Covered Entity Details

FQHCLA464A SOLVERA HEALTHCARE CENTER INC (ToBeTerminated) - information as of 5/6/2025 12:03:38 AM

Main Details

Name

SOLVERA HEALTHCARE CENTER INC

Subdivision Name

Solvera Health Carbondale

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-038935

340B ID

FQHCLA464A

Grant Number

LALCS53029

Additional Details

Current Program Status

ToBeTerminated

Registration Date

8/1/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/13/2024

Last Recertification Date

2/27/2025

Termination Date
Termination Reason

7/1/2025
Site closure

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

2250 Reed Station Pkwy, Ste 305
Carbondale, IL 62901-8104

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	036136586,524390610001,862788917003	1144008939,1619716214,1447514971,1750064838

Shipping Addresses

Shipping Address 1

Solvera Healthcare Center Inc
2250 Reed Station Pkwy
Ste 305
Carbondale, IL 62901

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
FQHCLA464	Active	BPS-LAL-038595	SOLVERA HEALTHCARE CENTER INC	Solvera Healthcare Center Inc	3525 N University St	Peoria	IL
FQHCLA464A	ToBeTerminated	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
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/2/2025 12:00:00 AM	5/5/2025 9:53 AM
Details	State	Update	Termination Request	Active	To Be Terminated	5/5/2025 9:53 AM
Terminations	Termination Date	Update	Termination Request		7/1/2025 12:00:00 AM	5/5/2025 9:53 AM
Terminations	Termination Effective Date	Update	Termination Request		5/5/2025 12:00:00 AM	5/5/2025 9:53 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	5/5/2025 9:53 AM
Addresses	Shipping Address	Delete	Recertification	Safecor Health, LLC 317 New Boston Street Suite 100 Woburn, MA 01801		2/27/2025 9:55 AM
Addresses	Shipping Address	Delete	Recertification	Safecor Health, LLC 4060 Business Park Drive Columbus, OH 43204		2/27/2025 9:55 AM
Details	Last Recertification Date	Update	Recertification		2/27/2025 9:55:59 AM	2/27/2025 9:55 AM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Addresses	Shipping Address	Insert	Change Request		Solvera Healthcare Center Inc 2250 Reed Station Pkwy Ste 305 Carbondale, IL 62901	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
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/25/2024 8:33 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		862788917003	9/25/2024 8:33 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	9/25/2024 8:33 AM
Contacts	Signed By	Insert	New Registration		Caplis, Patrick Joseph CEO Solvera Healthcare Center, Inc. 3094539052	8/13/2024 12:37 PM
Details	340B ID	Update	New Registration		FQHCLA464A	8/13/2024 12:37 PM
Dates	Participating Approval Date	Update	New Registration		8/13/2024 12:37:33 PM	8/13/2024 12:37 PM
Details	State	Update	New Registration	Pending	Approved	8/13/2024 12:37 PM
Dates	Signed By Date	Update	New Registration		8/1/2024 3:52:40 PM	8/13/2024 12:37 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/13/2024 12:37 PM
Addresses	Main Address	Insert	New Registration		2250 Reed Station Pkwy, Ste 305 Carbondale, IL 62901-8104	8/1/2024 3:50 PM
Addresses	Billing Address	Insert	New Registration		Solvera Healthcare Center Inc PO BOX 9727 Peoria, IL 61612-9727	8/1/2024 3:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/1/2024 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		036136586	8/1/2024 3:50 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	8/1/2024 3:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/1/2024 3:50 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		524390610001	8/1/2024 3:50 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	8/1/2024 3:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1144008939	8/1/2024 3:50 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	8/1/2024 3:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619716214	8/1/2024 3:50 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	8/1/2024 3:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1447514971	8/1/2024 3:50 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	8/1/2024 3:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1750064838	8/1/2024 3:50 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	8/1/2024 3:50 PM
Contacts	Authorizing Official	Insert	New Registration		Caplis, Patrick Joseph CEO Solvera Healthcare Center, Inc. 3094539052	8/1/2024 3:50 PM
Contacts	Primary Contact	Insert	New Registration		Caplis, Matthew Director of Administration Solvera Healthcare Center Inc 3099228166	8/1/2024 3:50 PM
Details	Assistance Received From Date	Insert	New Registration			8/1/2024 3:50 PM
Details	Assistance Received To Date	Insert	New Registration			8/1/2024 3:50 PM
Details	Last Recertification Date	Insert	New Registration			8/1/2024 3:50 PM
Details	Grant Number	Insert	New Registration		LALCS53029	8/1/2024 3:50 PM
Details	340B ID	Insert	New Registration			8/1/2024 3:50 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			8/1/2024 3:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			8/1/2024 3:50 PM
Details	Medicare Provider Number	Insert	New Registration			8/1/2024 3:50 PM
Details	Entity Name	Insert	New Registration		SOLVERA HEALTHCARE CENTER INC	8/1/2024 3:50 PM
Details	NOFO Number	Insert	New Registration			8/1/2024 3:50 PM
Details	Program Code	Insert	New Registration		FQHCLA	8/1/2024 3:50 PM
Details	Entity Subname	Insert	New Registration		Solvera Health Carbondale	8/1/2024 3:50 PM
Dates	Participating Approval Date	Insert	New Registration			8/1/2024 3:50 PM
Details	State	Insert	New Registration		Pending	8/1/2024 3:50 PM
Dates	Registration Date	Insert	New Registration		8/1/2024 3:50:43 PM	8/1/2024 3:50 PM
Dates	Signed By Date	Insert	New Registration			8/1/2024 3:50 PM
Dates	Start Date	Insert	New Registration			8/1/2024 3:50 PM
Terminations	Termination Comments	Insert	New Registration			8/1/2024 3:50 PM
Terminations	Termination Date	Insert	New Registration			8/1/2024 3:50 PM
Terminations	Termination Effective Date	Insert	New Registration			8/1/2024 3:50 PM
Terminations	Termination Reason	Insert	New Registration			8/1/2024 3:50 PM

340B Drug Pricing Program Database