Covered Entity Details

CH09287AF CHIRICAHUA COMMUNITY HEALTH CENTERS INC (Approved) - information as of 5/7/2025 10:40:56 PM

Main Details

Name

CHIRICAHUA COMMUNITY HEALTH CENTERS INC

Subdivision Name

Chiricahua Community Health Centers, Inc. 77 Calle Portal Suite C-260

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039921

340B ID

CH09287AF

Grant Number

H80CS00696

Additional Details

Current Program Status

Approved

Registration Date

4/15/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/24/2025

Last Recertification Date

Contacts

Authorizing Official

chiricahua community health centers
Jonathan Melk, CEO
(520) 227-9167

Primary Contact

Chiricahua Community Health Centers
David Andrew Merrell, Pharmacy Director
(480) 202-2497

Addresses

Street Address

77 Calle Portal, #C260
Sierra Vista, AZ 85635-2967

Billing Address

Chiricahua Community Health Centers, Inc.
1205 F Ave
Douglas, AZ 85607

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
CH092870	Active	BPS-H80-005066	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Cliff Whetten Clinic	10566 N Highway 191	Elfrida	AZ
CH09287A	Active	BPS-H80-003173	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Jennifer 'Ginger' Ryan Clinic	1100 ''F'' AVE	DOUGLAS	AZ
CH09287AA	Terminated	BPS-H80-009283	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	CCHCI Mobile Clinic	Chiricahua Community Health Centers, Inc Cochise County PO Box 263 Elfrida, AZ 85610	Elfrida	AZ
CH09287AB	Active	BPS-H80-036743	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. "Doyenne" Mobile Unit	815 E 15th St	Douglas	AZ
CH09287AC	Approved	BPS-H80-037220	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Behavioral Health Center Suite A140	77 Calle Portal, #A140	Sierra Vista	AZ
CH09287AD	Approved	BPS-H80-039925	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Behavioral Health B-150	77 Calle Portal STE B-150	Sierra Vista	AZ
CH09287AE	Approved	BPS-H80-039732	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Willcox Clinic	251 W Rex Allen Dr	Willcox	AZ
CH09287AF	Approved	BPS-H80-039921	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. 77 Calle Portal Suite C-260	77 Calle Portal, #C260	Sierra Vista	AZ
CH09287D	Active	BPS-H80-005106	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Bisbee Family Health Center	108 ARIZONA ST	BISBEE	AZ
CH09287E	Active	BPS-H80-008882	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers Inc. Pediatric Center of Excellence	815 15th Street	Douglas	AZ
CH09287F	Terminated	BPS-H80-013846	Chiricahua Community Health Centers, Inc.	Chiricahua Community Health Centers Vista Peds	1590 Paseo San Luis, Ste 102	Sierra Vista	AZ
CH09287G	Terminated	BPS-H80-013150	Chiricahua Community Health Centers, Inc.	Sierra Vista Clinic	4525 Campus Dr	Sierra Vista	AZ
CH09287H	Active	BPS-H80-015292	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Sierra Vista Adult Clinic	155 Calle Portal Ste 300	Sierra Vista	AZ
CH09287J	Active	BPS-H80-017246	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Sierra Vista Pediatrics	155 Calle Portal Ste 700	Sierra Vista	AZ
CH09287K	Terminated	BPS-H80-019614	Chiricahua Community Health Centers, Inc.	CCHCI SEABHS Clinic	4755 Campus Drive	Sierra Vista	AZ
CH09287L	Active	BPS-H80-018393	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Bisbee Pediatric Clinic and Community Health Services	310 Arizona St	Bisbee	AZ
CH09287M	Active	BPS-H80-022226	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Benson Family Health Center	335 S Ocotillo Ave	Benson	AZ
CH09287N	Active	BPS-H80-021656	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Early Childhood Center of Excellence	1151 16th Street	Douglas	AZ
CH09287P	Active	BPS-H80-027472	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Sierra Vista Family Dental Center and Administration	115 Calle Portal	Sierra Vista	AZ
CH09287Q	Active	BPS-H80-027231	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Douglas Acute Care, Laboratory, and Pharmacy	1111 N F Ave	Douglas	AZ
CH09287R	Active	BPS-H80-000466	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	CCHCI Mobile Dental Unit	1100 F Ave	Douglas	AZ
CH09287S	Active	BPS-H80-002558	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	CCHCI Mobile Medical Unit 'Murphy'	1100 F Ave	Douglas	AZ
CH09287T	Active	BPS-H80-030941	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Dardo Mobile Clinic	815 E 15th St	Douglas	AZ
CH09287U	Active	BPS-H80-015378	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Mobile Medical Clinic 'Sue'	1100 N F Ave	Douglas	AZ
CH09287V	Active	BPS-H80-027471	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Ronald Mobile Dental Clinic	115 Calle Portal	Sierra Vista	AZ
CH09287W	Active	BPS-H80-018624	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Adel Mobile Medical Unit	815 E 15th St	Douglas	AZ
CH09287X	Active	BPS-H80-027152	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Medical Mobile Clinic- 'Hank'	815 E 15th St	Douglas	AZ
CH09287Y	Active	BPS-H80-001545	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Migrant and Community Outreach Sites	1100 F Ave	Douglas	AZ
CH09287Z	Active	BPS-H80-036299	CHIRICAHUA COMMUNITY HEALTH CENTERS INC	Chiricahua Community Health Centers, Inc. Behavioral Health Center - Sierra Vista	77 Calle Portal STE C240	Sierra Vista	AZ

