Covered Entity Details

CHC11255-13 STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC. (Active) - information as of 4/28/2025 12:42:23 AM

Main Details

Name

STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.

Subdivision Name

MyCHN Pearland Administration

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038606

340B ID

CHC11255-13

Grant Number

H80CS11255

Additional Details

Current Program Status

Active

Registration Date

3/7/2025

Participating Start Date

4/1/2025

Participating Approval Date

3/10/2025

Last Recertification Date

Contacts

Authorizing Official

Stephen F. Austin Community Health Center
Mark Young, CEO
(281) 824-1480

Primary Contact

Stephen F. Austin Community Health Center
Linh Tran, CFO
(281) 824-1480 Ext: 1595

Addresses

Street Address

1346 Broadway St
Pearland, TX 77581-6482

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
CHC11255-00	Active	BPS-H80-008276	Stephen F Austin Community Health Center, Inc	Stephen F Austin	1111 W.Adoue St	Alvin	TX
CHC11255-01	Active	BPS-H80-012624	Stephen F Austin Community Health Center, Inc	Freeport Community Health Center	905 N. Gulf Blvd.	Freeport	TX
CHC11255-02	Active	BPS-H80-017037	STEPHEN F AUSTIN COMMUNITY HEALTH CENTER, INC	Women and Children's Health Center	218 E HOUSE ST	ALVIN	TX
CHC11255-03	Terminated	BPS-H80-018810	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	Angleton Integrated Health Clinic	101 Tigner Street Building 1 and 2	Angleton	TX
CHC11255-04	Terminated	BPS-H80-018808	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	SFACHN Integrated Health Care Clinic Gulf Coast MHMR	101 Brennen Ln.	Alvin	TX
CHC11255-05	Terminated	BPS-H80-018803	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	Velasco Elementary Health Center	401 North Gulf Blvd.	Freeport	TX
CHC11255-06	Terminated	BPS-H80-018802	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	Galveston Integrated Health Clinic	123 Rosenberg, 4th Floor	Galveston	TX
CHC11255-07	Active	BPS-H80-017613	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	Stephen F. Austin Administration	1612 Calloway Drive	Alvin	TX
CHC11255-08	Active	BPS-H80-021619	Stephen F. Austin Community Health Center, Inc.	Pearland Family Health Center	2552 E. Broadway, Suite 102	Pearland	TX
CHC11255-09	Active	BPS-H80-021729	Stephen F. Austin Community Health Center, Inc.	League City Integrated Pediatrics	2360 Gulf Freeway, Ste. 100	League City	TX
CHC11255-10	Active	BPS-H80-024502	Stephen F. Austin Community Health Center, Inc.	Bacliff Community Health Network	1136 Grand Avenue	Bacliff	TX
CHC11255-11	Active	BPS-H80-019473	Stephen F. Austin Community Health Center, Inc.	Brazoria County Dream Center Integrated Health Clinic	796 S. HWY 288-B	Clute	TX
CHC11255-12	Active	BPS-H80-033461	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	CHN Mobile Family Care	1612 Callaway Dr	Alvin	TX
CHC11255-13	Active	BPS-H80-038606	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	MyCHN Pearland Administration	1346 Broadway St	Pearland	TX
CHC11255-14	Active	BPS-H80-021559	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	Mobile Clinic	1612 Callaway Dr	Alvin	TX
CHC11255-15	Active	BPS-H80-036001	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	CHN Brazos Mall	100 Highway 332 West STE 1404	Lake Jackson	TX
CHC11255-16	Active	BPS-H80-037166	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	MyCHN Pasasdena	6243 Fairmont Parkway STE 203, 204	Pasadena	TX
CHC11255-17	Active	BPS-H80-034295	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	MyCHN Pearland Silverlake	9430 Broadway St STE 120	Pearland	TX
CHC11255-18	Active	BPS-H80-036745	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	MyCHN Technology Drive	4005 Technology Dr STE 1190	Angleton	TX
CHC11255-19	Active	BPS-H80-036666	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	MyCHN Lake Jackson	120 Flag Lake Dr STE 2	Lake Jackson	TX
CHC11255-20	Active	BPS-H80-029948	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	Angleton Internal Medicine and Primary Care	2020 E Mulberry St	Angleton	TX
