Yes
| OK | 200645490F,200645490H | 1285010413 |
| CHC33661-00 | Active | BPS-H80-029610 | Good Shepherd Community Clinic, Inc. | Good Shepherd Community Clinic, Inc. | 20 12th Avenue NW | | Ardmore | OK |
| CHC33661-01 | Active | BPS-H80-031314 | Good Shepherd Community Clinic, Inc. | Good Shepherd Community Clinic, Inc. - Walnut Dr. | 1104 Walnut Dr | | Ardmore | OK |
| CHC33661-02 | Active | BPS-H80-032331 | GOOD SHEPHERD COMMUNITY CLINIC, INC. | Good Shepherd Community Clinic, Inc. - 1116 Walnut | 1116 Walnut Dr | | Ardmore | OK |
| CHC33661-03 | Active | BPS-H80-037077 | GOOD SHEPHERD COMMUNITY CLINIC, INC. | Good Shepherd Community Clinic, Inc. 1520 N Commerce | 1520 N Commerce St | | Ardmore | OK |
| CHC33661-04 | Active | BPS-H80-039637 | GOOD SHEPHERD COMMUNITY CLINIC, INC. | Good Shepherd Community Clinic, Inc-2401 N Commerce | 2401 N Commerce | | Ardmore | OK |
| CHC33661-00 | ADVANCED CARE SCRIPTS, INC | CVS/SPECIALTY OR CARELONRX SPECIALTY PHA |
6251 CHANCELLOR DRIVE
SUITE 101
| ORLANDO | FL | 32809 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK FLORIDA SPECIALTY PHARMACY LLC | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
7930 WOODLAND CENTER BLVD STE 500
| TAMPA | FL | 33614 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK ILLINOIS SPECIALTY PHARMACY, LL | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
800 BIERMANN CT STE B
| MOUNT PROSPECT | IL | 60056 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK KANSAS SPECIALTY PHARMACY | CVS/SPECIALTY OR CARELONRX SPECIALTY PHA |
11162 RENNER BLVD
| LENEXA | KS | 66219 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK MASSACHUSETTS SPECIALTY PHARMAC | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
25 BIRCH STREET, BLDG B, SUITE 100
| MILFORD | MA | 01757 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK MICHIGAN SPECIALTY PHARMACY, LL | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
1307 ALLEN DR STE H
| TROY | MI | 48083 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK NEW JERSEY SPECIALTY PHCY, LLC | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
180 PASSAIC AVE UNIT B-5
| FAIRFIELD | NJ | 07004 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK NORTH CAROLINA SPECIALTY PHARMA | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
10700 WORLD TRADE BLVD STE 110
| RALEIGH | NC | 27617 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK TENNESSEE SPECIALTY PHARMACY, L | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
8370 WOLF LAKE DR
STE 107
| BARTLETT | TN | 38133 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK, L.L.C. | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
1127 BRYN MAWR AVE
SUITE A
| REDLANDS | CA | 92374 | 01/01/2025 | | |
| CHC33661-00 | CAREMARK, L.L.C. | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
7251 S. EASTERN AVE.
| LAS VEGAS | NV | 89119 | 01/01/2025 | | |
| CHC33661-00 | CVS CAREMARK | DBA CVS/CAREMARK OR CF# 11506 |
1 GREAT VALLEY BOULEVARD
| WILKES BARRE | PA | 18706 | 09/01/2022 | | |
| CHC33661-00 | CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC | DBA CVS/CAREMARK 48067 |