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH092870	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2024
CH092870	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2024
CH092870	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2020
CH092870	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	01/01/2025
CH092870	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	01/01/2025
CH092870	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2017
CH09287J	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287K	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024	07/01/2024
CH09287Y	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287T	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287X	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287U	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287Z	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287D	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287A	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287S	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287R	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287N	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287E	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287H	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287P	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287W	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024
CH09287AA	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08828	2090 EAST FRY BLVD.	SIERRA VISTA	AZ	85635	01/01/2024	01/01/2025
CH092870	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	01/01/2025
CH09287X	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287D	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287AA	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024	01/01/2025
CH09287A	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287J	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287E	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287Y	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287K	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024	07/01/2024
CH09287R	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287U	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287N	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH092870	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287S	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287W	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287Z	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287T	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH09287P	BEEWELL PHARMACY	EJBRX, LLC	3518 CANYON DE FLORES STE B	SIERRA VISTA	AZ	85650-5361	01/01/2024
CH092870	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2017	10/05/2018
CH092870	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	04/01/2021	06/25/2024
CH09287P	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287W	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287H	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287Y	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287R	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287K	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	07/01/2024
CH09287E	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287A	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287T	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287AA	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	01/01/2025
CH09287Z	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287Q	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287D	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287N	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287S	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287X	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287U	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH09287J	BEYOND PHARMACY BENSON DBA	R&M PHARMACIES LLC	795 W 4TH ST	BENSON	AZ	85602	01/01/2024	06/25/2024
CH092870	BEYOND PHARMACY WILLCOX	902 W REX ALLEN DR		WILLCOX	AZ	85643	01/01/2016	10/05/2018
CH092870	BEYOND PHARMACY WILLCOX	902 W REX ALLEN DR		WILLCOX	AZ	85643	07/01/2021	01/16/2024
CH092870	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2024
CH092870	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2024
CH092870	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2024
CH092870	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2024
CH092870	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2024
CH092870	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2020
CH092870	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2020
CH092870	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2020
CH092870	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2020
CH092870	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2020
CH092870	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2020
CH092870	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2020
CH092870	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2020
CH09287Y	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287W	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287D	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287T	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287U	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287P	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287R	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287E	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287H	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287X	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287J	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287AA	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024	01/01/2025
CH09287S	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287N	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287Z	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH09287K	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024	07/01/2024
CH092870	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	10/01/2021	01/31/2024
CH092870	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	10/01/2021	01/31/2024
CH092870	CORAM ALTERNATE SITE SERVICES, INC	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	12310 WORLD TRADE DRIVE SUITE 100	SAN DIEGO	CA	92128	04/01/2025
CH092870	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	4310 EAST COTTON CENTER BLVD SUITE 110	PHOENIX	AZ	85040-8857	01/01/2020	04/30/2025
CH092870	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	2345 WATERS DRIVE	MENDOTA HEIGHTS	MN	55120	07/01/2020
CH09287U	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287AB	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287AA	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024	01/01/2025
