Covered Entity Details

CH011280 DIMOCK COMM HEALTH CENTER (Active) - information as of 5/13/2025 10:58:20 PM

Main Details

Name

DIMOCK COMM HEALTH CENTER

Subdivision Name

DIMOCK COMM HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-005591

340B ID

CH011280

Grant Number

H80CS00151

Additional Details

Current Program Status

Active

Registration Date

7/1/2003

Participating Start Date

7/1/2003

Participating Approval Date

8/21/2003

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Dimock Community Health Center
Charles Anderson, CEO
(617) 442-8800 Ext: 1208

Primary Contact

The Dimock Center
Alejandra Barrios, Director of Compliance
(617) 981-0415

Addresses

Street Address

45 DIMOCK ST
ROXBURY, MA 02119

Billing Address

DIMOCK COMM HEALTH CENTER
55 Dimock St
Roxbury, MA 02119

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
ADDRESS	08/21/2003

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
MA	110027813A	1487894291

Shipping Addresses

Shipping Address 1

Dimock Pharmacy
55 Dimock St
Roxbury, MA 02119

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	07/20/2017	10/01/2017		10/01/2017
Contract Detail	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	01/15/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10605	37 WEST MAIN STREET	STAFFORD SPRINGS	CT	06076	04/15/2021	07/01/2021		07/01/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00943	1200 MAIN STREET	WILLIMANTIC	CT	06226	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/14/2020	01/01/2021		01/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/14/2020	01/01/2021		01/01/2021
Contract Detail	CVS PHARMACY, INC.	CVS/PHARMACY # 11301	55 DIMOCK ST.	ROXBURY	MA	02119	06/26/2019	06/29/2019	07/31/2024	09/20/2024
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02162	300 LONGWOOD AVE. CHILDRENS HOSPITAL	BOSTON	MA	02115	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00720	2235 DORCHESTER AVENUE	BOSTON	MA	02124	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02283	715 MORRISSEY BOULEVARD	DORCHESTER	MA	02122	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	CVS PHARMACY # 17018	7 ALLSTATE RD	DORCHESTER	MA	02125	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01264	704 CENTRE STREET	JAMAICA PLAIN	MA	02130	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01248	240 OAK STREET	BROCKTON	MA	02301	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 5464	1575 BLUE HILL AVE	MATTAPAN	MA	02126	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02070	467 CENTRE STREET	JAMAICA PLAIN	MA	02130	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01006	316 NORTH PEARL STREET	BROCKTON	MA	02301	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11036	451 WASHINGTON STREET	DORCHESTER	MA	02124	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01252	874 HARRISON AVE	BOSTON	MA	02118	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01049	942A HYDE PARK AVENUE	HYDE PARK	MA	02136	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01007	1267 MAIN ST	BROCKTON	MA	02301-7107	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02282	703 GALLIVAN BOULEVARD	DORCHESTER	MA	02124	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00471	778 DUDLEY ST.	DORCHESTER	MA	02125	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02592	468 BLUE HILL AVE	DORCHESTER	MA	02121	07/09/2019	10/01/2019		10/01/2019
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01263	10 BASSETT STREET	MILTON	MA	02186	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01862	1195 BOYLSTON STREET	CHESTNUT HILL	MA	02467	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01258	191 CAMBRIDGE ST	BOSTON	MA	02114	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00746	171 NORTH MAIN STREET	RANDOLPH	MA	02368	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00983	2019 LAKEVIEW AVENUE	DRACUT	MA	01826	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00114	12 HARVARD ST.	WALTHAM	MA	02453	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00055	1927 BEACON ST.	