Covered Entity Details

CH03015Q TOTAL HEALTH CARE, INC. (Active) - information as of 5/20/2025 11:36:19 PM

Main Details

Name

TOTAL HEALTH CARE, INC.

Subdivision Name

SOUTH BALTIMORE HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038169

340B ID

CH03015Q

Grant Number

H80CS00068

Additional Details

Current Program Status

Active

Registration Date

10/9/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/11/2024

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Total Health Care, Inc.
Danny Bellamy, CEO
(410) 728-4090

Primary Contact

Total Health Care
Adetoro Oriaifo, Chief Pharmacy Officer
(410) 710-7406

Addresses

Street Address

3540 S Hanover St
Brooklyn, MD 21225-1772

Billing Address

Total health care, INC
1501 W Saratoga St
Address line 2
BALTIMORE, MD 21223

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
MD	022037000,022235600,023522900,030201500,339808100,197519600	1013902485,1144578352,1346484516,1487888772,1588964399,1801880315,1801881271,1831323120,1932333226,1992889943,1588400907,1184437683

Shipping Addresses

Shipping Address 1

Total Health Care, INC
SOUTH BALTIMORE HEALTH CENTER
3540 S HANOVER ST
BALTIMORE, MD 21225-1772

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	Address Cont.	City	State
CH030150	Active	BPS-H80-004283	Total Health Care, Inc.	Division Health Center	1501 DIVISION STREET		BALTIMORE	MD
CH03015A	Active	BPS-H80-001868	TOTAL HEALTH CARE, INC.	SARATOGA HEALTH CENTER	1501 W Saratoga St		Baltimore	MD
CH03015B	Active	BPS-H80-004479	TOTAL HEALTH CARE, INC.	Kirk Health Center	2400 Kirk Ave		Baltimore	MD
CH03015C	Active	BPS-H80-005421	TOTAL HEALTH CARE, INC.	Mondawmin Mall Health Center	2401 Liberty Heights Avenue STE 111-113		BALTIMORE	MD
CH03015D	Active	BPS-H80-004283	TOTAL HEALTH CARE, INC.	DIVISION HEALTH CENTER	1501 DIVISION STREET		Baltimore	MD
CH03015J	Active	BPS-H80-014401	TOTAL HEALTH CARE, INC.	OPEN GATES HEALTH CENTER	1111 Washington Blvd		Baltimore	MD
CH03015K	Terminated	BPS-H80-005303	TOTAL HEALTH CARE, INC.	Men's Health Center	1515 W North Ave		Baltimore	MD
CH03015L	Active	BPS-H80-017656	TOTAL HEALTH CARE, INC.	Westside Health Center	2449 Frederick Avenue		Baltimore	MD
CH03015M	Terminated	BPS-H80-015309	TOTAL HEALTH CARE, INC.	Total Health Care @ MedStar Union Memorial Hospital	200 East 33rd Street		Baltimore	MD
CH03015N	Terminated	BPS-H80-004218	TOTAL HEALTH CARE, INC.	Mt. Royal Health Center	922-924 W. NORTH AVE		BALTIMORE	MD
CH03015P	Terminated	BPS-H80-017490	TOTAL HEALTH CARE, INC.	Odenton Health Center	1215 Annapolis Road		Odenton	MD
CH03015Q	Active	BPS-H80-038169	TOTAL HEALTH CARE, INC.	SOUTH BALTIMORE HEALTH CENTER	3540 S Hanover St		Brooklyn	MD
CH03015R	Active	BPS-H80-039061	TOTAL HEALTH CARE, INC.	Odenton Health Center	2288 Blue Water BLVD Suite 440	2288 Blue Water BLVD Suite 470	Odenton	MD

