Covered Entity Details

CH05039F NORTHWEST MICHIGAN HEALTH SERVICES, INC (Approved) - information as of 4/25/2025 6:35:35 PM

Main Details

Name

NORTHWEST MICHIGAN HEALTH SERVICES, INC

Subdivision Name

Traverse City West Middle School CAHC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-037946

340B ID

CH05039F

Grant Number

H80CS00669

Additional Details

Current Program Status

Approved

Registration Date

4/4/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/7/2025

Last Recertification Date

Contacts

Authorizing Official

Northwest Michigan Health Services
Heidi Britton, Chief Executive Officer
(231) 947-1112

Primary Contact

Northwest Michigan Health Services, Inc.
Kimberly A Corliss, Director of Administrative Operations
(231) 861-2130

Addresses

Street Address

3954 Silver Lake Rd
Traverse City, MI 49684-8946

Billing Address

NORTHWEST MICHIGAN HEALTH SERVICES, INC
10767 E TRAVERSE HWY
TRAVERSE CITY, MI 49684

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	Last Updated On
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/14/2025	07/01/2025	04/14/2025
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/14/2025	07/01/2025	04/14/2025
Contract Detail	HOMETOWN PHARMACY #41 - TRAVERSE CITY	4000 EASTERN SKY DR STE 1		TRAVERSE CITY	MI	49684	04/14/2025	07/01/2025	04/14/2025
Contract Detail	HOMETOWN PHARMACY #42 - HONOR	10587 MAIN ST		HONOR	MI	49640-9761	04/14/2025	07/01/2025	04/14/2025
Contract Detail	HOMETOWN PHARMACY #43 - SUTTONS BAY	321B N SAINT JOSEPH ST		SUTTONS BAY	MI	49682-5104	04/14/2025	07/01/2025	04/14/2025
Contract Detail	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	04/14/2025	07/01/2025	04/14/2025
Contract Detail	MEIJER INC #33	3955 U.S. 31 SOUTH HWY		TRAVERSE CITY	MI	49684	04/10/2025	07/01/2025	04/10/2025
Contract Detail	MEIJER PHARMACY #279	15 CABERFAE HWY M-55		MANISTEE	MI	49660	04/14/2025	07/01/2025	04/14/2025
Contract Detail	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	04/14/2025	07/01/2025	04/14/2025
Contract Detail	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-1348	5135 CAROLINA BEACH RD		WILMINGTON (S)	NC	28412	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-1432	8917 EAST 34 ROAD		CADILLAC	MI	49601	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-1542	950 EDLEWEISS PARKWAY		GAYLORD	MI	49735	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-1791	7083 W 48TH STREET		FREMONT	MI	49412	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-2014	2129 WEST HOUGHTON LAKE DRIVE		HOUGHTON LAKE	MI	48629	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-2061	412 CROSS OAKS MALL		PLAINWELL	MI	49080	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-2102	4854 WEST U.S. HWY 10		LUDINGTON	MI	49431	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-5386	14700 US 31		GRAND HAVEN	MI	49417	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07874	3900 N US 31 S	TRAVERSE CITY	MI	49684-4447	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12894	975 W SOUTH AIRPORT ROAD	TRAVERSE CITY	MI	49686-4846	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10186	1029 M 37 S	TRAVERSE CITY	MI	49685	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16475	555 MICHIGAN ST NE STE 100	GRAND RAPIDS	MI	49503	04/14/2025	07/01/2025	04/14/2025
Contract Detail	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WALMART PHARMACY #10-3458	2755 W HOLTON-WHITEHALL ROAD		WHITEHALL	MI	49461-4946	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/14/2025	07/01/2025	04/14/2025