CHC11255-21	Active	BPS-H80-027804	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	Scarsdale Integrated Health Clinic	10851 Scarsdale Blvd Ste 160	Houston	TX
CHC11255-22	Active	BPS-H80-021379	STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	Brazos Place Integrated Community Health Center	1103 N Avenue H	Freeport	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Carve-In Effective Date	Termination Date
CHC11255-00	1960 PHARMACY	5202 BISSONNET ST STE B		BELLAIRE	TX	77401	07/01/2017		01/28/2020
CHC11255-00	ABOUNDING PROSPERITY COMMUNITY PHARMACY	AMERICAN STAR PHARMACY, INC	1619 MARTIN LUTHER KING JR BLVD SUITE B	DALLAS	TX	75215	07/01/2025
CHC11255-02	ACCREDO HEALTH GROUP INC	361 INVERNESS DR S STE F		ENGLEWOOD	CO	80112-5861	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	2415 HEINZ ROAD		IOWA CITY	IA	52240	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	39625 LEWIS DR	STE 800	NOVI	MI	48377-2962	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	5249 NW 33RD AVENUE	BUILDING 6	FORT LAUDERDALE	FL	33309	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	2100 RIVERCHASE CTR STE 405		HOOVER	AL	35244-1852	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	261 CEDAR HILL ST	BUILDING C	MARLBOROUGH	MA	01752-3056	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	2410 WARDLOW RD	STE 101	CORONA	CA	92878	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	520 ELMWOOD PARK BLVD STE 100		NEW ORLEANS	LA	70123-6826	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	190 TECHNOLOGY PKWY STE 120		NORCROSS	GA	30092-2914	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	650 W GRAND AVE STE 102		ELMHURST	IL	60126-1024	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP INC	2915 WATERS RD STE 109		EAGAN	MN	55121-1562	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	212 CARPENTERS UNION WAY	SUITE 500	LAS VEGAS	NV	89119-4231	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	19060 Q ST STE 101		OMAHA	NE	68135-1504	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	3488 S MAIN ST		SALT LAKE CITY	UT	84115-4419	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	22623 68TH AVE S		KENT	WA	98032-1981	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	9307 KIRBY DR		HOUSTON	TX	77054-2516	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	4901 W RENO AVE STE 950		OKLAHOMA CITY	OK	73127-6394	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	422 GALLIMORE DAIRY RD	SUITE A	GREENSBORO	NC	27409	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	4343 W ROYAL LN STE 124		IRVING	TX	75063-2299	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP INC	2100 RIVERCHASE CTR STE 405		HOOVER	AL	35244-1852	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	2410 WARDLOW RD	STE 101	CORONA	CA	92878	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	5249 NW 33RD AVENUE	BUILDING 6	FORT LAUDERDALE	FL	33309	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	39625 LEWIS DR	STE 800	NOVI	MI	48377-2962	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	520 ELMWOOD PARK BLVD STE 100		NEW ORLEANS	LA	70123-6826	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	2415 HEINZ ROAD		IOWA CITY	IA	52240	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	190 TECHNOLOGY PKWY STE 120		NORCROSS	GA	30092-2914	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	261 CEDAR HILL ST	BUILDING C	MARLBOROUGH	MA	01752-3056	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	361 INVERNESS DR S STE F		ENGLEWOOD	CO	80112-5861	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	2915 WATERS RD STE 109		EAGAN	MN	55121-1562	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP INC	650 W GRAND AVE STE 102		ELMHURST	IL	60126-1024	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP, INC	749 GODDARD AVENUE		CHESTERFIELD	MO	63005	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2023
CHC11255-02	ACCREDO HEALTH GROUP, INC.	11411 STRANG LINE RD	STE A	LENEXA	KS	66215	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP, INC.	45 ROUTE 46 EAST	SUITE 609	PINE BROOK	NJ	07058	07/01/2023