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH030150	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2022
CH030150	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/01/2022
CH030150	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/01/2022
CH030150	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2022
CH030150	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/01/2022
CH030150	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/01/2022
CH030150	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2017	07/08/2019
CH030150	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2017	07/08/2019
CH030150	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2017	07/08/2019
CH030150	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2017	07/08/2019
CH030150	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2017	07/08/2019
CH030150	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2017
CH030150	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2017	07/08/2019
CH030150	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2017	07/08/2019
CH030150	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2017	07/08/2019
CH030150	EAGER PARK PHARMACY AND HEALTH SERVICES,	DBA WALGREENS #15284	900 N. WASHINGTON STREET SUITE 1	BALTIMORE	MD	21205	04/01/2017
CH030150	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/01/2022
CH030150	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/01/2022
CH030150	GIANT FOOD INC	GIANT PHARMACY 117	6223 BALTO NAT'L PIKE	BALTIMORE	MD	21228	10/01/2021
CH030150	GIANT OF MARYLAND	GIANT PHARMACY 145	5150 SINCLAIR LANE	BALTIMORE	MD	21206	10/01/2021
CH030150	GIANT PHARMACY #159	3757 OLD COURT RD		PIKESVILLE	MD	21208	10/01/2021	04/17/2022
CH030150	GIANT PHARMACY #303	601 EAST 33RD STREET		BALTIMORE	MD	21218	10/01/2021
CH030150	GIANT PHARMACY #322	11604 REISTERSTOWN RD		REISTERSTOWN	MD	21136	10/01/2021	04/17/2022
CH030150	GIANT PHARMACY #337	6620 REISTERSTOWN RD		BALTIMORE	MD	21215	10/01/2021
CH030150	GIANT PHARMACY 108	6340 YORK RD		BALTIMORE	MD	21212	10/01/2021	05/20/2022
CH030150	GIANT PHARMACY 166	4622 WILKENS AVE		BALTIMORE	MD	21229	10/01/2021	07/03/2023
CH030150	MARYLAND CVS PHARMACY, L.L.C	DBA CVS/PHARMACY #17778	6163 OXON HILL ROAD	OXON HILL	MD	20745	07/01/2020	03/05/2024
CH030150	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17456	3201 TIOGA PKWY	BALTIMORE	MD	21215	01/01/2018	12/14/2017
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03976	2509-2523 PENNSYLVANIA AVE.	BALTIMORE	MD	21217	01/01/2018
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	04/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10123	101 NORTH WOLFE ST.	BALTIMORE	MD	21231	04/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05764	2560 WEST FRANKLIN STREET	BALTIMORE	MD	21223	04/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02522	3300 BELAIR RD.	BALTIMORE	MD	21213	04/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04079	5603 BALTIMORE NATIONAL PIKE	BALTIMORE	MD	21228	04/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02334	2504 N. CHARLES STREET	BALTIMORE	MD	21218	04/01/2019	07/12/2023
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04411	5501 PARK HEIGHTS AVE	BALTIMORE	MD	21215	04/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05381	1000 S. CHARLES ST.	BALTIMORE	MD	21230	04/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02034	5200 YORK ROAD	BALTIMORE	MD	21212	04/01/2019	02/05/2025
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02010	1102 ANNAPOLIS RD	ODENTON	MD	21113	04/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04129	1000 TAYLOR AVE	TOWSON	MD	21286	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03974	5407-17 HARFORD RD	BALTIMORE	MD	21214	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04107	6828 REISTERSTOWN RD	BALTIMORE	MD	21215	10/01/2019	05/12/2022