1780 WALL ST
| MT PROSPECT | IL | 60056 | 09/01/2022 | | |
| CHC33661-00 | CVS/SPECIALTY OR CARELONRX SPECIALTY PHA | CAREMARK, LLC |
1001 SPINKS ROAD, STE 280
| FLOWER MOUND | TX | 75028 | 01/01/2025 | | |
| CHC33661-00 | HENRY ROBERT'S EXPRESS PHRMCY | 1316 12TH AVE NW |
| ARDMORE | OK | 73401-1285 | 09/01/2022 | | |
| CHC33661-00 | OKLAHOMA CVS PHARMACY, L.L.C. | DBA: CVS/PHARMACY # 06222 |
1220 N. COMMERCE ST.
| ARDMORE | OK | 73401 | 09/01/2022 | | |
| CHC33661-00 | PROCARE PHARMACY DIRECT, L.L.C. | DBA CVS/SPECIALTY OR CARELONRX SPECIALTY |
105 MALL BOULEVARD
| MONROEVILLE | PA | 15146 | 01/01/2025 | | |
| CHC33661-00 | PROCARE PHARMACY, L.L.C. | DBA CVS/PHARMACY #2923 |
3250 HARDEN ST. EXT. SUITE #300
| COLUMBIA | SC | 29203 | 01/01/2025 | | |
| CHC33661-00 | PROCARE PHARMACY, L.L.C. | DBA: CVS/PHARMACY #2909 |
1521 4TH AVE., SOUTH
| BIRMINGHAM | AL | 35233 | 01/01/2025 | | |
| CHC33661-00 | REED FAMILY PHARMACY | ARDMORE FAMILY PHARMACY LLC |
814 W BROADWAY ST
| ARDMORE | OK | 73401 | 09/21/2022 | | |
| CHC33661-00 | WAL-MART CENTRAL FILL 10-2670 | 608 SPRING HILL DR # 3 SUITE 300 |
| SPRING | TX | 77386 | 09/01/2022 | | |
| CHC33661-00 | WAL-MART PHARMACY 10-0129 | 1715 NORTH COMMERCE STREET |
| ARDMORE | OK | 73401 | 09/01/2022 | | |
| CHC33661-00 | WAL-MART PHARMACY 10-5997 | 9600 PARKSOUTH CT. SUITE 100 |
| ORLANDO | FL | 32837 | 09/01/2022 | | |
| CHC33661-00 | WALGREEN CO. | DBA: WALGREENS # 05739 |
1111 N COMMERCE STREET
| ARDMORE | OK | 73401 | 09/01/2022 | | |
| CHC33661-00 | WALGREEN CO. | DBA WALGREENS SPECIALTY PHARMACY #16515 |
519 NW 23RD ST STE 109
| OKLAHOMA CITY | OK | 73103 | 09/01/2022 | | |
| CHC33661-00 | Walgreens #21373 | Walgreens Central Fill #21373 |
4100 Dale Earnhardt Way
STE 200
| Northlake | TX | 76262 | 09/01/2022 | | |
| CHC33661-00 | WALMART PHARMACY 10-5169 | 2252 NORTH 8TH STREET |
SUITE A
| ROGERS | AR | 72756 | 10/01/2023 | | |
| CHC33661-00 | Walmart Pharmacy 10-7611 | 2501 Perry Rd |
| Plainfield | IN | 46168 | 01/01/2024 | | |
| Details | State | Update | | Approved | Active | 4/1/2025 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Myers, Teresa Mae
CEO
Good Shepherd Community Clinic, Inc.
5804653545 | 3/6/2025 2:48 PM |
| Details | 340B ID | Update | New Registration | | CHC33661-04 | 3/6/2025 2:48 PM |
| Dates | Participating Approval Date | Update | New Registration | | 3/6/2025 2:48:20 PM | 3/6/2025 2:48 PM |
| Details | State | Update | New Registration | Pending | Approved | 3/6/2025 2:48 PM |
| Dates | Signed By Date | Update | New Registration | | 3/6/2025 2:24:50 PM | 3/6/2025 2:48 PM |
| Dates | Start Date | Update | New Registration | | 4/1/2025 12:00:00 AM | 3/6/2025 2:48 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 3/6/2025 2:24 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 200645490F | 3/6/2025 2:24 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | OK | 3/6/2025 2:24 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 3/6/2025 2:24 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 200645490H | 3/6/2025 2:24 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | OK | 3/6/2025 2:24 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1285010413 | 3/6/2025 2:24 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | OK | 3/6/2025 2:24 PM |
| Addresses | Main Address | Insert | New Registration | |
2401 N Commerce
Ardmore, OK 73401-1311 | 3/4/2025 2:05 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Myers, Teresa Mae
CEO
Good Shepherd Community Clinic, Inc.
5804653545 | 3/4/2025 2:05 PM |
| Contacts | Primary Contact | Insert | New Registration | | Wright, Heidi Brooke
Pharmacy Director
Good Shepherd Community Clinic, Inc.
5802233411-238 | 3/4/2025 2:05 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Details | Grant Number | Insert | New Registration | | H80CS33661 | 3/4/2025 2:05 PM |
| Details | 340B ID | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Details | Entity Name | Insert | New Registration | | GOOD SHEPHERD COMMUNITY CLINIC, INC. | 3/4/2025 2:05 PM |
| Details | NOFO Number | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Details | Program Code | Insert | New Registration | | CH | 3/4/2025 2:05 PM |
| Details | Entity Subname | Insert | New Registration | | Good Shepherd Community Clinic, Inc-2401 N Commerce | 3/4/2025 2:05 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Details | State | Insert | New Registration | | Pending | 3/4/2025 2:05 PM |
| Dates | Registration Date | Insert | New Registration | | 3/4/2025 2:05:57 PM | 3/4/2025 2:05 PM |
| Dates | Signed By Date | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Dates | Start Date | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Terminations | Termination Date | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 3/4/2025 2:05 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 3/4/2025 2:05 PM |