CHC11255-00	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP, INC.	11411 STRANG LINE RD	STE A	LENEXA	KS	66215	04/01/2024
CHC11255-00	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2024
CHC11255-00	AHG OF NEW YORK, INC	DBA: ACCREDO	125 CLEARBROOK RD STE 122	ELMSFORD	NY	10523-1119	07/01/2023
CHC11255-00	ALLRX INC	222 W HARRISON AVE STE A		HARLINGEN	TX	78550	07/01/2025
CHC11255-00	AMEX PHARMACY NO 5	PARKVIEW PHARMACY INC. (DBA: AMEX PHAR	5420 BELLAIRE BLVD	BELLAIRE	TX	77401-3957	10/01/2024
CHC11255-00	ASSURANCE CONSOLIDATED PHARMACY #3	SPLENDORA HEALTHCARE, LLC	13841 HWY 59 STE. C	SPLENDORA	TX	77372	10/01/2015		09/14/2016
CHC11255-02	BIOPARTNERS IN CARE INC	11411 STRANG LINE RD		LENEXA	KS	66215-4047	07/01/2023
CHC11255-00	BIOPARTNERS IN CARE INC	11411 STRANG LINE RD		LENEXA	KS	66215-4047	04/01/2024
CHC11255-00	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	01/01/2025
CHC11255-00	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	01/01/2025
CHC11255-02	BVA UNITED PHARMACY	8845 SIX PINES DR STE 201		SHENANDOAH	TX	77380-2675	01/27/2023
CHC11255-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2023
CHC11255-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2023
CHC11255-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2023
CHC11255-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2023
CHC11255-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2023
CHC11255-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2023
CHC11255-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2023
CHC11255-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2023
CHC11255-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2023
CHC11255-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2023
CHC11255-00	CHALLENGE CARE PHARMACY	CHALLENGE CARE PHARMACY LLC	6105 BEVERLYHILL ST STE 200	HOUSTON	TX	77057	10/01/2019		02/03/2021
CHC11255-02	CK PHARMACY	CK PHARMACY& WELLNESS	1110 KINGWOOD DR # 108	KINGWOOD	TX	77339-3001	01/27/2023		06/09/2023
CHC11255-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CHC11255-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06704	117 OYSTER CREEK DR	LAKE JACKSON	TX	77566	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07663	101 N. RUFE SNOW DR.	KELLER	TX	76248	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA CVS/PHARMACY 10461	12806 BROADWAY STREET	PEARLAND	TX	77584	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07600	9620 WHITE SETTLEMENT RD	FORT WORTH	TX	76108	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06727	1600 SOUTH BYPASS 35	ALVIN	TX	77511	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06767	1853 WEST 2ND ST	FREEPORT	TX	77541	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 05877	2900 BROADWAY ST.	PEARLAND	TX	77581	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07821	5002 W MAIN ST	LEAGUE CITY	TX	77573	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 03699	3505 CENTER ST.	DEER PARK	TX	77536	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 06725	601 NORTH LOOP 274	ANGLETON	TX	77515	01/01/2025
CHC11255-00	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 05807	9522 BROADWAY ST.	PEARLAND	TX	77584	01/01/2025
CHC11255-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2023
CHC11255-00	CYPRESS FAIRBANKS-ACP	CYPRESS FAIRBANKS-ACP	11302 FALLBROOK DR STE 104	HOUSTON	TX	77065-5270	07/01/2017		01/28/2020
CHC11255-00	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2025
CHC11255-00	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2024
CHC11255-00	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2024
CHC11255-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2024
CHC11255-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2024
CHC11255-00	GENOA HEALTHCARE LLC	12234 SHADOW CREEK PKWY	BLDG 4, STE 104	PEARLAND	TX	77584	01/01/2025
CHC11255-00	GENOA HEALTHCARE LLC	7510 FM 1765 STE P1		TEXAS CITY	TX	77591	01/01/2025
CHC11255-02	HEB PHARMACY #707	97 OYSTER CREEK DR.		LAKE JACKSON	TX	77566	01/01/2024