CH030150	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04302	8302 LIBERTY RD	BALTIMORE	MD	21244	10/01/2019	01/18/2020
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04438	6635-37 BELAIR RD	BALTIMORE	MD	21206	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07952	630 EXETER ST.	BALTIMORE	MD	21202	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04429	7845 WISE AVE.	BALTIMORE	MD	21222	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02066	4625 FALLS ROAD	BALTIMORE	MD	21209	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10094	5405 LYNX LANE	COLUMBIA	MD	21044	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04030	11623 REISTERSTOWN RD	REISTERSTOWN	MD	21136	10/01/2019
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01621	3855 LEONARDTOWN RD.	WALDORF	MD	20601	07/01/2020
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #3047	8601 MARTIN LUTHER KING JR HIGHWAY	LANHAM	MD	20706	07/01/2020
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04418	8501 FORT SMALLWOOD RD.	PASADENA	MD	21122	10/01/2020
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02865	500 EASTERN AVE.	ESSEX	MD	21221	10/01/2020
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02160	9519 PHILADELPHIA ROAD	BALTIMORE	MD	21237	10/01/2020
CH030150	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07656	3915 HOLLINS FERRY ROAD	BALTIMORE	MD	21227	10/01/2020	03/06/2025
CH030150	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2017
CH030150	RITE AID OF MARYLAND, INC.	RITE AID #337	3935-37 ERDMAN AVENUE	BALTIMORE	MD	21213	04/01/2019	02/19/2019
CH030150	RITE AID OF MARYLAND, INC.	RITE AID #104	238 MCMECHEN STREET	BALTIMORE	MD	21217	04/01/2019	02/19/2019
CH030150	RITE AID OF MARYLAND, INC.	RITE AID #2280	300 MARTIN LUTHER KING JR BLVD	BALTIMORE	MD	21201	04/01/2019	02/19/2019
CH030150	RITE AID OF MARYLAND, INC.	RITE AID #336	3133 GREENMOUNT AVENUE	BALTIMORE	MD	21218	04/01/2019	02/19/2019
CH030150	RITE AID OF MARYLAND, INC.	RITE AID #362	4600 WEST NORTHERN PARKWAY	BALTIMORE	MD	21215	10/01/2021	04/01/2022
CH030150	RITE AID OF MARYLAND, INC.	RITE AID #2210	1400 SULPHUR SPRING ROAD	BALTIMORE	MD	21227	10/01/2021	04/01/2022
CH030150	RITE AID OF MARYLAND, INC.	RITE AID #349	4380 PARK HEIGHTS AVE.	BALTIMORE	MD	21215	10/01/2021	04/01/2022
CH030150	RITE AID OF MARYLAND, INC.	RITE AID #4295	250 WEST CHASE STREET	BALTIMORE	MD	21202	10/01/2021	01/17/2024
CH030150	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020
CH030150	WAL-MART PHARMACY 10-2009	401 CONSTANT FRIENDSHIP BLVD		ABINGDON	MD	21009	10/01/2021	06/01/2022
CH030150	WAL-MART PHARMACY 10-2248	6205 BALTIMORE NATIONAL PIKE		CATONSVILLE	MD	21228	10/01/2020	10/02/2020
CH030150	WAL-MART PHARMACY 10-2435	2399 NORTH POINT BLVD		DUNDALK	MD	21222	10/01/2021	06/01/2022
CH030150	WAL-MART PHARMACY 10-3481	112 CARROLL ISLAND RD		BALTIMORE	MD	21220	10/01/2021	06/01/2022
CH030150	WAL-MART PHARMACY 10-3489	6420 PETRIE WAY		BALTIMORE (ROSEDALE)	MD	21237	10/01/2021
CH030150	WAL-MART PHARMACY 10-3720	3601 WASHINGTON BLVD		ARBUTUS	MD	21227	10/01/2020
CH030150	WAL-MART PHARMACY 10-5344	1238 PUTTY HILL AVE STE 5		TOWSON	MD	21286-5878	10/01/2021	06/01/2022
CH030150	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2020
CH030150	WALGREEN CO.	DBA: WALGREENS # 05331	8050 LIBERTY ROAD	BALTIMORE	MD	21244	01/01/2013	11/06/2023
CH030150	WALGREEN CO.	DBA: WALGREENS # 05408	1300 EAST NORTH AVE	BALTIMORE	MD	21213-1406	01/01/2013	11/08/2024
CH030150	WALGREEN CO.	DBA: WALGREENS # 05409	4020 EASTERN AVENUE	BALTIMORE	MD	21224	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 05410	19 E FAYETTE ST STE 100	BALTIMORE	MD	21202	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 05587	9621 BELAIR RD	BALTIMORE	MD	21236	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 05623	3801 LIBERTY HEIGHTS AVE	BALTIMORE	MD	21215	01/01/2013	01/23/2025
