Covered Entity Details

CH01081AB SOUTHWEST COMMUNITY HEALTH CENTER INC (Active) - information as of 4/26/2025 11:38:49 PM

Main Details

Name

SOUTHWEST COMMUNITY HEALTH CENTER INC

Subdivision Name

Thomas Merton Family Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038505

340B ID

CH01081AB

Grant Number

H80CS00613

Additional Details

Current Program Status

Active

Registration Date

7/3/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/28/2024

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

South-West Community Health Center, Inc.
Mollie Melbourne, President/CEO
(203) 332-3501

Primary Contact

Southwest Community Health center,Inc
Naila Haroon, Manager 340 B Program & Credentialing
(203) 332-3564

Addresses

Street Address

1406 State Street STE 221
Bridgeport, CT 06605-2005

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
CH010810	Active	BPS-H80-008748	South-West Community Health Center, Inc.	SOUTHWEST COMMUNITY HLTH CTR, INC	46 Albion St	Bridgeport	CT
CH01081A	Terminated	BPS-H80-003410	Southwest Community Health Center, Inc.	SOUTHWEST COMMUNITY HLTH CTR, INC	743 South Ave	Bridgeport	CT
CH01081AA	Active	BPS-H80-035890	SOUTHWEST COMMUNITY HEALTH CENTER INC	SOUTHWEST COMMUNITY HEALTH CENTER, INC - UC	1020 Fairfield Ave	Bridgeport	CT
CH01081AB	Active	BPS-H80-038505	SOUTHWEST COMMUNITY HEALTH CENTER INC	Thomas Merton Family Center	1406 State Street STE 221	Bridgeport	CT
CH01081AC	Approved	BPS-H80-038646	SOUTHWEST COMMUNITY HEALTH CENTER INC	Geraldine W. Johnson School	475 Lexington Ave STE 123Health	Bridgeport	CT
CH01081B	Active	BPS-H80-004980	Southwest Community Health Center, Inc.	SOUTHWEST COMMUNITY HLTH CTR,INC	510 Clinton Ave	Bridgeport	CT
CH01081C	Active	BPS-H80-001613	Southwest Community Health Center, Inc.	SOUTHWEST COMMUNITY HLTH CTR,INC	1046 Fairfield Ave	Bridgeport	CT
CH01081E	Active	BPS-H80-007463	Southwest Community Health Center, Inc.	CASA	690 Arctic St	Bridgeport	CT
CH01081F	Active	BPS-H80-006795	Southwest Community Health Center, Inc.	Casa Recovery	1124 Iranistan Ave	Bridgeport	CT
CH01081G	Active	BPS-H80-007366	Southwest Community Health Center, Inc.	OPERATION HOPE	50 Nichols St	Fairfield	CT
CH01081H	Active	BPS-H80-007004	Southwest Community Health Center, Inc.	PIVOT MINISTRIES	495 Jane St	Bridgeport	CT
CH01081I	Active	BPS-H80-006881	Southwest Community Health Center, Inc.	PROSPECT HOUSE	392 Prospect St	Bridgeport	CT
CH01081K	Active	BPS-H80-006955	Southwest Community Health Center, Inc.	HARRISON APARTMENTS	651 State St	Bridgeport	CT
CH01081M	Active	BPS-H80-004521	Southwest Community Health Center, Inc.	SOUTHWEST COMMUNITY HLTH CTR, INC	968 Fairfield Ave	Bridgeport	CT
CH01081N	Active	BPS-H80-008147	Southwest Community Health Center, Inc.	Florance Blackham School, School Based Health Centr	425 Thorme St	Bridgeport	CT
CH01081P	Active	BPS-H80-008150	Southwest Community Health Center, Inc.	Central High School, School Based Health Center	1 Lincoln Blvd	Bridgeport	CT
CH01081Q	Active	BPS-H80-008145	Southwest Community Health Center, Inc.	Bassick High School, School Based Health Clinic	1181 Fairfield Ave	Bridgeport	CT
CH01081R	Active	BPS-H80-008161	Southwest Community Health Center, Inc.	Read School, School Based Health Center	130 Ezra Street	Bridgeport	CT
CH01081S	Terminated	BPS-H80-012394	South-West Community Health Center, Inc.	Roosevelt Swing Site School	160 Iranistan	Bridgeport	CT
CH01081T	Active	BPS-H80-010267	Southwest Community Health Center, Inc.	Cesar Batalla, School Based Health Center	606 Howard Ave	Bridgeport	CT
CH01081U	Active	BPS-H80-017002	Southwest Community Health Center, Inc.	Roosevelt School School Based Health Center	680 Park Ave	Bridgeport	CT
CH01081V	Active	BPS-H80-015380	Southwest Community Health Center, Inc.	James J. Curiale School	300 Laurel Avenue	Bridgeport	CT
CH01081W	Active	BPS-H80-021629	Southwest Community Health Center, Inc.	FAMILY HEALTH CENTER	762 Lindley St	Bridgeport	CT
CH01081X	Active	BPS-H80-031862	Southwest Community Health Center, Inc.	Liberation Programs	399 Mill Hill Ave	Bridgeport	CT
CH01081Y	Active	BPS-H80-033709	Southwest Community Health Center, Inc.	Windward Apartments	509 Park Ave	Bridgeport	CT
CH01081Z	Active	BPS-H80-037128	SOUTHWEST COMMUNITY HEALTH CENTER INC	Hall Neighborhood House	52 George E Pipkins Way	Bridgeport	CT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH010810	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	10/01/2023
CH010810	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	10/01/2017
CH010810	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2019