BRIGHTON	MA	02135	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00109	1010 REVERE BEACH PKWY	CHELSEA	MA	02150	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 03890	207 MARKET STREET	BRIGHTON	MA	02135	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01009	21 AUSTIN STREET BUNKER HILL MALL	CHARLESTOWN	MA	02129	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00155	539 MAIN ST # 545	WINCHESTER	MA	01890	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 03307	400 TREMONT STREET	BOSTON	MA	02116	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	CVS/PHARMACY #10517	91 SEAPORT BLVD UNIT H	BOSTON	MA	02210	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 05402	7 WASHINGTON ST.	TAUNTON	MA	02780	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01259	231 MASSACHUSETTS AVENUE	BOSTON	MA	02115	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00137	626 SOUTHERN ARTERY, RTE 3A	QUINCY	MA	02169	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00444	74 EAST MAIN STREET	WESTBOROUGH	MA	01581	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01861	884-886 WASHINGTON STREET	BRAINTREE	MA	02184	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06505	978 BOYLSTON ST	NEWTON	MA	02461	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00307	1735 MASSACHUSETTS AVENUE	LEXINGTON	MA	02420	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02454	321 QUINCY SHORE DRIVE	QUINCY	MA	02171	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02201	270 BUSSEY ST. DELLA PARK PLAZA	DEDHAM	MA	02026	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00240	6 JFK STREET	CAMBRIDGE	MA	02138	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00361	55 SUMMER STREET	BOSTON	MA	02110	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02325	1025 CENTRAL STREET	STOUGHTON	MA	02072	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00217	1900 MAIN ST,	TEWKSBURY	MA	01876	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00220	264 E MAIN ST	MARLBOROUGH	MA	01752-2669	01/15/2020	04/01/2020		04/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01012	27 MAIN ST	WATERTOWN	MA	02472	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00260	155-157 CHARLES STREET	BOSTON	MA	02114	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 08972	285 COLUMBUS AVE.	BOSTON	MA	02116	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00524	350 LONGWOOD AVENUE	BOSTON	MA	02115	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01008	230 EAST ASHLAND ST. CARY HILL PLAZA	BROCKTON	MA	02302	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01972	152 ELM STREET	WEST SPRINGFIELD	MA	01089	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01041	675 COUNTY STREET	TAUNTON	MA	02780	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01250	555 BELMONT STREET	BROCKTON	MA	02301	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	CVS PHARMACY # 16773	180 SOMERVILLE AVE	SOMERVILLE	MA	02143	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00026	590 FELLSWAY	MEDFORD	MA	02155	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01015	42 BEALE STREET	WOLLASTON	MA	02170	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00619	1150 SARATOGA STREET	EAST BOSTON	MA	02128	07/13/2020	10/01/2020		10/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01002	624 MASSACHUSETTS AVE.	CAMBRIDGE	MA	02139	07/13/2020	10/01/2020		10/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01022	215 ALEWIFE BROOK PARKWAY	CAMBRIDGE	MA	02138	07/13/2020	10/01/2020		10/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01031	4600 WASHINGTON STREET	ROSLINDALE	MA	02131	07/13/2020	10/01/2020		10/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01035	638 CHANDLER STREET	WORCESTER	MA	01602	07/13/2020	10/01/2020		10/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01265	210 BORDER STREET	EAST BOSTON	MA	02128	07/13/2020	10/01/2020		10/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07530	1249 BOYLSTON ST.	BOSTON	MA	02215	07/13/2020	10/01/2020		10/01/2020