CH030150	WALGREEN CO.	DBA: WALGREENS # 05638	4025 W NORTHERN PKWY	BALTIMORE	MD	21215	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 06265	9110 LIBERTY ROAD	RANDALLSTOWN	MD	21133	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 06320	2204 N ROLLING ROAD	BALTIMORE	MD	21244	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 21331	2001 W PATAPSCO AVE	BALTIMORE	MD	21230	01/01/2013	01/27/2025
CH030150	WALGREEN CO.	DBA: WALGREENS # 07554	7901 RITCHIE HIGHWAY	GLEN BURNIE	MD	21061	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 07573	6301 YORK ROAD	BALTIMORE	MD	21212-2636	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 07574	5657 BALTIMORE NATIONAL PIKE	CATONSVILLE	MD	21228-1412	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS # 09028	6700 RITCHIE HWY	GLEN BURNIE	MD	21061-2319	01/01/2013
CH030150	WALGREEN CO.	DBA: WALGREENS #16188	2000 W. BALTIMORE STREET	BALTIMORE	MD	21223	10/01/2015	02/19/2019
CH030150	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15308	6 N HOWARD ST	BALTIMORE	MD	21201	04/01/2017
CH030150	WALGREEN CO.	DBA: WALGREENS #16190	301 SAINT PAUL ST	BALTIMORE	MD	21202	04/01/2017
CH030150	WALGREEN CO.	DBA: WALGREENS #13816	8374 PINEY ORCHARD PKWY.	ODENTON	MD	21113-1538	04/01/2017
CH030150	WALGREEN CO.	DBA: WALGREENS #16191	2411 W. BELVEDERE AVENUE SUITE 101	BALTIMORE	MD	21215	04/01/2017
CH03015N	WALGREEN CO.	DBA: WALGREENS # 05408	1300 EAST NORTH AVE	BALTIMORE	MD	21213-1406	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 05331	8050 LIBERTY ROAD	BALTIMORE	MD	21244	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 05409	4020 EASTERN AVENUE	BALTIMORE	MD	21224	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 05410	19 E FAYETTE ST STE 100	BALTIMORE	MD	21202	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 05587	9621 BELAIR RD	BALTIMORE	MD	21236	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 05623	3801 LIBERTY HEIGHTS AVE	BALTIMORE	MD	21215	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 05638	4025 W NORTHERN PKWY	BALTIMORE	MD	21215	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 06265	9110 LIBERTY ROAD	RANDALLSTOWN	MD	21133	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 06320	2204 N ROLLING ROAD	BALTIMORE	MD	21244	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 21331	2001 W PATAPSCO AVE	BALTIMORE	MD	21230	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 07554	7901 RITCHIE HIGHWAY	GLEN BURNIE	MD	21061	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 07573	6301 YORK ROAD	BALTIMORE	MD	21212-2636	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 07574	5657 BALTIMORE NATIONAL PIKE	CATONSVILLE	MD	21228-1412	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS # 09028	6700 RITCHIE HWY	GLEN BURNIE	MD	21061-2319	01/01/2016	07/02/2019
CH03015N	WALGREEN CO.	DBA: WALGREENS #16188	2000 W. BALTIMORE STREET	BALTIMORE	MD	21223	01/01/2016	07/01/2023
CH030150	WALGREEN CO.	WALGREENS #17609	300 MARTIN LUTHER KING JR BLVD	BALTIMORE	MD	21201	01/01/2019	11/16/2023
CH030150	WALGREEN CO.	WALGREENS #17205	1030 W 41ST ST STE E	BALTIMORE	MD	21211-1662	01/01/2019
CH030150	WALGREEN CO.	WALGREENS #19383	1132 ANNAPOLIS RD	ODENTON	MD	21113	01/01/2019
CH030150	WALGREEN CO.	WALGREENS #18337	3700 FALLS RD	BALTIMORE	MD	21211	01/01/2019	11/13/2024
CH030150	WALGREEN CO.	WALGREENS #17889	3935 ERDMAN AVE # 37	BALTIMORE	MD	21213-2004	01/01/2019	02/21/2023
CH030150	WALGREEN CO.	WALGREENS #18082	6401 FREDERICK RD	CATONSVILLE	MD	21228	01/01/2019
CH030150	WALGREEN CO.	WALGREENS #19374	6622 SECURITY BLVD # 24	BALTIMORE	MD	21207-4010	01/01/2019	09/18/2023
CH030150	WALGREEN CO.	WALGREENS #19924	7649 HARFORD RD	BALTIMORE	MD	21234	01/01/2019
