340B Drug Pricing Program Database


FQHCLA431P VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTER (Active) - information as of 4/25/2025 6:32:13 PM

Main Details
VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTER
VHP Children's Clinic at 6th Street
Health Center Program Look-Alike
BPS-LAL-037746
FQHCLA431P
LALCS45056


Additional Details
Active
7/1/2024
10/1/2024
7/8/2024
2/27/2025

Contacts

Valley Health Partners Community Health Center
Veronica Gonzalez, Chief Executive Officer
(610) 969-2728

Valley Health Partners
Jennifer L Cicconetti, Chief of Pharmacy
(610) 969-4979

Addresses

101 N 6th Street
STE 330
Allentown, PA 18101

Valley Health Partners Community Health Center
400 N 17th St
STE 300
Allentown, PA 18104


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

No
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
FQHCLA431ActiveBPS-LAL-032970VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERFamily Health Center400 N 17th St AllentownPA
FQHCLA431AActiveBPS-LAL-032968VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERCentro de Salud1627 Chew St AllentownPA
FQHCLA431BActiveBPS-LAL-032971VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERCommunity Health & Wellness Center1627 Chew St AllentownPA
FQHCLA431CActiveBPS-LAL-032973VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERLehigh Valley Physicians Practice PCP1627 Chew St AllentownPA
FQHCLA431DActiveBPS-LAL-032974VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERChildren's Clinic1627 Chew St6th FloorAllentownPA
FQHCLA431EActiveBPS-LAL-032969VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERChildren's Clinic at Sheridan521 N 2nd St AllentownPA
FQHCLA431FActiveBPS-LAL-032972VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERCenter for Women's Medicine1627 Chew St AllentownPA
FQHCLA431GTerminatedBPS-LAL-035121Valley Health Partners Community Health CenterCommunity Smiles1627 Chew Street AllentownPA
FQHCLA431HTerminatedBPS-LAL-035116Valley Health Partners Community Health CenterValley Health Partners Community Vision Center401 N 17th St AllentownPA
FQHCLA431JActiveBPS-LAL-035120VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERChildren's Clinic at Hays1227 W Gordon St AllentownPA
FQHCLA431KActiveBPS-LAL-035122VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERCommunity Smiles - Dental Unit101 N 6th St AllentownPA
FQHCLA431LActiveBPS-LAL-036594VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP Community Vision Center at 6th Street101 N 6th St AllentownPA
FQHCLA431MActiveBPS-LAL-036595VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP Community Smiles at 6th Street101 N 6th St AllentownPA
FQHCLA431NActiveBPS-LAL-037749VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP Family Health Center at 6th Street101 N 6th St AllentownPA
FQHCLA431PActiveBPS-LAL-037746VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP Children's Clinic at 6th Street101 N 6th Street AllentownPA
FQHCLA431QActiveBPS-LAL-039405VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP - Center of Hope1627 Chew St. FL 3 AllentownPA
FQHCLA431RActiveBPS-LAL-039522VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP Pediatrics - Stroud West205 Applegate Rd STE 200 StroudsburgPA
FQHCLA431SActiveBPS-LAL-039519VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP Pediatrics - Plaza Ct.500 Plaza Ct East StroudsburgPA
FQHCLA431TActiveBPS-LAL-039520VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP Pediatrics - West End120 Burrus Blvd BrodheadsvillePA
FQHCLA431UActiveBPS-LAL-039521VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTERVHP Pediatrics - Tobyhanna100 Community Dr, Ste 202 TobyhannaPA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
FQHCLA431ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2022 07/14/2023
FQHCLA431ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/01/2022 07/14/2023
FQHCLA431ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2022 07/14/2023
FQHCLA431ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/01/2022 07/01/2023
FQHCLA431ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/01/2022 07/14/2023
FQHCLA431ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/01/2022  
FQHCLA431ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/01/2022 07/14/2023
FQHCLA431BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