CH09287A	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287M	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287E	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287N	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287P	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287X	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287V	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287T	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH092870	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287Y	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287Q	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287W	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287J	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287L	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287Z	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287S	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287D	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287R	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH09287H	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH092870	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287S	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287H	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287AB	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287M	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287U	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287X	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287T	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287J	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287N	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287R	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287L	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287W	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287Q	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287Y	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287A	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287AA	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024	01/01/2025
CH09287V	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287Z	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287E	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287D	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH09287P	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH092870	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2020
CH092870	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	08/05/2021	04/15/2022
CH092870	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2024
CH092870	DOUGLAS PHARMACY, LLC	DBA DOUGLAS HEALTH MART PHARMACY	94 W 5TH STREET	DOUGLAS	AZ	85607	01/01/2016	09/30/2016
CH092870	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2024
CH092870	GENOA HEALTHCARE LLC	1701 N DOUGLAS AVE		DOUGLAS	AZ	85607	07/01/2023
CH092870	GENOA HEALTHCARE LLC	4585 E SPEEDWAY BLVD	BLDG 2 STE P	TUCSON	AZ	85712	07/01/2023
CH092870	GENOA HEALTHCARE LLC	1210 E. PENNSYLVANIA ST.		TUCSON	AZ	85714	07/01/2023
CH092870	GENOA HEALTHCARE LLC	4755 CAMPUS DR		SIERRA VISTA	AZ	85635	07/01/2023
CH092870	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2017	03/17/2025
CH092870	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	07/01/2019
CH09287T	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287Y	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287X	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287P	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287A	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287Z	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287AA	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024	01/01/2025
CH09287Y	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287S	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287J	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287K	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	07/01/2024
CH09287X	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287K	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024	07/01/2024
CH09287P	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287W	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287N	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287A	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287J	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287H	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287W	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287Z	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287E	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287H	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287U	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287T	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287D	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287E	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287R	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287AA	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	01/01/2025
CH09287D	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287N	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16220	4151 E HIGHWAY 90	SIERRA VISTA	AZ	85635	01/01/2024
CH09287S	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH09287R	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 10859	286 E 7TH ST	DOUGLAS	AZ	85607	01/01/2024	03/17/2025
CH092870	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2025
CH092870	OPTUM INFUSION SERVICES 308, LLC	485 N JUNIPER DR	STE 2	CHANDLER	AZ	85226	01/01/2022	04/12/2023
CH092870	OPTUM INFUSION SERVICES 550, LLC	9045 E PIMA CENTER PKWY STE 1		SCOTTSDALE	AZ	85258-4621	01/01/2022	09/30/2022
CH092870	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	08/05/2021
CH092870	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	05/03/2022
CH09287A	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	01/01/2024
CH092870	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	08/05/2021
CH09287S	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CH09287T	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CH09287U	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CH09287V	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CH09287W	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CH09287X	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CH09287AA	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024	01/01/2025
CH09287N	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287E	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287J	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287K	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024	07/01/2024
CH09287Y	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287H	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287R	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287P	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287Z	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287A	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH09287D	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
CH092870	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	08/05/2021
CH092870	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	08/05/2021
CH092870	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	08/05/2021
CH092870	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	08/05/2021
CH09287Y	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287J	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287T	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287E	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287AA	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024	01/01/2025
CH09287W	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287K	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024	07/01/2024
