Covered Entity Details

CH01085D COOS COUNTY FAMILY HEALTH SERVICES, INC. (Active) - information as of 6/27/2025 12:34:01 AM

Main Details

Name

COOS COUNTY FAMILY HEALTH SERVICES, INC.

Subdivision Name

COOS COUNTY FAMILY HEALTH SERVICES

Type

HRSA-Funded Health Center

Site ID

BPS-H80-004311

340B ID

CH01085D

Grant Number

H80CS00508

Additional Details

Current Program Status

Active

Registration Date

7/1/2004

Participating Start Date

7/1/2004

Participating Approval Date

5/12/2004

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Coos County Family Health Services
KEN GORDON, CEO
(603) 752-2040 Ext: 4018

Primary Contact

Coos County Family Health Services
Phillip Kneer, Chief Financial Officer
(603) 752-2040 Ext: 1356

Addresses

Street Address

59 Page Hill Rd
Berlin, NH 03570-3531

Billing Address

COOS COUNTY FAMILY HEALTH SERVICES, INC.
133 PLEASANT STREET
BERLIN, NH 03570

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
NEW SITE - 07/01/2004	08/11/2005

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
Contract Detail	NOVIXUS PHARMACY SERVICES	43159 W 9 MILE RD.		NOVI	MI	48375-4117	10/13/2017	01/01/2018		10/13/2017	10/13/2017