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/14/2025	07/01/2025	04/14/2025
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 6843	626 WEST FRONT ST.	TRAVERSE CITY	MI	49684	04/10/2025	07/01/2025	04/10/2025
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 16197	3130 S AIRPORT RD W	TRAVERSE CITY	MI	49684	04/10/2025	07/01/2025	04/10/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH050390	Active	BPS-H80-004024	NORTHWEST MICHIGAN HEALTH SERVICES, INC	NORTHWEST MICHIGAN HEALTH SERVICES, INC.	10767 E Traverse Hwy	Traverse City	MI
CH05039A	Terminated	BPS-H80-000286	NORTHWEST MICHIGAN HEALTH SERVICES	NORTHWEST MICHIGAN HEALTH SERVICES, INC.	6433 EIGHT MILE ROAD	BEAR LAKE	MI
CH05039B	Active	BPS-H80-000129	NORTHWEST MICHIGAN HEALTH SERVICES, INC	Northwest Michigan Health Services, Inc.	119 S State St	Shelby	MI
CH05039C	Active	BPS-H80-015750	NORTHWEST MICHIGAN HEALTH SERVICES, INC	Northwest Michigan Health Services, Inc.	6051 Frankfort Hwy	Benzonia	MI
CH05039D	Active	BPS-H80-032962	NORTHWEST MICHIGAN HEALTH SERVICES, INC	Northwest Michigan Health Services, Inc.	148 W Parkdale Ave	Manistee	MI
CH05039E	Terminated	BPS-H80-030178	Northwest Michigan Health Services	Northwest Michigan Health Services Ludington	920 Diana St Ste 100	Ludington	MI
CH05039F	Approved	BPS-H80-037946	NORTHWEST MICHIGAN HEALTH SERVICES, INC	Traverse City West Middle School CAHC	3954 Silver Lake Rd	Traverse City	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH050390	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CH05039C	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2025
CH05039F	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2025
CH050390	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CH05039C	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2025
CH05039F	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2025
CH050390	FAMILY FARE PHARMACY #647	1057 US 31 SOUTH		MANISTEE	MI	49660	10/01/2021
CH05039D	FAMILY FARE PHARMACY #647	1057 US 31 SOUTH		MANISTEE	MI	49660	07/01/2025
CH05039B	FAMILY FARE PHARMACY #647	1057 US 31 SOUTH		MANISTEE	MI	49660	07/01/2025
CH05039C	FAMILY FARE PHARMACY #647	1057 US 31 SOUTH		MANISTEE	MI	49660	07/01/2025
CH050390	HOMETOWN PHARMACY #41 - TRAVERSE CITY	4000 EASTERN SKY DR STE 1		TRAVERSE CITY	MI	49684	04/01/2024
CH05039F	HOMETOWN PHARMACY #41 - TRAVERSE CITY	4000 EASTERN SKY DR STE 1		TRAVERSE CITY	MI	49684	07/01/2025
CH050390	HOMETOWN PHARMACY #42 - HONOR	10587 MAIN ST		HONOR	MI	49640-9761	10/01/2020
CH05039C	HOMETOWN PHARMACY #42 - HONOR	10587 MAIN ST		HONOR	MI	49640-9761	07/01/2025
CH05039D	HOMETOWN PHARMACY #42 - HONOR	10587 MAIN ST		HONOR	MI	49640-9761	07/01/2025
CH05039F	HOMETOWN PHARMACY #42 - HONOR	10587 MAIN ST		HONOR	MI	49640-9761	07/01/2025
CH050390	HOMETOWN PHARMACY #43 - SUTTONS BAY	321B N SAINT JOSEPH ST		SUTTONS BAY	MI	49682-5104	04/01/2024
CH05039F	HOMETOWN PHARMACY #43 - SUTTONS BAY	321B N SAINT JOSEPH ST		SUTTONS BAY	MI	49682-5104	07/01/2025
CH050390	HOMETOWN PHARMACY #53 - MUSKEGON	5866 HARVEY ST		MUSKEGON	MI	49444	04/01/2024
CH05039B	HOMETOWN PHARMACY #53 - MUSKEGON	5866 HARVEY ST		MUSKEGON	MI	49444	07/01/2025
CH050390	HOMETOWN PHARMACY, INC.	DBA HOMETOWN PHARMACY #21 - SHELBY	178 N MICHIGAN AVE	SHELBY	MI	49455-1028	10/01/2020
CH05039B	HOMETOWN PHARMACY, INC.	DBA HOMETOWN PHARMACY #21 - SHELBY	178 N MICHIGAN AVE	SHELBY	MI	49455-1028	07/01/2025
CH050390	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	07/01/2019
CH05039D	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	07/01/2025
