Covered Entity Details

CHC24165-10 NORTH COUNTRY FAMILY HEAL (Approved) - information as of 5/13/2025 10:57:15 PM

Main Details

Name

NORTH COUNTRY FAMILY HEAL

Subdivision Name

Lowville Family Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039990

340B ID

CHC24165-10

Grant Number

H80CS24165

Additional Details

Current Program Status

Approved

Registration Date

4/7/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/7/2025

Last Recertification Date

Contacts

Authorizing Official

North Country Family Health Center
Joey Marie Horton, Chief Executive Officer
(315) 782-9450

Primary Contact

North Country Family Health Center
Erin Elizabeth Hunter, Chief Financial Officer
(315) 782-9450 Ext: 8083

Addresses

Street Address

5402 Dayan St
Lowville, NY 13367-1100

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
CHC24165-00	Active	BPS-H80-011809	North Country Family Health Center, Inc.	North Country Family Health Center - Main Campus	238 Arsenal St	Watertown	NY
CHC24165-01	Active	BPS-H80-014018	NORTH COUNTRY FAMILY HEALTH CENTER, INC.	North Country Family Health Center - Lowville	7785 N. State Street	Lowville	NY
CHC24165-02	Active	BPS-H80-011839	NORTH COUNTRY FAMILY HEALTH CENTER, INC.	Mannsville Elementary School	423 N. Main St	Mannsville	NY
CHC24165-03	Active	BPS-H80-011816	NORTH COUNTRY FAMILY HEALTH CENTER, INC.	Watertown High School	1335 Washington St	Watertown	NY
CHC24165-04	Active	BPS-H80-011815	NORTH COUNTRY FAMILY HEALTH CENTER, INC.	Case Middle School	1237 Washington St	Watertown	NY
CHC24165-05	Active	BPS-H80-011805	NORTH COUNTRY FAMILY HEALTH CENTER, INC.	Wilson Elementary School	13180 US Route 11	Adams Center	NY
CHC24165-06	Active	BPS-H80-011802	NORTH COUNTRY FAMILY HEALTH CENTER, INC.	Wiley Intermediate School	1351 Washington St	Watertown	NY
CHC24165-07	Active	BPS-H80-011795	NORTH COUNTRY FAMILY HEALTH CENTER, INC.	North Elementary School	171 E. Hoard St	Watertown	NY
CHC24165-08	Active	BPS-H80-019061	NORTH COUNTRY FAMILY HEALTH CENTER, INC.	North Country Family Health Center - LeRay Dental	26908 Independence Way, Suite 202	Evans Mills	NY
CHC24165-09	Active	BPS-H80-030180	North Country Family Health Center, Inc.	JCC Health & Wellness Center	1220 Coffeen St Bldg 17	Watertown	NY
CHC24165-10	Approved	BPS-H80-039990	NORTH COUNTRY FAMILY HEAL	Lowville Family Health Center	5402 Dayan St	Lowville	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC24165-00	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #08	22056 U.S. ROUTE 11	WATERTOWN	NY	13601	10/01/2013	01/26/2024
CHC24165-00	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	10/01/2013
CHC24165-00	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2015
CHC24165-00	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2015
CHC24165-00	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	10/01/2024
CHC24165-01	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-01	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-01	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-01	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-02	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-02	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-02	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-02	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-03	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-03	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-03	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-03	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-04	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-04	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-04	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-04	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-05	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-05	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-05	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-05	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-06	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-06	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-06	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-06	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-07	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-07	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-07	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-07	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-08	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-08	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-08	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-08	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-09	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #13	1729 STATE STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-09	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #15	1304 WASHINGTON ST	WATERTOWN	NY	13601	01/01/2025
CHC24165-09	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #30	905 COFFEEN STREET	WATERTOWN	NY	13601	01/01/2025
CHC24165-09	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	01/01/2025
CHC24165-00	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-00	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-01	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-01	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-02	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-02	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-03	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-03	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-04	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-04	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-05	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-05	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-06	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-06	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-07	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-07	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-08	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-08	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-09	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #20	7395 UTICA BLVD	LOWVILLE	NY	13367	04/01/2025
CHC24165-09	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #06	401 STATE STREET	CARTHAGE	NY	13619	04/01/2025
CHC24165-00	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	10/01/2022