FQHCLA431BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
FQHCLA431BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2024 10/15/2024
FQHCLA431BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620301/01/2025  
FQHCLA431BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/01/2025  
FQHCLA431CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870612/22/2022  
FQHCLA431CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005612/22/2022  
FQHCLA431CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503312/22/2022  
FQHCLA431DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654104/01/2024  
FQHCLA431ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/01/2022 07/14/2023
FQHCLA431EXPRESS CARE PHARMACY1727 W LIBERTY ST UNIT 2
ALLENTOWNPA1810407/01/2022  
FQHCLA431DEXPRESS CARE PHARMACY1727 W LIBERTY ST UNIT 2
ALLENTOWNPA1810407/01/2023  
FQHCLA431EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/01/2022 07/14/2023
FQHCLA431EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/01/2022  
FQHCLA431EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/01/2022 07/14/2023
FQHCLA431ALEHIGH VALLEY PHARMACY SERVICES17TH & CHEW ST 1637 CHEW ST
ALLENTOWNPA1810204/01/2023  
FQHCLA431LEHIGH VALLEY PHARMACY SERVICES17TH & CHEW ST 1637 CHEW ST
ALLENTOWNPA1810204/01/2023  
FQHCLA431LEHIGH VALLEY PHARMACY SERVICES2024 LEHIGH ST STE 600
ALLENTOWNPA18103-493810/01/2024  
FQHCLA431MARYLAND CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 3517 825 WAYNE AVE.
SILVER SPRINGMD2091012/22/2022 11/20/2023
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02020 728 UNION BOULEVARD
ALLENTOWNPA1810912/22/2022 09/27/2023
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.CVS/PHARMACY # 11084 1225 THIRD STREET
WHITEHALLPA1805212/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 17462 912 AIRPORT CENTER DR
ALLENTOWNPA1810912/22/2022 11/20/2023
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05885 4082 JANDY BLVD.
NAZARETHPA1806412/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01901 35 N. MAIN ST.
BANGORPA1801312/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01311 2651 EASTON AVENUE
BETHLEHEMPA1801712/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02459 305 WEST FOURTH STREET
BETHLEHEMPA1801512/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01301 45 CONSTITUTION BLVD
VILLAGE SQUARE S/C 		KUTZTOWNPA1953012/22/2022 11/20/2023
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 16840 1600 N CEDAR CREST BLVD
ALLENTOWNPA1810412/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01093 7001 NORTH HIGHWAY 309
COOPERSBURGPA1803612/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02296 3295 PA ROUTE 100
MACUNGIEPA1806212/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01908 327 WOODLAWN AVENUE
BETHLEHEMPA1801812/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02507 3943 ROUTE 309
SCHNECKSVILLEPA1807812/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00461 3010 TILGHMAN STREET
ALLENTOWNPA1810412/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05743 29 WEST 21ST STREET
NORTHAMPTONPA1806712/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00960 1520 NORTHAMPTON STREET
EASTONPA1804212/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00858 315 WEST EMAUS AVENUE
ALLENTOWNPA1810312/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02267 958 SOUTH KROCKS ROAD
ALLENTOWNPA1810612/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00820 1457 8TH AVENUE
BETHLEHEMPA1801812/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07073 290 POTTSTOWN AVE.
PENNSBURGPA1807312/22/2022 11/20/2023
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 1787 4950 FREEMANSBURG AVE.
EASTONPA1804512/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01942 413 RR 1, RTE 611
TANNERSVILLEPA1837212/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01325 20 EAST LOCUST STREET
NESQUEHONINGPA1824012/22/2022 11/20/2023
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07670 620 OLD PHILADELPHIA RD.
EASTONPA1804212/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04234 5801 W. TILGHMAN ST.
ALLENTOWNPA1810412/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05879 855 S. BROADWAY
WIND GAPPA1809112/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01036 2434 CATASAUQUA ROAD
BETHLEHEMPA1801812/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01304 1802 LEHIGH STREET