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00009	339 SQUIRE RD	REVERE	MA	02151	10/08/2020	01/01/2021		01/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00062	6 THATCHER RD. E GLOUCESTER S/C	GLOUCESTER	MA	01930	10/08/2020	01/01/2021		01/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00496	324 BROADWAY	CHELSEA	MA	02150	10/08/2020	01/01/2021		01/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00861	355 CENTRE ST.	BROCKTON	MA	02302	10/08/2020	01/01/2021		01/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00979	423 WEST BROADWAY	SOUTH BOSTON	MA	02127	10/08/2020	01/01/2021		01/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06781	2323 W ILLINOIS AVE	DALLAS	TX	75224	10/08/2020	01/01/2021		01/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00321	95 WASHINGTON STREET	CANTON	MA	02021	04/15/2021	07/01/2021		07/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02112	19 EASTERN AVENUE	DEDHAM	MA	02026	04/15/2021	07/01/2021		07/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 4666	101 CANAL STREET	BOSTON	MA	02114	04/15/2021	07/01/2021		07/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00632	4 BROADWAY ROAD	DRACUT	MA	01826	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01056	25 WOOD STREET	LOWELL	MA	01851	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02054	136 NAHATAN ST.	NORWOOD	MA	02062	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 05493	336 BRIDGE ST.	LOWELL	MA	01850	07/12/2021	10/01/2021		10/01/2021
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11082	341 HARRISON AVENUE	BOSTON	MA	02118	04/23/2025	07/01/2025		04/23/2025
Contract Detail	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/20/2017	10/01/2017		10/01/2017
Contract Detail	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 01365	1637 P STREET NW	WASHINGTON	DC	20036	04/15/2021	07/01/2021		07/01/2021
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05980	949 LIVINGSTON AVE.	NORTH BRUNSWICK	NJ	08902	10/08/2020	01/01/2021		01/01/2021
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16945	1040 TIMBER DR E	GARNER	NC	27529	07/13/2020	10/01/2020		10/01/2020
Contract Detail	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	10/15/2018	01/01/2019		01/01/2019
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/09/2019	10/01/2019		10/01/2019
Contract Detail	WALGREEN EASTERN CO INC	WALGREENS SPECIALTY PHARMACY #15307	21 STANHOPE STREET #23	BOSTON	MA	02116	01/09/2014	04/01/2014		01/09/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04072	1890 COLUMBUS AVE	ROXBURY	MA	02119	01/09/2014	04/01/2014		01/09/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03016	416 WARREN ST	ROXBURY	MA	02119	01/09/2014	04/01/2014	01/15/2024	02/13/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09538	2275 WASHINGTON ST	ROXBURY	MA	02119-3212	01/09/2014	04/01/2014	10/01/2022	09/07/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #15001	980 AMERICAN LEGION HWY	ROSLINDALE	MA	02131-4701	01/09/2014	04/01/2014		01/09/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01847	757 GALLIVAN BLVD STE 3	DORCHESTER	MA	02122	01/09/2014	04/01/2014		01/09/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03135	825 MORTON STREET	BOSTON	MA	02126	01/09/2014	04/01/2014		01/09/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06805	130 BOWDOIN ST	DORCHESTER	MA	02122-1837	01/09/2014	04/01/2014		01/09/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06349	585 WASHINGTON ST	DORCHESTER	MA	02124-2032	01/09/2014	04/01/2014		01/09/2014
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS #16237	75 AMORY STREET SUITE 100	BOSTON	MA	02119	01/15/2017	04/01/2017	10/12/2017	02/27/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY#10996	429 BROOKLINE AVENUE	BOSTON	MA	02215	04/23/2019	07/01/2019		07/01/2019
Contract Detail	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	10/16/2023	01/01/2024		01/01/2024
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/09/2014	04/01/2014	07/22/2015	08/05/2015