CHC24165-01	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-02	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-03	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-04	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-05	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-06	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-07	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-08	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-09	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	01/01/2025
CHC24165-00	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	04/01/2024
CHC24165-01	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-02	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-03	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-04	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-05	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-06	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-07	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-08	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-09	PARKVIEW NOCO RX, LLC	238 ARSENAL ST STE 100		WATERTOWN	NY	13601	01/01/2025
CHC24165-00	THE GOLUB CORPORATION	PRICE CHOPPER PHARMACY #102	1283 ARSENAL ST	WATERTOWN	NY	13601	07/01/2022	07/14/2022
CHC24165-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020	09/22/2023
CHC24165-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-01	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-02	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-03	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-04	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-05	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-06	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-07	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-08	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-09	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CHC24165-00	WAL-MART PHARMACY 10-1871	20823 ST. - RT. #3		WATERTOWN	NY	13601	01/01/2020	09/22/2023
CHC24165-00	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-01	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-02	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-03	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-04	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-05	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-06	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-07	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-08	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-09	WAL-MART PHARMACY 10-5498	7155 STATE ROUTE #12 SOUTH		LOWVILLE	NY	13367	04/01/2025
CHC24165-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020	09/22/2023
CHC24165-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-01	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-02	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-03	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-04	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-05	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-06	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-07	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-08	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-09	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2025
CHC24165-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-01	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-02	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-03	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-04	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-05	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-06	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-07	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-08	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-09	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2025
CHC24165-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-01	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-02	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-03	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-04	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-05	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-06	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-07	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-08	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025
CHC24165-09	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Horton, Joey Marie Chief Executive Officer North Country Family Health Center 3157829450	4/7/2025 9:36 AM
Details	340B ID	Update	New Registration		CHC24165-10	4/7/2025 9:36 AM
Dates	Participating Approval Date	Update	New Registration		4/7/2025 9:36:22 AM	4/7/2025 9:36 AM
Details	State	Update	New Registration	Pending	Approved	4/7/2025 9:36 AM
Dates	Signed By Date	Update	New Registration		4/7/2025 8:48:41 AM	4/7/2025 9:36 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/7/2025 9:36 AM
Addresses	Main Address	Insert	New Registration		5402 Dayan St Lowville, NY 13367-1100	4/7/2025 8:48 AM
Contacts	Authorizing Official	Insert	New Registration		Horton, Joey Marie Chief Executive Officer North Country Family Health Center 3157829450	4/7/2025 8:48 AM
Contacts	Primary Contact	Insert	New Registration		Hunter, Erin Elizabeth Chief Financial Officer North Country Family Health Center 3157829450-8083	4/7/2025 8:48 AM
Details	Assistance Received From Date	Insert	New Registration			4/7/2025 8:48 AM
Details	Assistance Received To Date	Insert	New Registration			4/7/2025 8:48 AM
Details	Last Recertification Date	Insert	New Registration			4/7/2025 8:48 AM
Details	Grant Number	Insert	New Registration		H80CS24165	4/7/2025 8:48 AM
Details	340B ID	Insert	New Registration			4/7/2025 8:48 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/7/2025 8:48 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/7/2025 8:48 AM
Details	Medicare Provider Number	Insert	New Registration			4/7/2025 8:48 AM
Details	Entity Name	Insert	New Registration		NORTH COUNTRY FAMILY HEAL	4/7/2025 8:48 AM
Details	NOFO Number	Insert	New Registration			4/7/2025 8:48 AM
Details	Program Code	Insert	New Registration		CH	4/7/2025 8:48 AM
Details	Entity Subname	Insert	New Registration		Lowville Family Health Center	4/7/2025 8:48 AM
Dates	Participating Approval Date	Insert	New Registration			4/7/2025 8:48 AM
Details	State	Insert	New Registration		Pending	4/7/2025 8:48 AM
Dates	Registration Date	Insert	New Registration		4/7/2025 8:48:40 AM	4/7/2025 8:48 AM
Dates	Signed By Date	Insert	New Registration			4/7/2025 8:48 AM
Dates	Start Date	Insert	New Registration			4/7/2025 8:48 AM
Terminations	Termination Comments	Insert	New Registration			4/7/2025 8:48 AM
Terminations	Termination Date	Insert	New Registration			4/7/2025 8:48 AM
Terminations	Termination Effective Date	Insert	New Registration			4/7/2025 8:48 AM
Terminations	Termination Reason	Insert	New Registration			4/7/2025 8:48 AM

340B Drug Pricing Program Database