2/27/2025 9:56 AM
Addresses	Main Address	Update	Change Request	3525 N University St Rm 33 Peoria, IL 61604-1324	3525 N University St Peoria, IL 61604-1324	9/25/2024 8:33 AM
Addresses	Shipping Address	Insert	Change Request		Solvera Healthcare Center Inc 3525 N University St Rm 33 Peoria, IL 61604-1324	9/25/2024 8:33 AM
Addresses	Shipping Address	Insert	Change Request		Safecor Health, LLC 317 New Boston Street Suite 100 Woburn, MA 01801	9/25/2024 8:33 AM
Addresses	Shipping Address	Insert	Change Request		Safecor Health, LLC 4060 Business Park Drive Columbus, OH 43204	9/25/2024 8:33 AM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Addresses	Main Address	Update	Change Request	3525 N University St Peoria, IL 61604-1324	3525 N University St Rm 33 Peoria, IL 61604-1324	5/30/2024 8:14 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	pending (IL)		5/14/2024 12:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/14/2024 12:56 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		862788917002	5/14/2024 12:56 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/14/2024 12:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/14/2024 9:21 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		862788917001	5/14/2024 9:21 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	5/14/2024 9:21 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1164099198	5/14/2024 9:21 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	5/14/2024 9:21 AM
Contacts	Signed By	Insert	New Registration		Caplis, Patrick Joseph CEO Solvera Healthcare Center, Inc. 3094539052	5/14/2024 6:31 AM
Details	340B ID	Update	New Registration		FQHCLA464	5/14/2024 6:31 AM
Dates	Participating Approval Date	Update	New Registration		5/14/2024 6:31:21 AM	5/14/2024 6:31 AM
Details	State	Update	New Registration	Pending	Approved	5/14/2024 6:31 AM
Dates	Signed By Date	Update	New Registration		5/9/2024 12:09:20 PM	5/14/2024 6:31 AM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	5/14/2024 6:31 AM
Addresses	Main Address	Insert	New Registration		3525 N University St Peoria, IL 61604-1324	5/9/2024 12:09 PM
Addresses	Billing Address	Insert	New Registration		Solvera Healthcare Center Inc PO BOX 9727 Peoria, IL 61612-9727	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		pending	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		119981425001	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		036128585	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		036077426	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		326804693001	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		359604238001	5/9/2024 12:09 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1881442770	5/9/2024 12:09 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1457846834	5/9/2024 12:09 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1881891240	5/9/2024 12:09 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1215021100	5/9/2024 12:09 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124304407	5/9/2024 12:09 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1780231969	5/9/2024 12:09 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	5/9/2024 12:09 PM
Contacts	Authorizing Official	Insert	New Registration		Caplis, Patrick Joseph CEO Solvera Healthcare Center, Inc. 3094539052	5/9/2024 12:09 PM
Contacts	Primary Contact	Insert	New Registration		Caplis, Matthew Director of Administration Solvera Healthcare Center Inc 3099228166	5/9/2024 12:09 PM
Details	Assistance Received From Date	Insert	New Registration			5/9/2024 12:09 PM
Details	Assistance Received To Date	Insert	New Registration			5/9/2024 12:09 PM
Details	Last Recertification Date	Insert	New Registration			5/9/2024 12:09 PM
Details	Grant Number	Insert	New Registration		LALCS53029	5/9/2024 12:09 PM
Details	340B ID	Insert	New Registration			5/9/2024 12:09 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			5/9/2024 12:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			5/9/2024 12:09 PM
Details	Medicare Provider Number	Insert	New Registration			5/9/2024 12:09 PM
Details	Entity Name	Insert	New Registration		SOLVERA HEALTHCARE CENTER INC	5/9/2024 12:09 PM
Details	NOFO Number	Insert	New Registration			5/9/2024 12:09 PM
Details	Program Code	Insert	New Registration		FQHCLA	5/9/2024 12:09 PM
Details	Entity Subname	Insert	New Registration		Solvera Healthcare Center Inc	5/9/2024 12:09 PM
Dates	Participating Approval Date	Insert	New Registration			5/9/2024 12:09 PM
Details	State	Insert	New Registration		Pending	5/9/2024 12:09 PM
Dates	Registration Date	Insert	New Registration		5/9/2024 12:09:16 PM	5/9/2024 12:09 PM
Dates	Signed By Date	Insert	New Registration			5/9/2024 12:09 PM
Dates	Start Date	Insert	New Registration			5/9/2024 12:09 PM
Terminations	Termination Comments	Insert	New Registration			5/9/2024 12:09 PM
Terminations	Termination Date	Insert	New Registration			5/9/2024 12:09 PM
Terminations	Termination Effective Date	Insert	New Registration			5/9/2024 12:09 PM
Terminations	Termination Reason	Insert	New Registration			5/9/2024 12:09 PM

340B Drug Pricing Program Database