Covered Entity Details

CH05623B FAMILY HEALTH CENTER, INC. (Terminated) - information as of 4/29/2025 11:53:55 PM

Main Details

Name

FAMILY HEALTH CENTER, INC.

Subdivision Name

Type

HRSA-Funded Health Center

Site ID

BPS-H80-002765

340B ID

CH05623B

Grant Number

H80CS00336

Additional Details

Current Program Status

Terminated

Registration Date

4/1/2005

Participating Start Date

4/1/2005

Participating Approval Date

1/21/2005

Last Recertification Date

2/6/2019

Termination Date
Termination Reason

7/1/2019
Business decision by the Covered Entity

Contacts

Authorizing Official

Family Health Center
Denise Crawford, President/CEO
(269) 349-2461

Primary Contact

Family Health Center
Julie Koller, Director of Pharmacy
(269) 488-0850

Addresses

Street Address

325 E Centre Ave
Portage, MI 49002-5512

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
NEW SITE 4/1/05	04/09/2009

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	FAMILY HEALTH CENTER PHARMACY SOUTH	505 E ALCOTT ST		KALAMAZOO	MI	49001-6144	04/01/2005	04/01/2005		07/01/2019	07/01/2019

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH056230	Active	BPS-H80-005642	FAMILY HEALTH CENTER, INC.		117 WEST PATERSON STREET	KALAMAZOO	MI
CH056230D	Terminated	BPS-H80-010513	FAMILY HEALTH CENTER, INC.	SHERIDAN	2918 PORTAGE RD	KALAMAZOO	MI
CH05623B	Terminated	BPS-H80-002765	FAMILY HEALTH CENTER, INC.		325 E Centre Ave	Portage	MI
CH05623C	Terminated	BPS-H80-005169	FAMILY HEALTH CENTER, INC.		431 ROSE STREET	KALAMAZOO	MI
CH05623E	Terminated	BPS-H80-018865	FAMILY HEALTH CENTER INC.	FAMILY HEALTH CENTER GULL ROAD	3299 Gull Rd	Kalamazoo	MI
CH05623F	Terminated	BPS-H80-019268	FAMILY HEALTH CENTER INC.	COMMUNITY MENTAL HEALTH CLINIC	615 E Crosstown Parkway	Kalamazoo	MI
CH05623G	Active	BPS-H80-018866	FAMILY HEALTH CENTER INC.	FAMILY HEALTH CENTER MOBILE DENTAL	117 W. Paterson St.	Kalamazoo	MI
CH05623H	Active	BPS-H80-017479	FAMILY HEALTH CENTER INC.	FAMILY HEALTH CENTER MOBILE MEDICAL	117 W Paterson St	Kalamazoo	MI
CH05623J	Active	BPS-H80-008719	FAMILY HEALTH CENTER INC.	FAMILY HEALTH CENTER BURDICK	1308 N Burdick St	Kalamazoo	MI
CH05623K	Terminated	BPS-H80-005166	FAMILY HEALTH CENTER INC.	EDISON SCHOOL BASED HEALTH CENTER	924 Russell St	Kalamazoo	MI
CH05623L	Active	BPS-H80-019312	FAMILY HEALTH CENTER INC.	FAMILY HEALTH CENTER ALCOTT	505 E. Alcott St.	Kalamazoo	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH05623B	FAMILY HEALTH CENTER PHARMACY SOUTH	505 E ALCOTT ST		KALAMAZOO	MI	49001-6144	04/01/2005	07/01/2019
CH056230	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	10/01/2019
CH056230	MEIJER INC #21	5800 GULL ROAD		KALAMAZOO	MI	49048	07/01/2019
CH056230	MEIJER INC #22	5121 S WESTNEDGE		PORTAGE	MI	49002	07/01/2019
CH056230	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	07/01/2019
CH056230	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	07/01/2019
CH056230	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2019
CH056230	WAL-MART PHARMACY 10-5064	6065 GULL RD		KALAMAZOO	MI	49048	07/01/2019
CH056230	WAL-MART PHARMACY 10-5065	501 SOUTH 9TH STREET		KALAMAZOO(NW)	MI	49009	07/01/2019
CH056230	WAL-MART PHARMACY 10-5280	8350 SHAVER ROAD		PORTAGE	MI	49024	07/01/2019
CH056230	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2019
CH056230	WALGREEN CO	DBA: WALGREENS #12688	848 S KALAMAZOO ST	PAW PAW	MI	49079-9230	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 10513	605 NORTH AVE	BATTLE CREEK	MI	49017-3230	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 04991	3016 S WESTNEDGE AVE	KALAMAZOO	MI	49008	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS #12849	6649 W MAIN ST	KALAMAZOO	MI	49009	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 10081	5933 S WESTNEDGE AVE	PORTAGE	MI	49002-1455	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 07934	301 S US HWY 131	THREE RIVERS	MI	49093	