Covered Entity Details

CHC08784-38 LAKES COMMUNITY HEALTH CENTER, INC THE (Approved) - information as of 5/1/2025 11:50:49 PM

Main Details

Name

LAKES COMMUNITY HEALTH CENTER, INC THE

Subdivision Name

NorthLakes - Rice Lake New

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039464

340B ID

CHC08784-38

Grant Number

H80CS08784

Additional Details

Current Program Status

Approved

Registration Date

4/7/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/8/2025

Last Recertification Date

Contacts

Authorizing Official

The Lakes Community Health Center
Jason Akl, COO
(715) 372-5001

Primary Contact

The Lakes Community Health Center
Christine Marie Dryer, Pharmacy Director
(715) 372-5011

Addresses

Street Address

1051 West Ave
Rice Lake, WI 54868-4425

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
WI		1568800407

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
CHC08784-00	Active	BPS-H80-002175	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Iron River	7665 Us Highway 2	Iron River	WI
CHC08784-01	Terminated	BPS-H80-012595	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Hayward - Dental	15910 W Company Lake Road	Hayward	WI
CHC08784-02	Active	BPS-H80-012598	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Minong	600 W Shell Creek Rd	Minong	WI
CHC08784-03	Terminated	BPS-H80-012596	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Hayward	11128 N STATE HIGHWAY 77	HAYWARD	WI
CHC08784-04	Active	BPS-H80-008174	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Ashland East	719 Main St E	Ashland	WI
CHC08784-05	Terminated	BPS-H80-014863	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Turtle Lake	212 Maple Street South	Turtle Lake	WI
CHC08784-06	Terminated	BPS-H80-016988	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Balsam Lake	100 Polk County Plaza	Balsam Lake	WI
CHC08784-07	Terminated	BPS-H80-013937	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Ashland AODA	502 MAIN ST W	ASHLAND	WI
CHC08784-08	Active	BPS-H80-031291	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Washburn	320 Superior Avenue Suite D	Washburn	WI
CHC08784-09	Terminated	BPS-H80-018284	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - 212 W Main, Ashland	212 W. Main Street	Ashland	WI
CHC08784-10	Terminated	BPS-H80-018445	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Turtle Lake Annex	214-B Maple Street South	Turtle Lake	WI
CHC08784-11	Active	BPS-H80-016866	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Ashland Downtown	300 Main Street W	Ashland	WI
CHC08784-12	Active	BPS-H80-022055	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Rivers Edge	15954 River’s Edge Drive	Hayward	WI
CHC08784-13	Active	BPS-H80-022297	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Birchwood	108 S Main St	Birchwood	WI
CHC08784-14	Active	BPS-H80-024815	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes--Turtle Lake	730 Swede Avenue	Turtle Lake	WI
CHC08784-15	Terminated	BPS-H80-024950	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Park Falls	500 Birch St	Park Falls	WI
CHC08784-16	Active	BPS-H80-027202	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Lakewood	15397 State Highway 32	Lakewood	WI
CHC08784-17	ToBeTerminated	BPS-H80-027199	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Oconto	820 Arbutus Ave	Oconto	WI
CHC08784-18	Active	BPS-H80-027197	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - White Lake	524 Bissell Street	White Lake	WI
CHC08784-19	Terminated	BPS-H80-027414	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes Community Clinic	218 Main St W	Ashland	WI
CHC08784-20	Active	BPS-H80-027785	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes Hayward - Admin Building	15735 US Highway 63	Hayward	WI
CHC08784-21	Active	BPS-H80-030438	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Hurley	115 5th Avenue N	Hurley	WI
CHC08784-22	Active	BPS-H80-033972	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes- Park Falls	110 2nd Ave N	Park Falls	WI
CHC08784-23	Terminated	BPS-H80-034041	LAKES COMMUNITY HEALTH CENTER, INC., THE	Chippewa Falls Pediatric Dental Specialty	425 W Prairie View Rd	Chippewa Falls	WI