CH01081M	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081C	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081X	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081Z	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081B	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081AA	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081W	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081Y	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081F	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH01081E	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	04/01/2024
CH010810	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2023
CH010810	AVITA PHARMACY 1061	PHARMBLUE MASSACHUSETTS LLC DBA AVITA PH	163 PLEASANT ST	ATTLEBORO	MA	02703-2457	10/01/2023
CH010810	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/01/2017
CH010810	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	10/01/2024
CH010810	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	10/01/2024
CH010810	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	10/01/2024
CH01081K	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081A	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081I	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081G	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081C	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081H	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081B	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081E	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH010810	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005
CH01081F	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081M	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	12/14/2005	04/01/2019
CH01081E	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081Z	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081Y	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081W	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081AA	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081M	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081C	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081X	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081B	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH01081F	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	04/01/2024
CH010810	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	07/01/2019
CH01081W	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081Y	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081F	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081AA	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081Z	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081B	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081C	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081E	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081X	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH01081M	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	04/01/2024
CH010810	CANYON MEDICAL PHARMACY, INC.	7265 S REVERE PARKWAY, SUITE 902		CENTENNIAL	CO	80112	10/01/2017
CH010810	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2021
CH010810	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2021
CH010810	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2021
CH010810	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2021
CH010810	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2021
CH010810	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2020
CH010810	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2021
CH010810	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2021
CH010810	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2021
CH010810	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2021
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02143	3710 MAIN STREET	BRIDGEPORT	CT	06606	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17072	120 HAWLEY LN	TRUMBULL	CT	06611	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10367	965 WHITE PLAINS RD.	TRUMBULL	CT	06611	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03373	961 BLACK ROCK TPKE.	FAIRFIELD	CT	06825	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02572	1 HAWLEY LANE	STRATFORD	CT	06614	10/01/2019
CH01081A	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02573	1425 BARNUM AVENUE	STRATFORD	CT	06614	10/01/2019	04/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02573	1425 BARNUM AVENUE	STRATFORD	CT	06614	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01139	2610 E MAIN ST. BRIARWOODS S/C	BRIDGEPORT	CT	06610	10/01/2019	09/29/2022