CH05039C	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	07/01/2025
CH05039F	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	07/01/2025
CH050390	MEIJER INC #33	3955 U.S. 31 SOUTH HWY		TRAVERSE CITY	MI	49684	07/01/2019
CH05039D	MEIJER INC #33	3955 U.S. 31 SOUTH HWY		TRAVERSE CITY	MI	49684	07/01/2025
CH05039F	MEIJER INC #33	3955 U.S. 31 SOUTH HWY		TRAVERSE CITY	MI	49684	07/01/2025
CH05039C	MEIJER INC #33	3955 U.S. 31 SOUTH HWY		TRAVERSE CITY	MI	49684	07/01/2025
CH050390	MEIJER PHARMACY #279	15 CABERFAE HWY M-55		MANISTEE	MI	49660	01/01/2025
CH05039D	MEIJER PHARMACY #279	15 CABERFAE HWY M-55		MANISTEE	MI	49660	07/01/2025
CH05039C	MEIJER PHARMACY #279	15 CABERFAE HWY M-55		MANISTEE	MI	49660	07/01/2025
CH05039F	MEIJER PHARMACY #279	15 CABERFAE HWY M-55		MANISTEE	MI	49660	07/01/2025
CH050390	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	07/01/2019
CH05039D	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	07/01/2025
CH05039C	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	07/01/2025
CH05039F	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	07/01/2025
CH050390	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	07/01/2019
CH05039D	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	07/01/2025
CH05039C	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	07/01/2025
CH05039F	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	07/01/2025
CH050390	OCEANA PHARMACY	819 S STATE ST		HART	MI	49420-1236	10/01/2020
CH05039B	OCEANA PHARMACY	819 S STATE ST		HART	MI	49420-1236	07/01/2025
CH050390	PDS-I MICHIGAN, INC.	RITE AID #4407	1243 U.S. 31 SOUTH	MANISTEE	MI	49660	07/01/2019	04/08/2025
CH050390	PERRY DRUG STORES, INC.	RITE AID #4495	1201A SOUTH DIVISION STREET	TRAVERSE CITY	MI	49684	07/01/2019	04/08/2025
CH050390	RITE AID OF MICHIGAN, INC.	RITE AID #1010	13916 S.W. BAY SHORE DRIVE	TRAVERSE CITY	MI	49684	07/01/2019	04/08/2025
CH050390	RITE AID OF MICHIGAN, INC.	RITE AID #4276	939 US 31 SOUTH	TRAVERSE CITY	MI	49684	07/01/2019	04/08/2025
CH050390	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2021	06/25/2022
CH050390	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2025
CH05039B	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2025
CH05039D	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2025
CH05039C	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2025
CH05039F	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2025
CH050390	WAL-MART PHARMACY 10-1348	5135 CAROLINA BEACH RD		WILMINGTON (S)	NC	28412	04/01/2025
CH05039B	WAL-MART PHARMACY 10-1348	5135 CAROLINA BEACH RD		WILMINGTON (S)	NC	28412	07/01/2025
CH05039D	WAL-MART PHARMACY 10-1348	5135 CAROLINA BEACH RD		WILMINGTON (S)	NC	28412	07/01/2025
CH05039C	WAL-MART PHARMACY 10-1348	5135 CAROLINA BEACH RD		WILMINGTON (S)	NC	28412	07/01/2025
CH05039F	WAL-MART PHARMACY 10-1348	5135 CAROLINA BEACH RD		WILMINGTON (S)	NC	28412	07/01/2025
CH050390	WAL-MART PHARMACY 10-1432	8917 EAST 34 ROAD		CADILLAC	MI	49601	04/01/2025
CH05039B	WAL-MART PHARMACY 10-1432	8917 EAST 34 ROAD		CADILLAC	MI	49601	07/01/2025
CH05039D	WAL-MART PHARMACY 10-1432	8917 EAST 34 ROAD		CADILLAC	MI	49601	07/01/2025
CH05039C	WAL-MART PHARMACY 10-1432	8917 EAST 34 ROAD		CADILLAC	MI	49601	07/01/2025
CH05039F	WAL-MART PHARMACY 10-1432	8917 EAST 34 ROAD		CADILLAC	MI	49601	07/01/2025
CH050390	WAL-MART PHARMACY 10-1542	950 EDLEWEISS PARKWAY		GAYLORD	MI	49735	04/01/2025
CH05039B	WAL-MART PHARMACY 10-1542	950 EDLEWEISS PARKWAY		GAYLORD	MI	49735	07/01/2025
CH05039D	WAL-MART PHARMACY 10-1542	950 EDLEWEISS PARKWAY		GAYLORD	MI	49735	07/01/2025