CHC08784-24	Terminated	BPS-H80-035503	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Eau Claire	822 S Hastings Way	Eau Claire	WI
CHC08784-25	Active	BPS-H80-036901	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Cumberland	1150 6th Ave	Cumberland	WI
CHC08784-26	Terminated	BPS-H80-035799	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Marinette Temporary	2545 Roosevelt Road	Marinette	WI
CHC08784-27	Active	BPS-H80-036946	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Rice Lake	1035 North Main St	Rice Lake	WI
CHC08784-28	Active	BPS-H80-036799	LAKES COMMUNITY HEALTH CENTER, INC., THE	NorthLakes - Marinette	1435 Cleveland Avenue	Marinette	WI
CHC08784-29	Terminated	BPS-H80-037811	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes - Solon Springs	9893 E Jackson Dr	Solon Springs	WI
CHC08784-30	Terminated	BPS-H80-038023	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes - Bayfield TEMP	300 Manypenny Ave	Bayfield	WI
CHC08784-31	Active	BPS-H80-037639	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes - Poplar	9675 E Elm Rd	Poplar	WI
CHC08784-32	Active	BPS-H80-038247	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes - Solon Springs New	11178 O'Brien Parkway	Solon Springs	WI
CHC08784-33	Terminated	BPS-H80-036883	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes - Eau Claire BH	826 S Hastings Way	Eau Claire	WI
CHC08784-34	Active	BPS-H80-038830	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes - Augusta	207 W Lincoln St	Augusta	WI
CHC08784-35	Active	BPS-H80-038929	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes Eau Claire - Oak Ridge	2119 Heights Dr	Eau Claire	WI
CHC08784-36	Active	BPS-H80-038571	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes Eau Claire - Clairemont Avenue	1002 W Clairemont Ave	Eau Claire	WI
CHC08784-37	Approved	BPS-H80-039465	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes - Oconto	155 Memorial Dr	Oconto	WI
CHC08784-38	Approved	BPS-H80-039464	LAKES COMMUNITY HEALTH CENTER, INC THE	NorthLakes - Rice Lake New	1051 West Ave	Rice Lake	WI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC08784-00	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2022
CHC08784-00	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2022
CHC08784-00	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2022
CHC08784-00	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2022
CHC08784-00	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2022
CHC08784-00	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2022
CHC08784-00	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2022
CHC08784-00	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	04/01/2017	10/07/2024
CHC08784-00	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2019
CHC08784-00	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	10/01/2024
CHC08784-00	AMAZON PHARMACY #008	408 TECHNOLOGY PARKWAY	BUILDING B, STE 101	COLLEGE STATION	TX	77845	10/01/2024
CHC08784-00	AMAZON PHARMACY #009	7469 KINGSPOINTE PKWY STE 400		ORLANDO	FL	32819	10/01/2024
CHC08784-00	AMAZON PHARMACY #010	1331 E 6TH ST		CORONA	CA	92879	10/01/2024
CHC08784-00	ASHLAND PHARMACY INC DBA HUHN RX DRUG	522 MAIN ST W		ASHLAND	WI	54806	07/01/2023	07/11/2024
CHC08784-00	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CHC08784-00	CO-OP PHARMACY	15846 W US HIGHWAY 63 S		HAYWARD	WI	54843	07/01/2019	10/07/2024
CHC08784-00	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	04/01/2017	12/31/2021
CHC08784-00	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2022
CHC08784-00	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2022
CHC08784-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2022
CHC08784-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2022
CHC08784-00	IC PHARMACY LLC	AMAZON PHARMACY #004	34 35TH STREET STE 4BSW, UNIT 28	BROOKLYN	NY	11232	10/01/2024
CHC08784-00	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2019
CHC08784-00	NICOLET PHARMACY	15481 COMMERCIAL RD STE A		LAKEWOOD	WI	54138-9677	07/01/2019
CHC08784-00	PARK PHARMACY	138 2ND AVE N		PARK FALLS	WI	54552-1214	07/01/2023