CH09287H	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287D	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287N	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287X	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287P	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287Z	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287S	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287R	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287U	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH09287A	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH092870	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	08/05/2021
CH09287A	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/01/2023
CH09287D	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/01/2023
CH09287E	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/01/2023
CH09287H	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/01/2023
CH09287J	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/01/2023
CH09287K	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/01/2023	07/01/2024
CH09287R	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287T	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287Z	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287Y	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287S	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287P	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287W	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287U	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287N	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH09287AA	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024	01/01/2025
CH09287X	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH092870	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2025
CH092870	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	01/01/2025
CH092870	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2020
CH092870	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2024
CH092870	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2024
CH092870	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2017
CH092870	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2017
CH092870	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2017
CH09287AA	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024	01/01/2025
CH09287K	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024	07/01/2024
CH09287Y	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287N	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287Z	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287N	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287D	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287S	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287T	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287K	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024	07/01/2024
CH09287W	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287S	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287J	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287H	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287A	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287A	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287E	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287U	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287X	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287T	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287R	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287K	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024	07/01/2024
CH09287U	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287P	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287E	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287W	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287H	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287J	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287U	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287R	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287Y	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287S	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287E	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287P	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287R	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287Z	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287A	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287D	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287AA	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024	01/01/2025
CH09287D	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287P	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287J	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287X	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024
CH09287X	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287N	SAFEWAY INC	SAFEWAY PHARMACY #0261	101 NACO HIGHWAY BOX 101	BISBEE	AZ	85603	01/01/2024
CH09287Y	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287Z	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287AA	SAFEWAY INC	SAFEWAY PHARMACY #0272	650 N BISBEE AVENUE	WILLCOX	AZ	85643	01/01/2024	01/01/2025
CH09287W	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287H	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	01/01/2024
CH09287AE	SAFEWAY INC	SAFEWAY PHARMACY #1275	599 WEST 4TH STREET	BENSON	AZ	85602	07/01/2025
CH092870	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	07/01/2024
CH092870	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	04/13/2020
CH09287H	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287N	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287K	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024	07/01/2024
CH09287R	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287X	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287A	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287D	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287P	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287W	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287T	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287Y	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287E	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287U	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287S	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287Z	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH09287AA	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024	01/01/2025
CH09287J	SIERRA COMPOUNDING LLC	SIERRA PHARMACY AND COMPOUNDING LAB	2085 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2024
CH092870	SIERRA PHAMACY LLC	2085 E. FRY BLVD.		SIERRA VISTA	AZ	85635	04/01/2016	06/26/2020
CH092870	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2018
CH092870	WAL-MART PHARMACY 10-1240	500 N HWY 90 BYPASS		SIERRA VISTA	AZ	85635	01/01/2017
CH09287D	WAL-MART PHARMACY 10-1240	500 N HWY 90 BYPASS		SIERRA VISTA	AZ	85635	01/01/2024
CH092870	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	01/01/2017
CH09287A	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287D	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287E	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287H	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287J	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287K	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023	07/01/2024