CHC11255-02	HEB PHARMACY WAREHOUSE 208	H-E-B, LP	5311 DIETRICH RD STE 100	SAN ANTONIO	TX	78219	01/01/2024
CHC11255-02	HEB SPECIALTY PHARMACY #701	3503 FREDERICKSBURG RD	STE 450	SAN ANTONIO	TX	78201	01/01/2024
CHC11255-00	KELCARE PHARMACY	22001 SOUTHWEST FWY STE 110		RICHMOND	TX	77469-7002	07/01/2023		02/22/2024
CHC11255-00	NOVA HEALTH PHARMACY	22751 PROFESSIONAL DR STE 140		KINGWOOD	TX	77339	04/01/2024
CHC11255-00	NW-ACP	800 PEAKWOOD DR, STE 4A		HOUSTON	TX	77090	07/01/2017		01/28/2020
CHC11255-02	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	07/01/2023
CHC11255-02	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	07/01/2023
CHC11255-02	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	07/01/2023
CHC11255-02	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	07/01/2023
CHC11255-02	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	07/01/2023
CHC11255-02	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/01/2023
CHC11255-00	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CHC11255-02	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2023
CHC11255-02	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	07/01/2023
CHC11255-02	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	07/01/2023
CHC11255-02	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/01/2023
CHC11255-00	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	04/01/2024
CHC11255-02	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	07/01/2023
CHC11255-02	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/01/2023
CHC11255-02	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/01/2023
CHC11255-02	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2023
CHC11255-00	PARKWOOD PHARMACY	3415 S COOPER ST, STE 106		ARLINGTON	TX	76015-7601	01/01/2014		05/27/2016
CHC11255-00	PARKWOOD PHARMACY #1000	104 W. SEALY ST.		ALVIN	TX	77511	07/01/2016	10/01/2024
CHC11255-02	PERFECT RX PLANO	986 SPECIALTY PHARMACY 3 INC	6205 COIT RD STE 356	PLANO	TX	75024	01/01/2024
CHC11255-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2023
CHC11255-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2023
CHC11255-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2023
CHC11255-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2023
CHC11255-00	RAYFORD ACP	RX HEALTH, LLC	440 RAYFORD RD STE 155	SPRING	TX	77386	10/01/2015		01/28/2020
CHC11255-02	RICHMOND PHARMACY	RICHMOND PHARMACY LLC	9536 RICHMOND AVE STE I RICHMOND PHARMACY LLC	HOUSTON	TX	77063	01/27/2023		06/09/2023
CHC11255-01	ROSEWOOD FAMILY PHARMACY, PLLC	1010 SOUTH MAGNOLIA BLVD	SUITE D	MAGNOLIA	TX	77355	07/01/2019		02/03/2021
CHC11255-01	SMART RX PHARMACY TX 1	5431 BARKER CYPRESS RD STE 400		HOUSTON	TX	77084	01/01/2023		06/09/2023
CHC11255-02	SMARTSCRIPTS	1010 W MADISON ST		WASHINGTON	IA	52353-1624	01/01/2024
CHC11255-00	SNG PHARMACY	15115 WESTHEIMER RD STE R		HOUSTON	TX	77082	04/01/2025
CHC11255-00	SULLIVAN PHARMACY	1140 GRAND AVE		BACLIFF	TX	77518	07/01/2025
CHC11255-00	SURGE RX	4320 BROADWAY ST	SUITE 110	PEARLAND	TX	77581-4016	07/01/2023	10/01/2024
CHC11255-00	SWYFT SCRIPTS - DFW	1550 NORWOOD DR	STE 300	HURST	TX	76054	07/01/2024
CHC11255-00	SWYFT SCRIPTS - RICHMOND	22001 SOUTHWEST FWY STE 110		RICHMOND	TX	77469	07/01/2023
CHC11255-00	TEXIENNE PHARMACY #1	20185 US HIGHWAY 59 STE 68		NEW CANEY	TX	77357-8293	10/01/2024
CHC11255-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2024
CHC11255-00	WAL-MART PHARMACY 10-0462	400 SOUTH BYPASS 35		ALVIN	TX	77511	04/01/2024
CHC11255-00	WAL-MART PHARMACY 10-0527	1801 N. VELASCO		ANGLETON	TX	77515	04/01/2024
CHC11255-00	WAL-MART PHARMACY 10-0808	121 HIGHWAY 332 WEST		LAKE JACKSON	TX	77566	04/01/2024
CHC11255-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2024