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH011280	Active	BPS-H80-005591	DIMOCK COMM HEALTH CENTER	DIMOCK COMM HEALTH CENTER	45 DIMOCK ST		ROXBURY	MA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH011280	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/01/2017
CH011280	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH011280	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2019
CH011280	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2019
CH011280	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10605	37 WEST MAIN STREET	STAFFORD SPRINGS	CT	06076	07/01/2021
CH011280	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00943	1200 MAIN STREET	WILLIMANTIC	CT	06226	10/01/2021
CH011280	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2021
CH011280	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2021
CH011280	CVS PHARMACY, INC.	CVS/PHARMACY # 11301	55 DIMOCK ST.	ROXBURY	MA	02119	06/29/2019	07/31/2024
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02162	300 LONGWOOD AVE. CHILDRENS HOSPITAL	BOSTON	MA	02115	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00720	2235 DORCHESTER AVENUE	BOSTON	MA	02124	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02283	715 MORRISSEY BOULEVARD	DORCHESTER	MA	02122	10/01/2019
CH011280	CVS PHARMACY, INC.	CVS PHARMACY # 17018	7 ALLSTATE RD	DORCHESTER	MA	02125	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01264	704 CENTRE STREET	JAMAICA PLAIN	MA	02130	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01248	240 OAK STREET	BROCKTON	MA	02301	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 5464	1575 BLUE HILL AVE	MATTAPAN	MA	02126	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02070	467 CENTRE STREET	JAMAICA PLAIN	MA	02130	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01006	316 NORTH PEARL STREET	BROCKTON	MA	02301	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11036	451 WASHINGTON STREET	DORCHESTER	MA	02124	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01252	874 HARRISON AVE	BOSTON	MA	02118	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01049	942A HYDE PARK AVENUE	HYDE PARK	MA	02136	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01007	1267 MAIN ST	BROCKTON	MA	02301-7107	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02282	703 GALLIVAN BOULEVARD	DORCHESTER	MA	02124	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00471	778 DUDLEY ST.	DORCHESTER	MA	02125	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02592	468 BLUE HILL AVE	DORCHESTER	MA	02121	10/01/2019
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01263	10 BASSETT STREET	MILTON	MA	02186	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01862	1195 BOYLSTON STREET	CHESTNUT HILL	MA	02467	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01258	191 CAMBRIDGE ST	BOSTON	MA	02114	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00746	171 NORTH MAIN STREET	RANDOLPH	MA	02368	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00983	2019 LAKEVIEW AVENUE	DRACUT	MA	01826	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00114	12 HARVARD ST.	WALTHAM	MA	02453	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00055	1927 BEACON ST.	BRIGHTON	MA	02135	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00109	1010 REVERE BEACH PKWY	CHELSEA	MA	02150	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 03890	207 MARKET STREET	BRIGHTON	MA	02135	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01009	21 AUSTIN STREET BUNKER HILL MALL	CHARLESTOWN	MA	02129	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00155	539 MAIN ST # 545	WINCHESTER	MA	01890	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 03307	400 TREMONT STREET	BOSTON	MA	02116	04/01/2020