CH05039C	WAL-MART PHARMACY 10-1542	950 EDLEWEISS PARKWAY		GAYLORD	MI	49735	07/01/2025
CH05039F	WAL-MART PHARMACY 10-1542	950 EDLEWEISS PARKWAY		GAYLORD	MI	49735	07/01/2025
CH050390	WAL-MART PHARMACY 10-1791	7083 W 48TH STREET		FREMONT	MI	49412	04/01/2025
CH05039B	WAL-MART PHARMACY 10-1791	7083 W 48TH STREET		FREMONT	MI	49412	07/01/2025
CH05039D	WAL-MART PHARMACY 10-1791	7083 W 48TH STREET		FREMONT	MI	49412	07/01/2025
CH05039C	WAL-MART PHARMACY 10-1791	7083 W 48TH STREET		FREMONT	MI	49412	07/01/2025
CH05039F	WAL-MART PHARMACY 10-1791	7083 W 48TH STREET		FREMONT	MI	49412	07/01/2025
CH050390	WAL-MART PHARMACY 10-2014	2129 WEST HOUGHTON LAKE DRIVE		HOUGHTON LAKE	MI	48629	04/01/2025
CH05039B	WAL-MART PHARMACY 10-2014	2129 WEST HOUGHTON LAKE DRIVE		HOUGHTON LAKE	MI	48629	07/01/2025
CH05039D	WAL-MART PHARMACY 10-2014	2129 WEST HOUGHTON LAKE DRIVE		HOUGHTON LAKE	MI	48629	07/01/2025
CH05039C	WAL-MART PHARMACY 10-2014	2129 WEST HOUGHTON LAKE DRIVE		HOUGHTON LAKE	MI	48629	07/01/2025
CH05039F	WAL-MART PHARMACY 10-2014	2129 WEST HOUGHTON LAKE DRIVE		HOUGHTON LAKE	MI	48629	07/01/2025
CH050390	WAL-MART PHARMACY 10-2061	412 CROSS OAKS MALL		PLAINWELL	MI	49080	04/01/2025
CH05039B	WAL-MART PHARMACY 10-2061	412 CROSS OAKS MALL		PLAINWELL	MI	49080	07/01/2025
CH05039D	WAL-MART PHARMACY 10-2061	412 CROSS OAKS MALL		PLAINWELL	MI	49080	07/01/2025
CH05039C	WAL-MART PHARMACY 10-2061	412 CROSS OAKS MALL		PLAINWELL	MI	49080	07/01/2025
CH05039F	WAL-MART PHARMACY 10-2061	412 CROSS OAKS MALL		PLAINWELL	MI	49080	07/01/2025
CH050390	WAL-MART PHARMACY 10-2102	4854 WEST U.S. HWY 10		LUDINGTON	MI	49431	04/01/2025
CH05039B	WAL-MART PHARMACY 10-2102	4854 WEST U.S. HWY 10		LUDINGTON	MI	49431	07/01/2025
CH05039D	WAL-MART PHARMACY 10-2102	4854 WEST U.S. HWY 10		LUDINGTON	MI	49431	07/01/2025
CH05039C	WAL-MART PHARMACY 10-2102	4854 WEST U.S. HWY 10		LUDINGTON	MI	49431	07/01/2025
CH05039F	WAL-MART PHARMACY 10-2102	4854 WEST U.S. HWY 10		LUDINGTON	MI	49431	07/01/2025
CH050390	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	10/01/2021	06/25/2022
CH050390	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	04/01/2025
CH05039B	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	07/01/2025
CH05039D	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	07/01/2025
CH05039C	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	07/01/2025
CH05039F	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	07/01/2025
CH050390	WAL-MART PHARMACY 10-5386	14700 US 31		GRAND HAVEN	MI	49417	04/01/2025
CH05039B	WAL-MART PHARMACY 10-5386	14700 US 31		GRAND HAVEN	MI	49417	07/01/2025
CH05039D	WAL-MART PHARMACY 10-5386	14700 US 31		GRAND HAVEN	MI	49417	07/01/2025
CH05039C	WAL-MART PHARMACY 10-5386	14700 US 31		GRAND HAVEN	MI	49417	07/01/2025
CH05039F	WAL-MART PHARMACY 10-5386	14700 US 31		GRAND HAVEN	MI	49417	07/01/2025
CH050390	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2021	06/25/2022
CH050390	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CH05039C	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2025
CH05039B	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2025
CH05039D	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2025
CH05039F	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2025
CH050390	WALGREEN CO	DBA: WALGREENS #11417	3284 COLBY RD	WHITEHALL	MI	49461-9637	04/01/2025
CH05039B	WALGREEN CO	DBA: WALGREENS #11417	3284 COLBY RD	WHITEHALL	MI	49461-9637	07/01/2025
CH05039D	WALGREEN CO	DBA: WALGREENS #11417	3284 COLBY RD	WHITEHALL	MI	49461-9637	07/01/2025
