Covered Entity Details

CH072110U CHARLES DREW HEALTH CENTER INC (Approved) - information as of 5/23/2025 12:02:40 AM

Main Details

Name

CHARLES DREW HEALTH CENTER INC

Subdivision Name

Charles Drew Health Center Inc. at Benson SBHC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039942

340B ID

CH072110U

Grant Number

H80CS00438

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/3/2025

Last Recertification Date

Contacts

Authorizing Official

Charles Drew Health Center, Inc.
Kenny D. McMorris, Chief Executive Officer
(402) 457-1245

Primary Contact

Charles Drew Health Center, Inc.
Mark A Cherney, Senior Director of Pharmacy Services
(402) 810-9909

Addresses

Street Address

5120 Maple St. STE 101
Omaha, NE 68104-3555

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?
Yes

State	Medicaid Number	NPI Number
NE	47066671550	1659743920

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
CH072110	Active	BPS-H80-005334	Charles Drew Health Center, Inc	Charles Drew Health Center, Inc.	2915 Grant St	Omaha	NE
CH072110A	Terminated	BPS-H80-002440	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Siena Francis House	1111 N 17th St.	Omaha	NE
CH072110B	Terminated	BPS-H80-008208	Charles Drew Health Center Inc	Benson Community Health Center	5420 North West Radial Highway	Omaha	NE
CH072110C	Active	BPS-H80-005550	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Campus for HOPE	1490 N 16th St,	Omaha	NE
CH072110D	Active	BPS-H80-010009	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Belvedere Elementary School	3775 Curtis Ave	Omaha	NE
CH072110E	Active	BPS-H80-010010	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at King Science and Technology Magnet Middle School	3720 Florence Blvd	Omaha	NE
CH072110F	Active	BPS-H80-010011	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Kellom Elementary School	1311 N 24th St	Omaha	NE
CH072110G	Active	BPS-H80-012135	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Northwest High School	8204 Crown Point Ave.	Omaha	NE
CH072110H	Active	BPS-H80-011540	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Florence Tower	5100 Florence Blvd	Omaha	NE
CH072110J	Active	BPS-H80-011553	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Jackson Tower	600 S 27th St	Omaha	NE
CH072110K	Active	BPS-H80-011568	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Evans Tower	3600 N 24th St	Omaha	NE
CH072110L	Active	BPS-H80-011573	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. at Crown Tower	5904 Henninger Dr	Omaha	NE
CH072110M	Active	BPS-H80-006336	Charles Drew Health Center Inc	Charles Drew Health Center, Inc. Mobile Medical Unit	2915 Grant St	Omaha	NE
CH072110N	Terminated	BPS-H80-017221	CHARLES DREW HEALTH CENTER INC	Charles Drew Health Center, Inc. at St. Richards	4320 Fort Street	Omaha	NE
CH072110P	Active	BPS-H80-017241	CHARLES DREW HEALTH CENTER INC	Charles Drew Health Center Inc. Dental Mobile Unit - Tooth Mobile	2915 Grant Street	Omaha	NE
CH072110Q	Active	BPS-H80-027445	Charles Drew Health Center, Inc.	Charles Drew Health Center, Inc. at 30 Metro	5319 N 30th St.	Omaha	NE
CH072110R	Active	BPS-H80-031403	Charles Drew Health Center, Inc.	Charles Drew Health Center Inc. at Omaha Home for Boys	5190 Sprague Plz Ste 201	Omaha	NE
CH072110S	Active	BPS-H80-033088	Charles Drew Health Center, Inc.	Charles Drew Health Center, Inc. Teen & Young Adult Health Center at Benson	5920 Maple St	Omaha	NE
CH072110T	Active	BPS-H80-037035	CHARLES DREW HEALTH CENTER INC	Charles Drew Health Center Inc. at Radius	5030 Grand Ave	Omaha	NE
CH072110U	Approved	BPS-H80-039942	CHARLES DREW HEALTH CENTER INC	Charles Drew Health Center Inc. at Benson SBHC	5120 Maple St. STE 101	Omaha	NE