CH011280	CVS PHARMACY, INC.	CVS/PHARMACY #10517	91 SEAPORT BLVD UNIT H	BOSTON	MA	02210	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 05402	7 WASHINGTON ST.	TAUNTON	MA	02780	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01259	231 MASSACHUSETTS AVENUE	BOSTON	MA	02115	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00137	626 SOUTHERN ARTERY, RTE 3A	QUINCY	MA	02169	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00444	74 EAST MAIN STREET	WESTBOROUGH	MA	01581	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01861	884-886 WASHINGTON STREET	BRAINTREE	MA	02184	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06505	978 BOYLSTON ST	NEWTON	MA	02461	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00307	1735 MASSACHUSETTS AVENUE	LEXINGTON	MA	02420	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02454	321 QUINCY SHORE DRIVE	QUINCY	MA	02171	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02201	270 BUSSEY ST. DELLA PARK PLAZA	DEDHAM	MA	02026	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00240	6 JFK STREET	CAMBRIDGE	MA	02138	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00361	55 SUMMER STREET	BOSTON	MA	02110	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02325	1025 CENTRAL STREET	STOUGHTON	MA	02072	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00217	1900 MAIN ST,	TEWKSBURY	MA	01876	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00220	264 E MAIN ST	MARLBOROUGH	MA	01752-2669	04/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01012	27 MAIN ST	WATERTOWN	MA	02472	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00260	155-157 CHARLES STREET	BOSTON	MA	02114	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 08972	285 COLUMBUS AVE.	BOSTON	MA	02116	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00524	350 LONGWOOD AVENUE	BOSTON	MA	02115	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01008	230 EAST ASHLAND ST. CARY HILL PLAZA	BROCKTON	MA	02302	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01972	152 ELM STREET	WEST SPRINGFIELD	MA	01089	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01041	675 COUNTY STREET	TAUNTON	MA	02780	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01250	555 BELMONT STREET	BROCKTON	MA	02301	07/01/2020
CH011280	CVS PHARMACY, INC.	CVS PHARMACY # 16773	180 SOMERVILLE AVE	SOMERVILLE	MA	02143	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00026	590 FELLSWAY	MEDFORD	MA	02155	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01015	42 BEALE STREET	WOLLASTON	MA	02170	07/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00619	1150 SARATOGA STREET	EAST BOSTON	MA	02128	10/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01002	624 MASSACHUSETTS AVE.	CAMBRIDGE	MA	02139	10/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01022	215 ALEWIFE BROOK PARKWAY	CAMBRIDGE	MA	02138	10/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01031	4600 WASHINGTON STREET	ROSLINDALE	MA	02131	10/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01035	638 CHANDLER STREET	WORCESTER	MA	01602	10/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01265	210 BORDER STREET	EAST BOSTON	MA	02128	10/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07530	1249 BOYLSTON ST.	BOSTON	MA	02215	10/01/2020
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00009	339 SQUIRE RD	REVERE	MA	02151	01/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00062	6 THATCHER RD. E GLOUCESTER S/C	GLOUCESTER	MA	01930	01/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00496	324 BROADWAY	CHELSEA	MA	02150	01/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00861	355 CENTRE ST.	BROCKTON	MA	02302	01/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00979	423 WEST BROADWAY	SOUTH BOSTON	MA	02127	01/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06781	2323 W ILLINOIS AVE	DALLAS	TX	75224	01/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00321	95 WASHINGTON STREET	CANTON	MA	02021	07/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02112	19 EASTERN AVENUE	DEDHAM	MA	02026	07/01/2021
CH011280	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 4666	101 CANAL STREET	BOSTON	MA	02114	07/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00632	4 BROADWAY ROAD	DRACUT	MA	01826	10/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01056	25 WOOD STREET	LOWELL	MA	01851	10/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02054	136 NAHATAN ST.	NORWOOD	MA	02062	10/01/2021