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH010850	Active	BPS-H80-004919	COOS COUNTY FAMILY HEALTH SERVICES, INC.	COOS COUNTY FAMILY HEALTH SVCS	133 Pleasant St	Berlin	NH
CH01085D	Active	BPS-H80-004311	COOS COUNTY FAMILY HEALTH SERVICES, INC.	COOS COUNTY FAMILY HEALTH SERVICES	59 Page Hill Rd	Berlin	NH
CH01085E	Active	BPS-H80-000285	COOS COUNTY FAMILY HEALTH SERVICES, INC.	COOS COUNTY FAMILY HEALTH SERVICES	2 Broadway Ave	Gorham	NH
CH01085F	Active	BPS-H80-035392	Coos County Family Health Services, Inc.	Coos County Family Health - Colebrook Site	6 First	Colebrook	NH
CH01085G	Active	BPS-H80-037610	COOS COUNTY FAMILY HEALTH SERVICES	Coos County Family Health - Express Care	167 Main Street STE 2	Gorham	NH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH010850	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2020	12/31/2020
CH010850	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2021
CH010850	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2021
CH010850	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2021
CH010850	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2021
CH010850	MAXI DRUG NORTH, INC.	RITE AID #10287	200 PLEASANT STREET	BERLIN	NH	03570	04/01/2013	01/24/2018
CH010850	MEDIMPACT DIRECT, LLC	8060 S KYRENE RD		TEMPE	AZ	85284-2109	10/01/2018	07/01/2020
CH010850	NORTH COUNTRY HEALTHCARE PHARMACY	141 CORLISS LN		COLEBROOK	NH	03576	08/15/2022
CH010850	NOVIXUS PHARMACY SERVICES	43159 W 9 MILE RD.		NOVI	MI	48375-4117	01/01/2018	07/01/2020
CH01085D	NOVIXUS PHARMACY SERVICES	43159 W 9 MILE RD.		NOVI	MI	48375-4117	01/01/2018	10/13/2017
CH010850	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2017
CH010850	WAL-MART PHARMACY 10-2634	561 MAIN STREET		GORHAM	NH	03581	04/01/2013
CH010850	WAL-MART PHARMACY 10-2681	615 MEADOW STREET		LITTLETON	NH	03561	04/01/2020
CH010850	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2017
CH010850	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10410	274 DELLS ROAD	LITTLETON	NH	03561	10/01/2014
CH010850	WALGREEN EASTERN CO., INC.	WALGREENS #17583	173 PLEASANT ST	BERLIN	NH	03570	01/30/2018
CH010850	WALGREEN EASTERN CO., INC.	WALGREENS #17167	177 MAIN ST.	LANCASTER	NH	03584	07/01/2019
CH010850	WALGREEN EASTERN CO., INC.	WALGREENS #19398	91 MAIN ST	COLEBROOK	NH	03576-3060	07/01/2022
CH010850	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	10/01/2023
CH010850	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2014	08/31/2015
CH010850	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2014	01/01/2018
CH010850	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2018
CH010850	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2018
CH010850	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 7:39:11 AM	2/11/2025 7:10:15 AM	2/11/2025 7:10 AM
Details	Last Recertification Date	Update	Recertification	1/30/2023 7:50:38 AM	1/29/2024 7:39:11 AM	1/29/2024 7:39 AM
Details	Last Recertification Date	Update	Recertification	1/31/2022 11:44:38 AM	1/30/2023 7:50:38 AM	1/30/2023 7:50 AM
Details	Last Recertification Date	Update	Recertification	2/1/2021 9:19:04 AM	1/31/2022 11:44:38 AM	1/31/2022 11:44 AM
Details	Last Recertification Date	Update	Recertification	1/28/2020 9:14:21 AM	2/1/2021 9:19:04 AM	2/1/2021 9:19 AM
Contacts	Primary Contact	Update	Change Request	FRENETTE, MELISSA CHIEF FINANCIAL OFFICER Coos County Family Health Services 6037522040-1356	Kneer, Phillip Chief Financial Officer Coos County Family Health Services 6037522040-1356	8/28/2020 6:44 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 2:55:35 PM	1/28/2020 9:14:21 AM	1/28/2020 9:14 AM
Details	Last Recertification Date	Update	Recertification	2/8/2018 5:53:33 AM	1/29/2019 2:55:35 PM	1/29/2019 2:55 PM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/8/2018 5:53:33 AM	2/8/2018 5:53 AM
Contacts	Primary Contact	Update	Change Request	FRENETTE, MELISSA CHIEF FINANCIAL OFFICER 6037522040-1356	FRENETTE, MELISSA CHIEF FINANCIAL OFFICER Coos County Family Health Services 6037522040-1356	1/5/2018 1:31 PM
Contacts	Authorizing Official	Update		GORDON, KEN CEO 6037522040-4018	GORDON, KEN CEO Coos County Family Health Services 6037522040-4018	9/27/2017 9:10 AM
Contacts	Authorizing Official	Insert			GORDON, KEN CEO 6037522040-4018	5/12/2017 11:08 AM
Contacts	Primary Contact	Insert			FRENETTE, MELISSA CHIEF FINANCIAL OFFICER 6037522040-1356	5/12/2017 11:08 AM
Addresses	Main Address	Insert			59 Page Hill Rd Berlin, NH 03570-3531	1/25/2017 9:42 AM
Details	Last Recertification Date	Update		2/29/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 9:41 AM
Details	Last Recertification Date	Update		1/28/2015 12:00:00 AM	2/29/2016 12:00:00 AM	2/29/2016 7:47 AM
Addresses	Billing Address	Insert			COOS COUNTY FAMILY HEALTH SERVICES, INC. 133 PLEASANT STREET BERLIN, NH 03570	3/25/2015 5:09 PM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	1/28/2015 12:00:00 AM	1/28/2015 9:56 AM
Details	Entity Subname	Update			COOS COUNTY FAMILY HEALTH SERVICES	3/31/2014 4:25 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/10/2014 12:00:00 AM	2/10/2014 1:00 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/15/2013 12:07 PM
Details	Last Recertification Date	Insert				8/11/2005 7:14 AM
Details	Grant Number	Insert			H80CS00508	8/11/2005 7:14 AM
Details	340B ID	Insert			CH01085D	8/11/2005 7:14 AM
Details	Is Authorizing Official EHB Data	Insert				8/11/2005 7:14 AM
Dates	Last Date That 340B Drugs Purchased	Insert				8/11/2005 7:14 AM
Details	Medicare Provider Number	Insert				8/11/2005 7:14 AM
Details	Entity Name	Insert			COOS COUNTY FAMILY HEALTH SERVICES, INC.	8/11/2005 7:14 AM
Details	Program Code	Insert			CH	8/11/2005 7:14 AM
Details	Entity Subname	Insert				8/11/2005 7:14 AM
Dates	Participating Approval Date	Insert			5/12/2004 12:00:00 AM	8/11/2005 7:14 AM
Details	State	Insert			Active	8/11/2005 7:14 AM
Dates	Registration Date	Insert			7/1/2004 12:00:00 AM	8/11/2005 7:14 AM
Dates	Signed By Date	Insert				8/11/2005 7:14 AM
Dates	Start Date	Insert			7/1/2004 12:00:00 AM	8/11/2005 7:14 AM
Terminations	Termination Comments	Insert				8/11/2005 7:14 AM
Terminations	Termination Date	Insert				8/11/2005 7:14 AM
Terminations	Termination Effective Date	Insert				8/11/2005 7:14 AM
Terminations	Termination Reason	Insert				8/11/2005 7:14 AM
Details	Comments Public	Insert			NEW SITE - 07/01/2004	8/11/2005 7:14 AM

340B Drug Pricing Program Database