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17425	5065 MAIN ST STE TARGET	TRUMBULL	CT	06611	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01153	1875 BOSTON AVE, CVS PLAZA	BRIDGEPORT	CT	06610	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00133	698 POST RD.	FAIRFIELD	CT	06824	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01912	1968 BLACK ROCK TURNPIKE. FAIRWAY PLAZA	FAIRFIELD	CT	06825	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2151	330 GRASMERE AVE	FAIRFIELD	CT	06824	10/01/2019
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01941	511 MONROE TURNPIKE, RT 111 CENTURY PLZ	MONROE	CT	06468	04/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00718	24 PERSHING DR # 36	ANSONIA	CT	06401-2214	04/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00071	989 BOSTON POST ROAD	MILFORD	CT	06460	04/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01960	1279 WEST MAIN STREET	WATERBURY	CT	06708	04/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 16872	21 BROAD ST	STAMFORD	CT	06901	07/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #7856	281 CONNECTICUT AVENUE	NORWALK	CT	06854-1938	07/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02388	2000 NORTH MAIN STREET	WATERBURY	CT	06704	07/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00623	397 POST ROAD EAST	WESTPORT	CT	06880	07/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01149	696 WEST AVE.	NORWALK	CT	06850	07/01/2020
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 343	66 HIGH RIDGE ROAD	STAMFORD	CT	06905	01/01/2021
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01097	661 MAIN STREET	TORRINGTON	CT	06790	01/01/2021
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01968	369 MAIN STREET	EAST HAVEN	CT	06512	01/01/2021
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00775	2045 DIXWELL AVE.	HAMDEN	CT	06514	01/01/2021
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00124	98 BRIDGE ST.	NAUGATUCK	CT	06770	04/01/2021
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11264	705 BRIDGEPORT AVENUE	SHELTON	CT	06484	10/01/2021
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00811	1150 WHALLEY AVENUE	NEW HAVEN	CT	06515	10/01/2021
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01027	372 WEST MAIN STREET	NORWICH	CT	06360	04/01/2022
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00760	713 WEST MAIN STREET	NEW BRITAIN	CT	06053	04/01/2022
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 16633	475 HARTFORD RD	NEW BRITAIN	CT	06053	07/01/2022
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11007	123 CHURCH ST.	NEW HAVEN	CT	06510	07/01/2022
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #3549	355 CAMPBELL AVE.	WEST HAVEN	CT	06516-5329	07/01/2022
CH010810	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00377	915 POQUONNOCK RD.	GROTON	CT	06340	07/01/2022
CH01081F	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01153	1875 BOSTON AVE, CVS PLAZA	BRIDGEPORT	CT	06610	07/01/2024
CH01081E	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02143	3710 MAIN STREET	BRIDGEPORT	CT	06606	07/01/2024
CH01081T	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00133	698 POST RD.	FAIRFIELD	CT	06824	07/01/2024
CH01081R	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03373	961 BLACK ROCK TPKE.	FAIRFIELD	CT	06825	07/01/2024
CH01081W	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01912	1968 BLACK ROCK TURNPIKE. FAIRWAY PLAZA	FAIRFIELD	CT	06825	07/01/2024
CH01081V	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2151	330 GRASMERE AVE	FAIRFIELD	CT	06824	07/01/2024
CH01081P	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02572	1 HAWLEY LANE	STRATFORD	CT	06614	01/01/2025
CH01081Z	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17072	120 HAWLEY LN	TRUMBULL	CT	06611	01/01/2025
CH01081U	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02573	1425 BARNUM AVENUE	STRATFORD	CT	06614	01/01/2025
CH010810	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	05/13/2021
CH010810	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	05/13/2021
CH010810	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00693	1616 MEMORIAL DR.	CHICOPEE	MA	01020	05/13/2021
CH010810	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2021
CH010810	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	10/01/2017
CH010810	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08886	8601 SOUTH SEPULVEDA BOULEVARD	LOS ANGELES	CA	90045	05/13/2021
CH010810	GENOA HEALTHCARE LLC	941 BRIDGEPORT AVE	SUITE M5	MILFORD	CT	06460-3142	04/01/2025
CH010810	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2019