ALLENTOWNPA1810312/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01178 702 CHESTNUT ST.
EMMAUSPA1804912/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02115 1332 MAIN STREET
HELLERTOWNPA1805512/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00974 1601 W. LIBERTY STREET
ALLENTOWNPA1810212/22/2022  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05533 6050 STERNER'S WAY
BETHLEHEMPA1801712/22/2022  
FQHCLA431FPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00974 1601 W. LIBERTY STREET
ALLENTOWNPA1810207/01/2023  
FQHCLA431JPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00858 315 WEST EMAUS AVENUE
ALLENTOWNPA1810301/01/2024  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01312 1111 NORTH 9TH ST.
STROUDSBURGPA1836004/01/2025  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02002 239 FOX RUN LANE
EAST STROUDSBURGPA1830204/01/2025  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 3062 3192 ROUTE 115
EFFORTPA1833004/01/2025  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #342 3016 ROUTE 940
P. O. BOX 2320 		POCONO SUMMITPA1834604/01/2025  
FQHCLA431PENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03998 5122 MILFORD RD.
EAST STROUDSBURGPA1830204/01/2025  
FQHCLA431RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255004/01/2024  
FQHCLA431RITE AID OF PENNSYLVANIA, LLCRITE AID #7836 1401 W TILGHMAN STREET
ALLENTOWNPA1810207/01/2022 01/01/2023
FQHCLA431RITE AID OF PENNSYLVANIA, LLCRITE AID #6778 27 N 7TH ST STE 100
ALLENTOWNPA18101-135707/01/2022  
FQHCLA431CRITE AID OF PENNSYLVANIA, LLCRITE AID #6778 27 N 7TH ST STE 100
ALLENTOWNPA18101-135712/22/2022  
FQHCLA431RITE AID OF PENNSYLVANIA, LLCRITE AID #1355 504 MARION LN
BRODHEADSVILLEPA18322-706404/01/2025  
FQHCLA431RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2024  
FQHCLA431SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2024 10/15/2024
FQHCLA431THRIFT DRUG, INC.RITE AID #11169 23 NORTH ELM STREET
KUTZTOWNPA1953007/01/2022  
FQHCLA431THRIFT DRUG, INC.RITE AID #11048 110 MAIN STREET
HELLERTOWNPA1805507/01/2022  
FQHCLA431THRIFT DRUG, INC.RITE AID #11055 1650 NORTH CEDAR CREST BLVD.
ALLENTOWNPA1810407/01/2022 05/15/2024
FQHCLA431THRIFT DRUG, INC.RITE AID #11045 601 SOUTH 25TH STREET
EASTONPA1804507/01/2022 09/07/2023
FQHCLA431ATHRIFT DRUG, INC.RITE AID #11169 23 NORTH ELM STREET
KUTZTOWNPA1953001/01/2023 01/01/2023
FQHCLA431BTHRIFT DRUG, INC.RITE AID #11055 1650 NORTH CEDAR CREST BLVD.
ALLENTOWNPA1810412/22/2022  
FQHCLA431WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2024  
FQHCLA431WAL-MART PHARMACY 10-21452601 MACARTHUR RD
WHITEHALLPA1805204/01/2024  
FQHCLA431LWAL-MART PHARMACY 10-21452601 MACARTHUR RD
WHITEHALLPA1805204/01/2024  
FQHCLA431WAL-MART PHARMACY 10-2368355 LINCOLN AVE
EAST STROUDSBURGPA1830104/01/2025  
FQHCLA431MWAL-MART PHARMACY 10-26411091 MILLCREEK ROAD
ALLENTOWNPA1810604/01/2024  
FQHCLA431WAL-MART PHARMACY 10-26411091 MILLCREEK ROAD
ALLENTOWNPA1810604/01/2024  
FQHCLA431WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2024  
FQHCLA431WAL-MART PHARMACY WHSE #452250 NORTH 8TH STREET SUITE 102-A
ROGERSAR7275604/01/2024 04/05/2024
FQHCLA431WALGREEN EASTERN CO., INC.DBA: WALGREENS # 03255 1319 HANOVER AVE.
ALLENTOWNPA18109-201812/22/2022  
FQHCLA431WALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21169 541 HAMILTON ST
ALLENTOWNPA1810112/22/2022  
FQHCLA431WALGREEN EASTERN CO., INC.DBA: WALGREENS # 09801 6379 HAMILTON BLVD STE 7
ALLENTOWNPA1810612/22/2022  
FQHCLA431WALGREEN EASTERN CO., INC.DBA: WALGREENS # 05985 2535 WILLIAM PENN HWY
EASTONPA18045-522212/22/2022  
FQHCLA431WALGREEN EASTERN CO., INC.DBA: WALGREENS # 03241 1855 SOUTH 5TH STREET
ALLENTOWNPA1810312/22/2022  
FQHCLA431WALGREEN EASTERN CO., INC.DBA: WALGREENS # 03495 2979 LINDEN ST
BETHLEHEMPA1801712/22/2022  
FQHCLA431WALGREEN EASTERN CO., INC.DBA: WALGREENS # 09994 1955 SULLIVAN TRAIL
EASTONPA1804012/22/2022  
FQHCLA431WALGREEN EASTERN CO., INC.DBA: WALGREENS # 04852 2240 SCHOENERSVILLE RD
BETHLEHEMPA1801712/22/2022  
FQHCLA431WALGREEN EASTERN CO., INC.DBA: WALGREENS # 05715 1702 W TILGHMAN ST.
ALLENTOWNPA1810412/22/2022  
FQHCLA431EWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05715 1702 W TILGHMAN ST.
ALLENTOWNPA1810407/01/2023  
FQHCLA431CWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03241 1855 SOUTH 5TH STREET
ALLENTOWNPA1810310/01/2023 12/31/2023