CH030150	WALGREEN CO.	WALGREENS #18015	4733 WESTLAND BLVD STE 21	ARBUTUS	MD	21227	01/01/2019
CH030150	WALGREEN CO.	RITE AID #00368	1538 HAVENWOOD RD, SUITE 42	BALTIMORE	MD	21218	01/01/2019	06/17/2019
CH030150	WALGREEN CO.	RITE AID #00336	3133 GREENMOUNT AVENUE	BALTIMORE	MD	21218	01/01/2019	02/10/2020
CH030150	WALGREEN CO.	WALGREENS #18951	2633 BRANDERMILL BLVD	GAMBRILLS	MD	21054	01/01/2019
CH030150	WALGREEN CO.	WALGREENS #18155	4214 FRANKFORD AVE	BALTIMORE	MD	21206-5131	01/01/2019	01/22/2025
CH030150	WALGREEN CO.	DBA: WALGREENS #16049	2041 GEORGIA AVE NW #1-J10	WASHINGTON	DC	20060	01/01/2019
CH030150	WALGREEN CO.	WALGREENS #18308	2700 REMINGTON AVE STE 500	BALTIMORE	MD	21211-3043	01/01/2019
CH030150	WALGREEN CO.	DBA: WALGREENS #16199	900 S. CATON AVENUE	BALTIMORE	MD	21229	01/01/2019	10/14/2019
CH030150	WALGREEN CO.	WALGREENS #17587	6838 LOCH RAVEN BLVD	BALTIMORE	MD	21286	01/01/2019
CH030150	WALGREEN CO.	WALGREENS #19577	903 E FORT AVE	BALTIMORE	MD	21230	01/01/2019	11/15/2022
CH030150	WALGREEN CO.	WALGREENS #19427	403 GEORGE CLAUSS BLVD	SEVERN	MD	21144	01/01/2019
CH030150	WALGREEN CO.	WALGREENS #19401	711 W 40TH ST	BALTIMORE	MD	21211-2120	01/01/2019	05/03/2023
CH030150	WALGREEN CO.	WALGREENS #17522	238 MCMECHEN ST	BALTIMORE	MD	21217	01/01/2019
CH030150	WALGREEN CO.	RITE AID #00366	2497 FREDERICK AVE	BALTIMORE	MD	21223	04/01/2019	05/20/2019
CH030150	WALGREEN CO.	DBA: WALGREENS #16186	6565 N. CHARLES STREET	BALTIMORE	MD	21204	04/01/2019	11/15/2022
CH030150	WALGREEN CO.	RITE AID #01792	5618 THE ALAMEDA	BALTIMORE	MD	21239	07/01/2019	05/03/2019
CH030150	WALGREEN CO.	WALGREENS #19115	140 BACK RIVER NECK RD	BALTIMORE	MD	21221-3924	07/01/2019
CH030150	WALGREEN CO.	DBA: WALGREENS #16188	2000 W. BALTIMORE STREET	BALTIMORE	MD	21223	10/01/2019
CH030150	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21166	1114 CATHEDRAL ST. SUITE 3	BALTIMORE	MD	21201	10/01/2021
CH030150	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH030150	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Change Request	Totalhealthcare INC 1501 W Saratoga St Address line 2 BALTIMORE, MD 21223	Total health care, INC 1501 W Saratoga St Address line 2 BALTIMORE, MD 21223	3/5/2025 1:19 PM
Addresses	Shipping Address	Insert	Change Request		Total Health Care, INC SOUTH BALTIMORE HEALTH CENTER 3540 S HANOVER ST BALTIMORE, MD 21225-1772	3/5/2025 1:19 PM
Addresses	Billing Address	Update	Change Request	Totalhealthcare INC 1501 DIVISION STREET Address line 2 BALTIMORE, MD 21217-8030	Totalhealthcare INC 1501 W Saratoga St Address line 2 BALTIMORE, MD 21223	2/19/2025 7:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/19/2025 7:59 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		197519600	2/19/2025 7:59 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	2/19/2025 7:59 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1285018226 (MD)		2/19/2025 7:59 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1942295423 (MD)		2/19/2025 7:59 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1184437683	2/19/2025 7:59 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	2/19/2025 7:59 AM
Details	Entity Subname	Update	Change Request	Brooklyn Location	SOUTH BALTIMORE HEALTH CENTER	2/19/2025 7:59 AM
Details	Last Recertification Date	Update	Recertification		2/10/2025 10:39:02 AM	2/10/2025 10:39 AM