CH01081Z	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081M	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081Y	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081X	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081E	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081C	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081F	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081AA	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081W	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH01081B	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	04/01/2024
CH010810	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	10/01/2023
CH010810	MAXI DRUG, INC.	RITE AID #10386	1619 POST ROAD	FAIRFIELD	CT	06824	07/01/2020	08/01/2024
CH01081U	MAXI DRUG, INC.	RITE AID #10386	1619 POST ROAD	FAIRFIELD	CT	06824	07/01/2024	08/01/2024
CH010810	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01742	2901 WESLEY CHAPEL STOUTS RD.	MONROE	NC	28110	05/13/2021
CH010810	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05463	9805 ROCKY RIVER RD.	CHARLOTTE	NC	28215	05/13/2021
CH010810	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/01/2025
CH010810	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/01/2025
CH010810	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	04/01/2025
CH010810	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2025
CH010810	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/01/2025
CH010810	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2025
CH010810	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	10/01/2023	05/20/2024
CH010810	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2020
CH010810	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2021
CH010810	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2021
CH010810	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2021
CH010810	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY# 11235	9555 KINGS CHARTER DR., SUITE D	ASHLAND	VA	23005	04/01/2022	06/13/2023
CH010810	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2516	35 KNEELAND STREET	BOSTON	MA	02111	10/01/2024
CH01081R	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2516	35 KNEELAND STREET	BOSTON	MA	02111	04/01/2025
CH010810	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/01/2017
CH010810	RITE AID OF CONNECTICUT, INC.	RITE AID #3619	1060 EAST MAIN STREET	BRIDGEPORT	CT	06608	07/01/2020	08/01/2024
CH01081G	RITE AID OF CONNECTICUT, INC.	RITE AID #3619	1060 EAST MAIN STREET	BRIDGEPORT	CT	06608	07/01/2024	08/01/2024
CH010810	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/01/2017
CH010810	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03565	901 MARKET ST.	CHERAW	SC	29520	05/13/2021
CH010810	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #670	4531 MAIN STREET	BRIDGEPORT	CT	06606-1846	10/01/2020
CH010810	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #620	100 QUALITY STREET	TRUMBULL	CT	06611	10/01/2020
CH01081H	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #670	4531 MAIN STREET	BRIDGEPORT	CT	06606-1846	07/01/2024
CH01081Y	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #620	100 QUALITY STREET	TRUMBULL	CT	06611	07/01/2024
CH010810	UNITY PHARMACY BRIDGEPORT	679 FAIRFIELD AVE		BRIDGEPORT	CT	06604-3906	07/01/2020	01/20/2021
CH010810	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CH010810	WAL-MART PHARMACY 10-2163	465 BRIDGEPORT AVE		SHELTON	CT	06484	10/01/2019	07/01/2024
CH01081P	WAL-MART PHARMACY 10-2163	465 BRIDGEPORT AVE		SHELTON	CT	06484	07/01/2024
CH010810	WAL-MART PHARMACY 10-2585	150 BARNUM AVENUE CUTOFF		STRATFORD	CT	06614	10/01/2019
CH01081Q	WAL-MART PHARMACY 10-2585	150 BARNUM AVENUE CUTOFF		STRATFORD	CT	06614	07/01/2024
CH010810	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09521	1000 PARK AVENUE	BRIDGEPORT	CT	06604-3406	03/19/2012
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05723	960 NORTH AVE	BRIDGEPORT	CT	06606-5741	07/01/2013	08/19/2024
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #16080	414 KINGS HWY E	FAIRFIELD	CT	06825-4846	07/01/2013
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07522	4083 MAIN STREET	BRIDGEPORT	CT	06606	07/01/2013
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03359	1606 BARNUM AVE	STRATFORD	CT	06614-5301	07/01/2013
CH010810	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16548	300 FAIRFIELD AVE STE 103	BRIDGEPORT	CT	06604	04/01/2018
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07602	275 MONROE TURNPIKE	MONROE	CT	06468-2125	04/01/2022
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10177	54 WEST AVE	NORWALK	CT	06854-2225	04/01/2022