CH050390	WALGREEN CO.	DBA: WALGREENS # 05560	33 S PERE MARQUETTE HWY	LUDINGTON	MI	49431	04/01/2025
CH050390	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16475	555 MICHIGAN ST NE STE 100	GRAND RAPIDS	MI	49503	04/01/2025
CH050390	WALGREEN CO.	DBA: WALGREENS # 07874	3900 N US 31 S	TRAVERSE CITY	MI	49684-4447	07/01/2025
CH050390	WALGREEN CO.	DBA: WALGREENS # 10186	1029 M 37 S	TRAVERSE CITY	MI	49685	07/01/2025
CH050390	WALGREEN CO.	DBA: WALGREENS #12894	975 W SOUTH AIRPORT ROAD	TRAVERSE CITY	MI	49686-4846	07/01/2025
CH05039B	WALGREEN CO.	DBA: WALGREENS # 05560	33 S PERE MARQUETTE HWY	LUDINGTON	MI	49431	07/01/2025
CH05039B	WALGREEN CO.	DBA: WALGREENS # 07874	3900 N US 31 S	TRAVERSE CITY	MI	49684-4447	07/01/2025
CH05039B	WALGREEN CO.	DBA: WALGREENS #12894	975 W SOUTH AIRPORT ROAD	TRAVERSE CITY	MI	49686-4846	07/01/2025
CH05039B	WALGREEN CO.	DBA: WALGREENS # 10186	1029 M 37 S	TRAVERSE CITY	MI	49685	07/01/2025
CH05039B	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16475	555 MICHIGAN ST NE STE 100	GRAND RAPIDS	MI	49503	07/01/2025
CH05039D	WALGREEN CO.	DBA: WALGREENS # 05560	33 S PERE MARQUETTE HWY	LUDINGTON	MI	49431	07/01/2025
CH05039D	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16475	555 MICHIGAN ST NE STE 100	GRAND RAPIDS	MI	49503	07/01/2025
CH05039D	WALGREEN CO.	DBA: WALGREENS # 07874	3900 N US 31 S	TRAVERSE CITY	MI	49684-4447	07/01/2025
CH05039D	WALGREEN CO.	DBA: WALGREENS #12894	975 W SOUTH AIRPORT ROAD	TRAVERSE CITY	MI	49686-4846	07/01/2025
CH05039D	WALGREEN CO.	DBA: WALGREENS # 10186	1029 M 37 S	TRAVERSE CITY	MI	49685	07/01/2025
CH05039F	WALGREEN CO.	DBA: WALGREENS # 07874	3900 N US 31 S	TRAVERSE CITY	MI	49684-4447	07/01/2025
CH05039F	WALGREEN CO.	DBA: WALGREENS #12894	975 W SOUTH AIRPORT ROAD	TRAVERSE CITY	MI	49686-4846	07/01/2025
CH05039F	WALGREEN CO.	DBA: WALGREENS # 10186	1029 M 37 S	TRAVERSE CITY	MI	49685	07/01/2025
CH05039F	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16475	555 MICHIGAN ST NE STE 100	GRAND RAPIDS	MI	49503	07/01/2025
CH050390	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	04/01/2025
CH05039B	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	07/01/2025	04/09/2025
CH05039B	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	07/01/2025
CH05039D	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	07/01/2025
CH05039F	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	07/01/2025
CH050390	WALMART PHARMACY #10-3458	2755 W HOLTON-WHITEHALL ROAD		WHITEHALL	MI	49461-4946	04/01/2025
CH05039B	WALMART PHARMACY #10-3458	2755 W HOLTON-WHITEHALL ROAD		WHITEHALL	MI	49461-4946	07/01/2025
CH05039D	WALMART PHARMACY #10-3458	2755 W HOLTON-WHITEHALL ROAD		WHITEHALL	MI	49461-4946	07/01/2025
CH05039C	WALMART PHARMACY #10-3458	2755 W HOLTON-WHITEHALL ROAD		WHITEHALL	MI	49461-4946	07/01/2025
CH05039F	WALMART PHARMACY #10-3458	2755 W HOLTON-WHITEHALL ROAD		WHITEHALL	MI	49461-4946	07/01/2025
CH050390	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	04/01/2025	04/10/2025
CH050390	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CH05039B	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2025
CH05039D	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2025
CH05039C	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2025
CH05039F	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2025
CH050390	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CH05039B	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2025
CH05039D	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2025
CH05039C	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2025