CH09287L	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287M	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287N	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287P	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287Q	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287R	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287S	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287T	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287U	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287V	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287W	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH09287X	WAL-MART PHARMACY 10-1846	199 WEST 5TH STREET		DOUGLAS	AZ	85607	10/01/2023
CH092870	WAL-MART PHARMACY 10-3807	201 SOUTH PRICKLY PEAR AVENUE		BENSON	AZ	85602	07/01/2018
CH09287A	WAL-MART PHARMACY 10-3807	201 SOUTH PRICKLY PEAR AVENUE		BENSON	AZ	85602	10/01/2023
CH09287D	WAL-MART PHARMACY 10-3807	201 SOUTH PRICKLY PEAR AVENUE		BENSON	AZ	85602	10/01/2023
CH09287E	WAL-MART PHARMACY 10-3807	201 SOUTH PRICKLY PEAR AVENUE		BENSON	AZ	85602	10/01/2023
CH09287H	WAL-MART PHARMACY 10-3807	201 SOUTH PRICKLY PEAR AVENUE		BENSON	AZ	85602	10/01/2023
CH09287J	WAL-MART PHARMACY 10-3807	201 SOUTH PRICKLY PEAR AVENUE		BENSON	AZ	85602	10/01/2023
CH09287K	WAL-MART PHARMACY 10-3807	201 SOUTH PRICKLY PEAR AVENUE		BENSON	AZ	85602	10/01/2023	07/01/2024
CH092870	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2021
CH09287X	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287T	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287AA	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024	01/01/2025
CH09287S	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287D	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287H	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287J	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287P	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287Z	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287R	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287U	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287N	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287A	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287E	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287Y	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287W	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024
CH09287K	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2024	07/01/2024
CH092870	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2018
CH092870	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 05027	1950 E FRY BLVD	SIERRA VISTA	AZ	85635	01/01/2017
CH092870	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	10/01/2021
CH09287L	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 05027	1950 E FRY BLVD	SIERRA VISTA	AZ	85635	10/01/2023
CH09287M	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 05027	1950 E FRY BLVD	SIERRA VISTA	AZ	85635	10/01/2023
CH09287N	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 05027	1950 E FRY BLVD	SIERRA VISTA	AZ	85635	10/01/2023
CH09287P	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 05027	1950 E FRY BLVD	SIERRA VISTA	AZ	85635	10/01/2023
CH09287Q	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 05027	1950 E FRY BLVD	SIERRA VISTA	AZ	85635	10/01/2023
CH09287R	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 05027	1950 E FRY BLVD	SIERRA VISTA	AZ	85635	10/01/2023
CH092870	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH09287Z	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287T	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287N	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH092870	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287P	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287D	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287J	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287K	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024	07/01/2024
CH09287S	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287U	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287A	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287R	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287X	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287Y	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287AA	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024	01/01/2025
CH09287E	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287H	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH09287W	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Melk, Jonathan CEO chiricahua community health centers 5202279167	4/24/2025 9:51 AM
Details	340B ID	Update	New Registration		CH09287AF	4/24/2025 9:51 AM
Dates	Participating Approval Date	Update	New Registration		4/24/2025 9:51:25 AM	4/24/2025 9:51 AM
Details	State	Update	New Registration	Pending	Approved	4/24/2025 9:51 AM
Dates	Signed By Date	Update	New Registration		4/15/2025 1:34:53 PM	4/24/2025 9:51 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/24/2025 9:51 AM
Addresses	Main Address	Insert	New Registration		77 Calle Portal, #C260 Sierra Vista, AZ 85635-2967	4/15/2025 1:30 PM
Addresses	Billing Address	Insert	New Registration		Chiricahua Community Health Centers, Inc. 1205 F Ave Douglas, AZ 85607	4/15/2025 1:30 PM
Contacts	Authorizing Official	Insert	New Registration		Melk, Jonathan CEO chiricahua community health centers 5202279167	4/15/2025 1:30 PM
Contacts	Primary Contact	Insert	New Registration		Merrell, David Andrew Pharmacy Director Chiricahua Community Health Centers 4802022497	4/15/2025 1:30 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2025 1:30 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2025 1:30 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2025 1:30 PM
Details	Grant Number	Insert	New Registration		H80CS00696	4/15/2025 1:30 PM
Details	340B ID	Insert	New Registration			4/15/2025 1:30 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2025 1:30 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2025 1:30 PM
Details	Medicare Provider Number	Insert	New Registration			4/15/2025 1:30 PM
Details	Entity Name	Insert	New Registration		CHIRICAHUA COMMUNITY HEALTH CENTERS INC	4/15/2025 1:30 PM
Details	NOFO Number	Insert	New Registration			4/15/2025 1:30 PM
Details	Program Code	Insert	New Registration		CH	4/15/2025 1:30 PM
Details	Entity Subname	Insert	New Registration		Chiricahua Community Health Centers, Inc. 77 Calle Portal Suite C-260	4/15/2025 1:30 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2025 1:30 PM
Details	State	Insert	New Registration		Pending	4/15/2025 1:30 PM
Dates	Registration Date	Insert	New Registration		4/15/2025 1:30:06 PM	4/15/2025 1:30 PM
Dates	Signed By Date	Insert	New Registration			4/15/2025 1:30 PM
Dates	Start Date	Insert	New Registration			4/15/2025 1:30 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2025 1:30 PM
Terminations	Termination Date	Insert	New Registration			4/15/2025 1:30 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2025 1:30 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2025 1:30 PM

340B Drug Pricing Program Database