FQHCLA431CWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05715 1702 W TILGHMAN ST.
ALLENTOWNPA1810410/01/2023 12/31/2023
FQHCLA431HWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03255 1319 HANOVER AVE.
ALLENTOWNPA18109-201801/01/2024 12/31/2023
FQHCLA431KWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03241 1855 SOUTH 5TH STREET
ALLENTOWNPA1810301/01/2024  
FQHCLA431NWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03255 1319 HANOVER AVE.
ALLENTOWNPA18109-201804/01/2024  
FQHCLA431WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818812/22/2022  
FQHCLA431WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503312/22/2022  
FQHCLA431WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527512/22/2022  
FQHCLA431WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275607/01/2024  
FQHCLA431Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesMain AddressUpdateRecertification 101 N 6th Street STE 300 Allentown, PA 18101 101 N 6th Street STE 330 Allentown, PA 181012/27/2025 10:00 AM
DetailsLast Recertification DateUpdateRecertification 2/27/2025 10:00:13 AM2/27/2025 10:00 AM
AddressesMain AddressUpdateChange Request 101 N 6th Street STE 330 Allentown, PA 18101 101 N 6th Street STE 300 Allentown, PA 181012/6/2025 10:50 AM
Medicaid BillingNPI: NumberDeleteChange Request1558996421 (PA) 2/6/2025 10:50 AM
ContactsPrimary ContactUpdateProfile Change RequestCicconetti, Jennifer L Director - Pharmacy Valley Health Partners 6109694979Cicconetti, Jennifer L Chief of Pharmacy Valley Health Partners 61096949791/12/2025 7:35 PM
DetailsStateUpdate ApprovedActive10/1/2024 12:01 AM
ContactsSigned ByInsertNew Registration Gonzalez, Veronica Chief Executive Officer Valley Health Partners Community Health Center 61096927287/8/2024 9:06 AM
Details340B IDUpdateNew Registration FQHCLA431P7/8/2024 9:06 AM
DatesParticipating Approval DateUpdateNew Registration 7/8/2024 9:06:12 AM7/8/2024 9:06 AM
DetailsStateUpdateNew RegistrationPendingApproved7/8/2024 9:06 AM
DatesSigned By DateUpdateNew Registration 7/1/2024 8:24:34 PM7/8/2024 9:06 AM
DatesStart DateUpdateNew Registration 10/1/2024 12:00:00 AM7/8/2024 9:06 AM
AddressesMain AddressInsertNew Registration  101 N 6th Street STE 330 Allentown, PA 181017/1/2024 7:53 PM
AddressesBilling AddressInsertNew Registration Valley Health Partners Community Health Center 400 N 17th St STE 300 Allentown, PA 181047/1/2024 7:53 PM
Medicaid BillingNPI: NumberInsertNew Registration 15589964217/1/2024 7:53 PM
Medicaid BillingNPI: StateInsertNew Registration PA7/1/2024 7:53 PM
ContactsAuthorizing OfficialInsertNew Registration Gonzalez, Veronica Chief Executive Officer Valley Health Partners Community Health Center 61096927287/1/2024 7:53 PM
ContactsPrimary ContactInsertNew Registration Cicconetti, Jennifer L Director - Pharmacy Valley Health Partners 61096949797/1/2024 7:53 PM
DetailsAssistance Received From DateInsertNew Registration  7/1/2024 7:53 PM
DetailsAssistance Received To DateInsertNew Registration  7/1/2024 7:53 PM
DetailsLast Recertification DateInsertNew Registration  7/1/2024 7:53 PM
DetailsGrant NumberInsertNew Registration LALCS450567/1/2024 7:53 PM
Details340B IDInsertNew Registration  7/1/2024 7:53 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/1/2024 7:53 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/1/2024 7:53 PM
DetailsMedicare Provider NumberInsertNew Registration  7/1/2024 7:53 PM
DetailsEntity NameInsertNew Registration VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTER7/1/2024 7:53 PM
DetailsNOFO NumberInsertNew Registration  7/1/2024 7:53 PM
DetailsProgram CodeInsertNew Registration FQHCLA7/1/2024 7:53 PM
DetailsEntity SubnameInsertNew Registration VHP Children's Clinic at 6th Street7/1/2024 7:53 PM
DatesParticipating Approval DateInsertNew Registration  7/1/2024 7:53 PM
DetailsStateInsertNew Registration Pending7/1/2024 7:53 PM
DatesRegistration DateInsertNew Registration 7/1/2024 7:53:03 PM7/1/2024 7:53 PM
DatesSigned By DateInsertNew Registration  7/1/2024 7:53 PM
DatesStart DateInsertNew Registration  7/1/2024 7:53 PM
TerminationsTermination CommentsInsertNew Registration  7/1/2024 7:53 PM
TerminationsTermination DateInsertNew Registration  7/1/2024 7:53 PM
TerminationsTermination Effective DateInsertNew Registration  7/1/2024 7:53 PM
TerminationsTermination ReasonInsertNew Registration  7/1/2024 7:53 PM