CH05039F	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2025
CH050390	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 6843	626 WEST FRONT ST.	TRAVERSE CITY	MI	49684	01/01/2024
CH050390	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 16197	3130 S AIRPORT RD W	TRAVERSE CITY	MI	49684	01/01/2024
CH05039C	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 6843	626 WEST FRONT ST.	TRAVERSE CITY	MI	49684	07/01/2025
CH05039C	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 16197	3130 S AIRPORT RD W	TRAVERSE CITY	MI	49684	07/01/2025
CH05039F	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 6843	626 WEST FRONT ST.	TRAVERSE CITY	MI	49684	07/01/2025
CH05039F	WOODWARD DETROIT CVS, L.L.C.	CVS PHARMACY # 16197	3130 S AIRPORT RD W	TRAVERSE CITY	MI	49684	07/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Insert	Change Request		NORTHWEST MICHIGAN HEALTH SERVICES, INC 10767 E TRAVERSE HWY TRAVERSE CITY, MI 49684	4/9/2025 10:11 AM
Contacts	Signed By	Insert	New Registration		Britton, Heidi Chief Executive Officer Northwest Michigan Health Services 2319471112	4/7/2025 6:35 AM
Details	340B ID	Update	New Registration		CH05039F	4/7/2025 6:35 AM
Dates	Participating Approval Date	Update	New Registration		4/7/2025 6:35:36 AM	4/7/2025 6:35 AM
Details	State	Update	New Registration	Pending	Approved	4/7/2025 6:35 AM
Dates	Signed By Date	Update	New Registration		4/4/2025 1:24:30 PM	4/7/2025 6:35 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/7/2025 6:35 AM
Addresses	Main Address	Insert	New Registration		3954 Silver Lake Rd Traverse City, MI 49684-8946	4/4/2025 1:24 PM
Contacts	Authorizing Official	Insert	New Registration		Britton, Heidi Chief Executive Officer Northwest Michigan Health Services 2319471112	4/4/2025 1:24 PM
Contacts	Primary Contact	Insert	New Registration		Corliss, Kimberly A Director of Administrative Operations Northwest Michigan Health Services, Inc. 2318612130	4/4/2025 1:24 PM
Details	Assistance Received From Date	Insert	New Registration			4/4/2025 1:24 PM
Details	Assistance Received To Date	Insert	New Registration			4/4/2025 1:24 PM
Details	Last Recertification Date	Insert	New Registration			4/4/2025 1:24 PM
Details	Grant Number	Insert	New Registration		H80CS00669	4/4/2025 1:24 PM
Details	340B ID	Insert	New Registration			4/4/2025 1:24 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2025 1:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2025 1:24 PM
Details	Medicare Provider Number	Insert	New Registration			4/4/2025 1:24 PM
Details	Entity Name	Insert	New Registration		NORTHWEST MICHIGAN HEALTH SERVICES, INC	4/4/2025 1:24 PM
Details	NOFO Number	Insert	New Registration			4/4/2025 1:24 PM
Details	Program Code	Insert	New Registration		CH	4/4/2025 1:24 PM
Details	Entity Subname	Insert	New Registration		Traverse City West Middle School CAHC	4/4/2025 1:24 PM
Dates	Participating Approval Date	Insert	New Registration			4/4/2025 1:24 PM
Details	State	Insert	New Registration		Pending	4/4/2025 1:24 PM
Dates	Registration Date	Insert	New Registration		4/4/2025 1:24:29 PM	4/4/2025 1:24 PM
Dates	Signed By Date	Insert	New Registration			4/4/2025 1:24 PM
Dates	Start Date	Insert	New Registration			4/4/2025 1:24 PM
Terminations	Termination Comments	Insert	New Registration			4/4/2025 1:24 PM
Terminations	Termination Date	Insert	New Registration			4/4/2025 1:24 PM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2025 1:24 PM
Terminations	Termination Reason	Insert	New Registration			4/4/2025 1:24 PM

340B Drug Pricing Program Database