CH011280	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 05493	336 BRIDGE ST.	LOWELL	MA	01850	10/01/2021
CH011280	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11082	341 HARRISON AVENUE	BOSTON	MA	02118	07/01/2025
CH011280	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	10/01/2017
CH011280	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 01365	1637 P STREET NW	WASHINGTON	DC	20036	07/01/2021
CH011280	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05980	949 LIVINGSTON AVE.	NORTH BRUNSWICK	NJ	08902	01/01/2021
CH011280	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16945	1040 TIMBER DR E	GARNER	NC	27529	10/01/2020
CH011280	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2019
CH011280	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2019
CH011280	WALGREEN EASTERN CO INC	WALGREENS SPECIALTY PHARMACY #15307	21 STANHOPE STREET #23	BOSTON	MA	02116	04/01/2014
CH011280	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04072	1890 COLUMBUS AVE	ROXBURY	MA	02119	04/01/2014
CH011280	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03016	416 WARREN ST	ROXBURY	MA	02119	04/01/2014	01/15/2024
CH011280	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09538	2275 WASHINGTON ST	ROXBURY	MA	02119-3212	04/01/2014	10/01/2022
CH011280	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #15001	980 AMERICAN LEGION HWY	ROSLINDALE	MA	02131-4701	04/01/2014
CH011280	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01847	757 GALLIVAN BLVD STE 3	DORCHESTER	MA	02122	04/01/2014
CH011280	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03135	825 MORTON STREET	BOSTON	MA	02126	04/01/2014
CH011280	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06805	130 BOWDOIN ST	DORCHESTER	MA	02122-1837	04/01/2014
CH011280	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06349	585 WASHINGTON ST	DORCHESTER	MA	02124-2032	04/01/2014
CH011280	WALGREEN EASTERN CO., INC.	DBA WALGREENS #16237	75 AMORY STREET SUITE 100	BOSTON	MA	02119	04/01/2017	10/12/2017
CH011280	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY#10996	429 BROOKLINE AVENUE	BOSTON	MA	02215	07/01/2019
CH011280	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	01/01/2024
CH011280	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2014	07/22/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/7/2024 11:14:49 AM	2/12/2025 10:22:20 AM	2/12/2025 10:22 AM
Addresses	Shipping Address	Update	Change Request	Dimock Community Health Center 55 Dimock St Roxbury, MA 02119	Dimock Pharmacy 55 Dimock St Roxbury, MA 02119	6/20/2024 1:18 PM
Addresses	Billing Address	Update	Change Request	DIMOCK COMM HEALTH CENTER 55 Dimock Street Roxbury, MA 02119	DIMOCK COMM HEALTH CENTER 55 Dimock St Roxbury, MA 02119	6/14/2024 1:53 PM
Addresses	Shipping Address	Insert	Change Request		Dimock Community Health Center 55 Dimock St Roxbury, MA 02119	6/14/2024 1:53 PM
Details	Last Recertification Date	Update	Recertification	2/27/2023 12:46:02 PM	2/7/2024 11:14:49 AM	2/7/2024 11:14 AM
Contacts	Primary Contact	Update	PC Change Request	Baddeley, Sarah Director of Compliance Dimock Community Health Center 6174428800-1481	Barrios, Alejandra Director of Compliance The Dimock Center 6179810415	2/1/2024 3:14 PM
Contacts	Authorizing Official	Update	Change Request	Gerondeau, Peter Interim CEO Dimock Community Health Center 6174429667-1203	Anderson, Charles CEO Dimock Community Health Center 6174428800-1208	8/21/2023 1:59 PM
Details	Last Recertification Date	Update	Recertification	2/9/2022 12:53:14 PM	2/27/2023 12:46:02 PM	2/27/2023 12:46 PM
Contacts	Primary Contact	Update	Recertification	Oh, Holly Chief Medical Officer Dimock Community Health Center 6174428800-1261	Baddeley, Sarah Director of Compliance Dimock Community Health Center 6174428800-1481	2/9/2022 12:53 PM
Details	Last Recertification Date	Update	Recertification	2/26/2021 4:07:00 PM	2/9/2022 12:53:14 PM	2/9/2022 12:53 PM
Medicaid Billing	NPI: State	Update	Recertification		MA	2/26/2021 4:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1487894291 ( )		2/26/2021 4:07 PM