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH072110	BAKER'S PHARMACY	7312 N. 30TH STREET		OMAHA	NE	68112	04/01/2017
CH072110	BAKER'S PHARMACY # 301	4405 NORTH 72ND STREET		OMAHA	NE	68134	04/01/2017
CH072110	WALGREEN CO.	DBA: WALGREENS # 03202	7202 NORTH 30TH STREET	OMAHA	NE	68112	01/01/2016
CH072110	WALGREEN CO.	DBA: WALGREENS # 03621	9001 BLONDO STREET	OMAHA	NE	68134-6029	01/01/2016
CH072110	WALGREEN CO.	DBA: WALGREENS # 04772	3005 LAKE ST	OMAHA	NE	68111	01/01/2016
CH072110	WALGREEN CO.	DBA: WALGREENS # 05741	3001 DODGE STREET	OMAHA	NE	68131-2627	01/01/2016
CH072110	WALGREEN CO.	DBA: WALGREENS # 06936	4310 AMES AVENUE	OMAHA	NE	68111-2149	01/01/2016	11/06/2019
CH072110	WALGREEN CO.	DBA: WALGREENS # 07693	225 N SADDLE CREEK ROAD	OMAHA	NE	68131-2228	01/01/2016
CH072110	WALGREEN CO.	DBA: WALGREENS # 10437	5225 N 90TH ST	OMAHA	NE	68134-2831	01/01/2016
CH072110	WALGREEN CO.	DBA: WALGREENS #15237	2929 N. 60TH STREET	OMAHA	NE	68104	01/01/2016
CH072110	WALGREEN CO.	DBA: WALGREENS #11205	6005 N. 72ND ST.	OMAHA	NE	68134	10/01/2017
CH072110	WALGREEN CO.	DBA: WALGREENS # 05190	2323 L STREET	OMAHA	NE	68107	10/01/2017	02/20/2025
CH072110	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY#16270	240 S. 77TH ST	OMAHA	NE	68114	10/01/2020
CH072110	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16528	1704 INGERSOLL AVE STE 102	DES MOINES	IA	50309	10/01/2020
CH072110	WALGREEN CO.	DBA: WALGREENS #13137	13510 Q STREET	OMAHA	NE	68137	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 05540	6905 S 36TH ST	BELLEVUE	NE	68147	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 04754	8380 HARRISON ST	LA VISTA	NE	68128	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 07563	8989 W DODGE ROAD	OMAHA	NE	68114-3301	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 06962	3121 S 24TH STREET	OMAHA	NE	68108	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 05306	301 W BENNETT AVE	COUNCIL BLUFFS	IA	51503	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 04443	9001 WEST CENTER RD.	OMAHA	NE	68124	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 03700	535 E. BROADWAY	COUNCIL BLUFFS	IA	51503	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 05143	7151 CASS ST	OMAHA	NE	68132	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 04974	5038 CENTER ST.	OMAHA	NE	68106	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 04405	2508 W BROADWAY	COUNCIL BLUFFS	IA	51501	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 05059	10725 FORT ST	OMAHA	NE	68134	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 03694	1802 GALVIN ROAD SOUTH	BELLEVUE	NE	68005	10/01/2022
CH072110	WALGREEN CO.	DBA: WALGREENS # 03186	3701 N. 132ND STREET	OMAHA	NE	68164	07/01/2023
CH072110	WALGREEN CO.	DBA: WALGREENS # 07272	13155 W CENTER RD	OMAHA	NE	68144-3740	07/01/2023
CH072110	WALGREEN CO.	DBA: WALGREENS #11355	9512 S. 71ST PLAZA	PAPILLION	NE	68133	07/01/2023
CH072110	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	07/01/2023
CH072110	WALMART PHARMACY 10-3151	5018 AMES AVE		OMAHA	NE	68104	04/01/2017
CH072110	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		McMorris, Kenny D. Chief Executive Officer Charles Drew Health Center, Inc. 4024571245	4/3/2025 9:57 AM
Details	340B ID	Update	New Registration		CH072110U	4/3/2025 9:57 AM
Dates	Participating Approval Date	Update	New Registration		4/3/2025 9:57:24 AM	4/3/2025 9:57 AM
Details	State	Update	New Registration	Pending	Approved	4/3/2025 9:57 AM
Dates	Signed By Date	Update	New Registration		4/3/2025 9:03:34 AM	4/3/2025 9:57 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/3/2025 9:57 AM
Addresses	Main Address	Insert	New Registration		5120 Maple St. STE 101 Omaha, NE 68104-3555	4/2/2025 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		47066671550	4/2/2025 9:57 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NE	4/2/2025 9:57 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1659743920	4/2/2025 9:57 AM
Medicaid Billing	NPI: State	Insert	New Registration		NE	4/2/2025 9:57 AM
Contacts	Authorizing Official	Insert	New Registration		McMorris, Kenny D. Chief Executive Officer Charles Drew Health Center, Inc. 4024571245	4/2/2025 9:57 AM
Contacts	Primary Contact	Insert	New Registration		Cherney, Mark A Senior Director of Pharmacy Services Charles Drew Health Center, Inc. 4028109909	4/2/2025 9:57 AM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 9:57 AM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 9:57 AM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 9:57 AM
Details	Grant Number	Insert	New Registration		H80CS00438	4/2/2025 9:57 AM
Details	340B ID	Insert	New Registration			4/2/2025 9:57 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 9:57 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 9:57 AM
Details	Medicare Provider Number	Insert	New Registration			4/2/2025 9:57 AM
Details	Entity Name	Insert	New Registration		CHARLES DREW HEALTH CENTER INC	4/2/2025 9:57 AM
Details	NOFO Number	Insert	New Registration			4/2/2025 9:57 AM
Details	Program Code	Insert	New Registration		CH	4/2/2025 9:57 AM
Details	Entity Subname	Insert	New Registration		Charles Drew Health Center Inc. at Benson SBHC	4/2/2025 9:57 AM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 9:57 AM
Details	State	Insert	New Registration		Pending	4/2/2025 9:57 AM
Dates	Registration Date	Insert	New Registration		4/2/2025 9:57:41 AM	4/2/2025 9:57 AM
Dates	Signed By Date	Insert	New Registration			4/2/2025 9:57 AM
Dates	Start Date	Insert	New Registration			4/2/2025 9:57 AM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 9:57 AM
Terminations	Termination Date	Insert	New Registration			4/2/2025 9:57 AM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 9:57 AM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 9:57 AM

340B Drug Pricing Program Database