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Addresses	Billing Address	Update	Change Request	Totalhealthcare INC 2401 Liberty Heights Avenue lower level Baltimore, MD 21215-8030	Totalhealthcare INC 1501 DIVISION STREET Address line 2 BALTIMORE, MD 21217-8030	11/5/2024 11:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		022037000	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		022235600	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		023522900	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		030201500	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		339808100	10/30/2024 2:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1013902485	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144578352	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1285018226	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1346484516	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1487888772	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1588964399	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1801880315	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1801881271	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1831323120	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932333226	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1942295423	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1992889943	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1588400907	10/30/2024 2:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/30/2024 2:39 PM
Contacts	Signed By	Insert	New Registration		Bellamy, Danny CEO Total Health Care, Inc. 4107284090	10/11/2024 10:35 AM
Details	340B ID	Update	New Registration		CH03015Q	10/11/2024 10:35 AM
Dates	Participating Approval Date	Update	New Registration		10/11/2024 10:35:24 AM	10/11/2024 10:35 AM
Details	State	Update	New Registration	Pending	Approved	10/11/2024 10:35 AM
Dates	Signed By Date	Update	New Registration		10/10/2024 9:10:09 AM	10/11/2024 10:35 AM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/11/2024 10:35 AM
Addresses	Main Address	Insert	New Registration		3540 S Hanover St Brooklyn, MD 21225-1772	10/9/2024 12:59 PM
Addresses	Billing Address	Insert	New Registration		Totalhealthcare INC 2401 Liberty Heights Avenue lower level Baltimore, MD 21215-8030	10/9/2024 12:59 PM
Contacts	Authorizing Official	Insert	New Registration		Bellamy, Danny CEO Total Health Care, Inc. 4107284090	10/9/2024 12:59 PM
Contacts	Primary Contact	Insert	New Registration		Oriaifo, Adetoro Chief Pharmacy Officer Total Health Care 4107107406	10/9/2024 12:59 PM
Details	Assistance Received From Date	Insert	New Registration			10/9/2024 12:59 PM
Details	Assistance Received To Date	Insert	New Registration			10/9/2024 12:59 PM
Details	Last Recertification Date	Insert	New Registration			10/9/2024 12:59 PM
Details	Grant Number	Insert	New Registration		H80CS00068	10/9/2024 12:59 PM
Details	340B ID	Insert	New Registration			10/9/2024 12:59 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/9/2024 12:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/9/2024 12:59 PM
Details	Medicare Provider Number	Insert	New Registration			10/9/2024 12:59 PM
Details	Entity Name	Insert	New Registration		TOTAL HEALTH CARE, INC.	10/9/2024 12:59 PM
Details	NOFO Number	Insert	New Registration			10/9/2024 12:59 PM
Details	Program Code	Insert	New Registration		CH	10/9/2024 12:59 PM
Details	Entity Subname	Insert	New Registration		Brooklyn Location	10/9/2024 12:59 PM
Dates	Participating Approval Date	Insert	New Registration			10/9/2024 12:59 PM
Details	State	Insert	New Registration		Pending	10/9/2024 12:59 PM
Dates	Registration Date	Insert	New Registration		10/9/2024 12:59:41 PM	10/9/2024 12:59 PM
Dates	Signed By Date	Insert	New Registration			10/9/2024 12:59 PM
Dates	Start Date	Insert	New Registration			10/9/2024 12:59 PM
Terminations	Termination Comments	Insert	New Registration			10/9/2024 12:59 PM
Terminations	Termination Date	Insert	New Registration			10/9/2024 12:59 PM
Terminations	Termination Effective Date	Insert	New Registration			10/9/2024 12:59 PM
Terminations	Termination Reason	Insert	New Registration			10/9/2024 12:59 PM

340B Drug Pricing Program Database