CHC08784-00	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2019
CHC08784-00	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	10/01/2024
CHC08784-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2014
CHC08784-00	WAL-MART PHARMACY 10-3245	15594 STATE HIGHWAY 77		HAYWARD	WI	54843	04/01/2014
CHC08784-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2014
CHC08784-00	WALGREEN CO	DBA: WALGREENS #11954	802 E CLOVERLAND DR	IRONWOOD	MI	49938-1502	04/01/2023
CHC08784-00	WALGREEN CO.	DBA: WALGREENS # 03064	2015 TOWER AVENUE	SUPERIOR	WI	54880	08/30/2011
CHC08784-00	WALGREEN CO.	DBA: WALGREENS #10758	110 LAKE SHORE DR. W	ASHLAND	WI	54806-1645	08/30/2011
CHC08784-00	WALGREEN CO.	DBA: WALGREENS #11857	10489 STATE ROAD 27	HAYWARD	WI	54843	07/01/2013
CHC08784-00	WALGREEN CO.	DBA: WALGREENS #11860	502 S. MAIN ST.	RICE LAKE	WI	54868-2576	07/01/2013
CHC08784-00	WALGREEN CO.	DBA: WALGREENS # 01937	1106 W CLAIREMONT AVE	EAU CLAIRE	WI	54701-6124	01/01/2025
CHC08784-00	WALGREEN CO.	DBA: WALGREENS # 03497	1819 S HASTINGS WAY	EAU CLAIRE	WI	54701	07/01/2025
CHC08784-00	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	01/03/2018
CHC08784-00	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	07/11/2024
CHC08784-00	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018	10/07/2024
CHC08784-00	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CHC08784-00	WHITE CROSS PHARMACY INC	314 SILVER ST		HURLEY	WI	54534-1254	07/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Change Request		1568800407	4/14/2025 10:40 AM
Medicaid Billing	NPI: State	Insert	Change Request		WI	4/14/2025 10:40 AM
Contacts	Signed By	Insert	New Registration		Akl, Jason COO The Lakes Community Health Center 7153725001	4/8/2025 9:17 AM
Details	340B ID	Update	New Registration		CHC08784-38	4/8/2025 9:17 AM
Dates	Participating Approval Date	Update	New Registration		4/8/2025 9:17:01 AM	4/8/2025 9:17 AM
Details	State	Update	New Registration	Pending	Approved	4/8/2025 9:17 AM
Dates	Signed By Date	Update	New Registration		4/8/2025 7:59:44 AM	4/8/2025 9:17 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/8/2025 9:17 AM
Addresses	Main Address	Insert	New Registration		1051 West Ave Rice Lake, WI 54868-4425	4/7/2025 4:49 PM
Contacts	Authorizing Official	Insert	New Registration		Akl, Jason COO The Lakes Community Health Center 7153725001	4/7/2025 4:49 PM
Contacts	Primary Contact	Insert	New Registration		Dryer, Christine Marie Pharmacy Director The Lakes Community Health Center 7153725011	4/7/2025 4:49 PM
Details	Assistance Received From Date	Insert	New Registration			4/7/2025 4:49 PM
Details	Assistance Received To Date	Insert	New Registration			4/7/2025 4:49 PM
Details	Last Recertification Date	Insert	New Registration			4/7/2025 4:49 PM
Details	Grant Number	Insert	New Registration		H80CS08784	4/7/2025 4:49 PM
Details	340B ID	Insert	New Registration			4/7/2025 4:49 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/7/2025 4:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/7/2025 4:49 PM
Details	Medicare Provider Number	Insert	New Registration			4/7/2025 4:49 PM
Details	Entity Name	Insert	New Registration		LAKES COMMUNITY HEALTH CENTER, INC THE	4/7/2025 4:49 PM
Details	NOFO Number	Insert	New Registration			4/7/2025 4:49 PM
Details	Program Code	Insert	New Registration		CH	4/7/2025 4:49 PM
Details	Entity Subname	Insert	New Registration		NorthLakes - Rice Lake New	4/7/2025 4:49 PM
Dates	Participating Approval Date	Insert	New Registration			4/7/2025 4:49 PM
Details	State	Insert	New Registration		Pending	4/7/2025 4:49 PM
Dates	Registration Date	Insert	New Registration		4/7/2025 4:49:49 PM	4/7/2025 4:49 PM
Dates	Signed By Date	Insert	New Registration			4/7/2025 4:49 PM
Dates	Start Date	Insert	New Registration			4/7/2025 4:49 PM
Terminations	Termination Comments	Insert	New Registration			4/7/2025 4:49 PM
Terminations	Termination Date	Insert	New Registration			4/7/2025 4:49 PM
Terminations	Termination Effective Date	Insert	New Registration			4/7/2025 4:49 PM
Terminations	Termination Reason	Insert	New Registration			4/7/2025 4:49 PM

340B Drug Pricing Program Database