Details	Last Recertification Date	Update	Recertification	1/28/2020 7:23:50 AM	2/26/2021 4:07:00 PM	2/26/2021 4:07 PM
Details	Last Recertification Date	Update	Recertification	1/29/2019 2:22:54 PM	1/28/2020 7:23:50 AM	1/28/2020 7:23 AM
Contacts	Authorizing Official	Update	Change Request	minter-Jordan, Myechia CEO Dimock Community Health Center 6174428800-1201	Gerondeau, Peter Interim CEO Dimock Community Health Center 6174429667-1203	9/10/2019 7:58 AM
Details	Last Recertification Date	Update	Recertification	2/27/2018 10:22:59 AM	1/29/2019 2:22:54 PM	1/29/2019 2:22 PM
Addresses	Billing Address	Insert	Change Request		DIMOCK COMM HEALTH CENTER 55 Dimock Street Roxbury, MA 02119	10/15/2018 2:12 PM
Addresses	Main Address	Update	Change Request	45-55 DIMOCK ST ROXBURY, MA 02119	45 DIMOCK ST ROXBURY, MA 02119	10/15/2018 2:12 PM
Details	Entity Subname	Update	Change Request		DIMOCK COMM HEALTH CENTER	10/15/2018 2:12 PM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/27/2018 10:22:59 AM	2/27/2018 10:22 AM
Contacts	Primary Contact	Update		Oh, Holly Chief Medical Officer 6174428800-1261	Oh, Holly Chief Medical Officer Dimock Community Health Center 6174428800-1261	1/8/2018 3:35 PM
Contacts	Authorizing Official	Update		minter-Jordan, Myechia CEO 6174428800-1201	minter-Jordan, Myechia CEO Dimock Community Health Center 6174428800-1201	1/8/2018 3:33 PM
Contacts	Authorizing Official	Update		Fitch, Ruth Ellen CEO 6174428800-1201	minter-Jordan, Myechia CEO 6174428800-1201	7/20/2017 11:09 AM
Addresses	Main Address	Insert			45-55 DIMOCK ST ROXBURY, MA 02119	2/1/2017 11:24 AM
Contacts	Primary Contact	Update		Fitch, Ruth Ellen CEO 6174428800-1201	Oh, Holly Chief Medical Officer 6174428800-1261	2/1/2017 11:24 AM
Details	Last Recertification Date	Update		2/29/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 11:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/18/2016 2:38 PM
Medicaid Billing	Medicaid: Number	Insert			110027813A	4/18/2016 2:38 PM
Medicaid Billing	Medicaid: State	Insert			MA	4/18/2016 2:38 PM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	2/29/2016 12:00:00 AM	2/29/2016 9:43 AM
Details	Last Recertification Date	Update		3/14/2014 12:00:00 AM	2/10/2015 12:00:00 AM	2/10/2015 12:14 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/14/2014 12:00:00 AM	3/14/2014 10:29 AM
Medicaid Billing	NPI: Number	Insert			1487894291	2/21/2013 9:25 AM
Medicaid Billing	NPI: Number	Insert			1487894291	2/21/2013 9:25 AM
Contacts	Authorizing Official	Insert			Fitch, Ruth Ellen CEO 6174428800-1201	2/21/2013 9:25 AM
Contacts	Primary Contact	Insert			Fitch, Ruth Ellen CEO 6174428800-1201	2/21/2013 9:25 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/21/2013 9:25 AM
Dates	Participating Approval Date	Update		8/21/2003 11:43:48 AM	8/21/2003 12:00:00 AM	11/5/2012 11:11 AM
Details	Last Recertification Date	Insert				8/21/2003 11:43 AM
Details	Grant Number	Insert			H80CS00151	8/21/2003 11:43 AM
Details	340B ID	Insert			CH011280	8/21/2003 11:43 AM
Details	Is Authorizing Official EHB Data	Insert				8/21/2003 11:43 AM
Dates	Last Date That 340B Drugs Purchased	Insert				8/21/2003 11:43 AM
Details	Medicare Provider Number	Insert				8/21/2003 11:43 AM
Details	Entity Name	Insert			DIMOCK COMM HEALTH CENTER	8/21/2003 11:43 AM
Details	Program Code	Insert			CH	8/21/2003 11:43 AM
Details	Entity Subname	Insert				8/21/2003 11:43 AM
Dates	Participating Approval Date	Insert			8/21/2003 11:43:48 AM	8/21/2003 11:43 AM
Details	State	Insert			Active	8/21/2003 11:43 AM
Dates	Registration Date	Insert			7/1/2003 12:00:00 AM	8/21/2003 11:43 AM
Dates	Signed By Date	Insert				8/21/2003 11:43 AM
Dates	Start Date	Insert			7/1/2003 12:00:00 AM	8/21/2003 11:43 AM
Terminations	Termination Comments	Insert				8/21/2003 11:43 AM
Terminations	Termination Date	Insert				8/21/2003 11:43 AM
Terminations	Termination Effective Date	Insert				8/21/2003 11:43 AM
Terminations	Termination Reason	Insert				8/21/2003 11:43 AM
Details	Comments Public	Insert			ADDRESS	8/21/2003 11:43 AM

340B Drug Pricing Program Database