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 10080	7920 SHAVER RD	PORTAGE	MI	49024	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 07894	5815 GULL RD	KALAMAZOO	MI	49048-1094	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 03147	918 RIVERVIEW DRIVE	KALAMAZOO	MI	49048	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 07484	1277 M-89	PLAINWELL	MI	49080-1919	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS #15690	760 WEST MICHIGAN AVE	KALAMAZOO	MI	49007	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 07158	50 COLUMBIA AVENUE W	BATTLE CREEK	MI	49015	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS # 07430	5020 W MAIN	KALAMAZOO	MI	49009	07/01/2022
CH056230	WALGREEN CO.	DBA: WALGREENS #15633	797 CAPITAL AVE NE	BATTLE CREEK	MI	49017	07/01/2022
CH056230	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024
CH056230	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		3/29/2019 12:00:00 AM	4/30/2019 8:25 AM
Details	State	Update	Termination Request	Active	To Be Terminated	4/30/2019 8:25 AM
Terminations	Termination Date	Update	Termination Request		7/1/2019 12:00:00 AM	4/30/2019 8:25 AM
Terminations	Termination Effective Date	Update	Termination Request		4/1/2019 12:00:00 AM	4/30/2019 8:25 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	4/30/2019 8:25 AM
Details	Last Recertification Date	Update	Recertification	2/14/2018 4:17:51 PM	2/6/2019 10:46:30 AM	2/6/2019 10:46 AM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/14/2018 4:17:51 PM	2/14/2018 4:17 PM
Contacts	Authorizing Official	Update		Crawford, Denise President/CEO 2693492461	Crawford, Denise President/CEO Family Health Center 2693492461	2/13/2018 5:08 PM
Contacts	Primary Contact	Update		Koller, Julie Director of Pharmacy 2694880850	Koller, Julie Director of Pharmacy Family Health Center 2694880850	2/13/2018 10:28 AM
Contacts	Primary Contact	Update		MALLETT, TIM DIRECTOR OF PHARMACY 2694880850	Koller, Julie Director of Pharmacy 2694880850	5/15/2017 2:13 PM
Contacts	Authorizing Official	Insert			Crawford, Denise President/CEO 2693492461	5/15/2017 2:13 PM
Addresses	Main Address	Insert			325 E Centre Ave Portage, MI 49002-5512	1/25/2017 2:48 PM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 2:48 PM
Details	Last Recertification Date	Update		1/28/2015 12:00:00 AM	2/12/2016 12:00:00 AM	2/12/2016 4:06 PM
Contacts	Primary Contact	Insert			MALLETT, TIM DIRECTOR OF PHARMACY 2694880850	1/28/2015 12:34 PM
Details	Last Recertification Date	Update		3/7/2014 12:00:00 AM	1/28/2015 12:00:00 AM	1/28/2015 12:34 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/7/2014 12:00:00 AM	3/7/2014 2:04 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/14/2013 2:11 PM
Details	Last Recertification Date	Insert				4/9/2009 2:55 PM
Details	Grant Number	Insert			H80CS00336	4/9/2009 2:55 PM
Details	340B ID	Insert			CH05623B	4/9/2009 2:55 PM
Details	Is Authorizing Official EHB Data	Insert				4/9/2009 2:55 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/9/2009 2:55 PM
Details	Medicare Provider Number	Insert				4/9/2009 2:55 PM
Details	Entity Name	Insert			FAMILY HEALTH CENTER, INC.	4/9/2009 2:55 PM
Details	Program Code	Insert			CH	4/9/2009 2:55 PM
Details	Entity Subname	Insert				4/9/2009 2:55 PM
Dates	Participating Approval Date	Insert			1/21/2005 12:00:00 AM	4/9/2009 2:55 PM
Details	State	Insert			Active	4/9/2009 2:55 PM
Dates	Registration Date	Insert			4/1/2005 12:00:00 AM	4/9/2009 2:55 PM
Dates	Signed By Date	Insert				4/9/2009 2:55 PM
Dates	Start Date	Insert			4/1/2005 12:00:00 AM	4/9/2009 2:55 PM
Terminations	Termination Comments	Insert				4/9/2009 2:55 PM
Terminations	Termination Date	Insert				4/9/2009 2:55 PM
Terminations	Termination Effective Date	Insert				4/9/2009 2:55 PM
Terminations	Termination Reason	Insert				4/9/2009 2:55 PM
Details	Comments Public	Insert			NEW SITE 4/1/05	4/9/2009 2:55 PM

340B Drug Pricing Program Database