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07935	54 BOSTON POST RD	ORANGE	CT	06477-3201	04/01/2022	05/03/2023
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03192	649 W MAIN ST STE 2	WATERBURY	CT	06702	04/01/2022
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09612	700 BRIDGEPORT AVE STE 101	SHELTON	CT	06484	04/01/2022
CH01081G	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10058	235 MAIN ST	NORWALK	CT	06851	04/01/2022	01/13/2022
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06966	11 MERIDEN ROAD	WATERBURY	CT	06705-1933	04/01/2022	04/22/2025
CH010810	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10058	235 MAIN ST	NORWALK	CT	06851	04/01/2022
CH010810	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #21180	60 BANK ST STE 100	WATERBURY	CT	06702	10/01/2022
CH01081N	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16548	300 FAIRFIELD AVE STE 103	BRIDGEPORT	CT	06604	07/01/2024
CH01081I	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09521	1000 PARK AVENUE	BRIDGEPORT	CT	06604-3406	07/01/2024
CH01081M	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07522	4083 MAIN STREET	BRIDGEPORT	CT	06606	07/01/2024
CH01081X	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #16080	414 KINGS HWY E	FAIRFIELD	CT	06825-4846	07/01/2024
CH01081K	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05723	960 NORTH AVE	BRIDGEPORT	CT	06606-5741	07/01/2024	01/31/2025
CH01081G	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16548	300 FAIRFIELD AVE STE 103	BRIDGEPORT	CT	06604	01/01/2025
CH01081N	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03359	1606 BARNUM AVE	STRATFORD	CT	06614-5301	01/01/2025
CH010810	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	08/10/2015
CH010810	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	08/10/2015
CH010810	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH01081Z	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH010810	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/10/2025 9:56:08 AM	2/10/2025 9:56 AM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Melbourne, Mollie President/CEO South-West Community Health Center, Inc. 2033323501	8/28/2024 12:40 PM
Details	340B ID	Update	New Registration		CH01081AB	8/28/2024 12:40 PM
Dates	Participating Approval Date	Update	New Registration		8/28/2024 12:40:33 PM	8/28/2024 12:40 PM
Details	State	Update	New Registration	Pending	Approved	8/28/2024 12:40 PM
Dates	Signed By Date	Update	New Registration		7/3/2024 3:46:44 PM	8/28/2024 12:40 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/28/2024 12:40 PM
Addresses	Main Address	Insert	New Registration		1406 State Street STE 221 Bridgeport, CT 06605-2005	7/3/2024 3:23 PM
Contacts	Authorizing Official	Insert	New Registration		Melbourne, Mollie President/CEO South-West Community Health Center, Inc. 2033323501	7/3/2024 3:23 PM
Contacts	Primary Contact	Insert	New Registration		Haroon, Naila Manager 340 B Program & Credentialing Southwest Community Health center,Inc 2033323564	7/3/2024 3:23 PM
Details	Assistance Received From Date	Insert	New Registration			7/3/2024 3:23 PM
Details	Assistance Received To Date	Insert	New Registration			7/3/2024 3:23 PM
Details	Last Recertification Date	Insert	New Registration			7/3/2024 3:23 PM
Details	Grant Number	Insert	New Registration		H80CS00613	7/3/2024 3:23 PM
Details	340B ID	Insert	New Registration			7/3/2024 3:23 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/3/2024 3:23 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/3/2024 3:23 PM
Details	Medicare Provider Number	Insert	New Registration			7/3/2024 3:23 PM
Details	Entity Name	Insert	New Registration		SOUTHWEST COMMUNITY HEALTH CENTER INC	7/3/2024 3:23 PM
Details	NOFO Number	Insert	New Registration			7/3/2024 3:23 PM
Details	Program Code	Insert	New Registration		CH	7/3/2024 3:23 PM
Details	Entity Subname	Insert	New Registration		Thomas Merton Family Center	7/3/2024 3:23 PM
Dates	Participating Approval Date	Insert	New Registration			7/3/2024 3:23 PM
Details	State	Insert	New Registration		Pending	7/3/2024 3:23 PM
Dates	Registration Date	Insert	New Registration		7/3/2024 3:23:58 PM	7/3/2024 3:23 PM
Dates	Signed By Date	Insert	New Registration			7/3/2024 3:23 PM
Dates	Start Date	Insert	New Registration			7/3/2024 3:23 PM
Terminations	Termination Comments	Insert	New Registration			7/3/2024 3:23 PM
Terminations	Termination Date	Insert	New Registration			7/3/2024 3:23 PM
Terminations	Termination Effective Date	Insert	New Registration			7/3/2024 3:23 PM
Terminations	Termination Reason	Insert	New Registration			7/3/2024 3:23 PM

340B Drug Pricing Program Database