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 04837	6120 HIGHWAY 6	MISSOURI CITY	TX	77459	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 05733	6302 FAIRMONT PKWY	PASADENA	TX	77505	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 04100	51 DIXIE DRIVE	CLUTE	TX	77531	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 04113	1620 S GORDON STREET	ALVIN	TX	77511	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 06089	4016 HWY 3	DICKINSON	TX	77539	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 10477	11633 SHADOW CREEK PKWY	PEARLAND	TX	77584	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 05833	1801 FM 1765	LA MARQUE	TX	77568	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 03138	3920 GARTH ROAD	BAYTOWN	TX	77521	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 09507	102 N FRIENDSWOOD DR	FRIENDSWOOD	TX	77546	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS #12052	100 E. BRAZOS AVE.	WEST COLUMBIA	TX	77486-2726	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 04373	1001 LOOP 274	ANGLETON	TX	77515	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 07020	104 E PARKWOOD AVE	FRIENDSWOOD	TX	77546-5176	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 06584	8430 BROADWAY ST	PEARLAND	TX	77584-7883	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 09604	156 FM 518 RD	KEMAH	TX	77565-3215	07/01/2023
CHC11255-00	WALGREEN CO.	DBA: WALGREENS # 05709	16590 EL CAMINO REAL	HOUSTON	TX	77062-5723	07/01/2023
CHC11255-00	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	10/01/2023
CHC11255-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2025
CHC11255-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2025
CHC11255-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2025
CHC11255-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2024
CHC11255-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Young, Mark CEO Stephen F. Austin Community Health Center 2818241480	3/10/2025 7:23 AM
Details	340B ID	Update	New Registration		CHC11255-13	3/10/2025 7:23 AM
Dates	Participating Approval Date	Update	New Registration		3/10/2025 7:23:59 AM	3/10/2025 7:23 AM
Details	State	Update	New Registration	Pending	Approved	3/10/2025 7:23 AM
Dates	Signed By Date	Update	New Registration		3/7/2025 2:01:26 PM	3/10/2025 7:23 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	3/10/2025 7:23 AM
Addresses	Main Address	Insert	New Registration		1346 Broadway St Pearland, TX 77581-6482	3/7/2025 1:52 PM
Contacts	Primary Contact	Insert	New Registration		Tran, Linh CFO Stephen F. Austin Community Health Center 2818241480-1595	3/7/2025 1:52 PM
Contacts	Authorizing Official	Insert	New Registration		Young, Mark CEO Stephen F. Austin Community Health Center 2818241480	3/7/2025 1:52 PM
Details	Assistance Received From Date	Insert	New Registration			3/7/2025 1:52 PM
Details	Assistance Received To Date	Insert	New Registration			3/7/2025 1:52 PM
Details	Last Recertification Date	Insert	New Registration			3/7/2025 1:52 PM
Details	Grant Number	Insert	New Registration		H80CS11255	3/7/2025 1:52 PM
Details	340B ID	Insert	New Registration			3/7/2025 1:52 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			3/7/2025 1:52 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			3/7/2025 1:52 PM
Details	Medicare Provider Number	Insert	New Registration			3/7/2025 1:52 PM
Details	Entity Name	Insert	New Registration		STEPHEN F. AUSTIN COMMUNITY HEALTH CENTER, INC.	3/7/2025 1:52 PM
Details	NOFO Number	Insert	New Registration			3/7/2025 1:52 PM
Details	Program Code	Insert	New Registration		CH	3/7/2025 1:52 PM
Details	Entity Subname	Insert	New Registration		MyCHN Pearland Administration	3/7/2025 1:52 PM
Dates	Participating Approval Date	Insert	New Registration			3/7/2025 1:52 PM
Details	State	Insert	New Registration		Pending	3/7/2025 1:52 PM
Dates	Registration Date	Insert	New Registration		3/7/2025 1:52:56 PM	3/7/2025 1:52 PM
Dates	Signed By Date	Insert	New Registration			3/7/2025 1:52 PM
Dates	Start Date	Insert	New Registration			3/7/2025 1:52 PM
Terminations	Termination Comments	Insert	New Registration			3/7/2025 1:52 PM
Terminations	Termination Date	Insert	New Registration			3/7/2025 1:52 PM
Terminations	Termination Effective Date	Insert	New Registration			3/7/2025 1:52 PM
Terminations	Termination Reason	Insert	New Registration			3/7/2025 1:52 PM

340B Drug Pricing Program Database