| Details | State | Update | | To Be Terminated | Terminated | 1/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 10/27/2023 12:00:00 AM | 10/30/2023 5:06 PM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 10/30/2023 5:06 PM |
| Terminations | Termination Date | Update | Termination Request | | 1/1/2024 12:00:00 AM | 10/30/2023 5:06 PM |
| Terminations | Termination Effective Date | Update | Termination Request | | 10/27/2023 12:00:00 AM | 10/30/2023 5:06 PM |
| Terminations | Termination Reason | Update | Termination Request | | Site closure | 10/30/2023 5:06 PM |
| Addresses | Main Address | Update | Change Request |
3540 S Hanover Street
Brooklyn, MD 21225 |
3540 S HANOVER ST
BROOKLYN, MD 21225-1772 | 8/11/2023 6:00 PM |
| Addresses | Billing Address | Update | Change Request | FAMILY HEALTH CENTERS OF BALTIMORE, INC. - HEADQUARTERS
631 CHERRY HILL ROAD
BALTIMORE, MD 21225 | FAMILY HEALTH CENTERS OF BALTIMORE, INC. - HEADQUARTERS
631 Cherry Hill Rd
Cherry Hill Road
Baltimore, MD 21225 | 8/11/2023 6:00 PM |
| Addresses | Shipping Address | Insert | Change Request | | FAMILY HEALTH CENTERS OF BALTIMORE, INC.
3540 S HANOVER ST
BROOKLYN, MD 21225-1772 | 8/11/2023 6:00 PM |
| Addresses | Main Address | Update | Change Request |
3540 S Hanover Street
BALTIMORE, MD 21225 |
3540 S Hanover Street
Brooklyn, MD 21225 | 7/5/2023 8:53 AM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2022 10:57:10 AM | 1/30/2023 11:59:55 AM | 1/30/2023 11:59 AM |
| Details | Last Recertification Date | Update | Recertification | 3/1/2021 8:59:11 AM | 2/4/2022 10:57:10 AM | 2/4/2022 10:57 AM |
| Contacts | Authorizing Official | Update | OPA Edit | Hawkins, Brian Aoki
President and Chief Executive Officer
Family Health Centers of Baltimore
4103542001 | McCray, Winnie
Chief Executive Officer
Family Health Centers of Baltimore
4103542000-11233 | 2/2/2022 6:33 AM |
| Contacts | Primary Contact | Update | OPA Edit | McCray, Winnie
Chief Executive Officer
Family Health Centers of Baltimore
4103542000-11233 | Perry, Matthew Charles
Director of Pharmacy
Family Health Centers of Baltimore
4103542000-11428 | 2/2/2022 6:33 AM |
| Contacts | Primary Contact | Update | Profile Change Request | McCray, Winnie
Health Services Administrator
Family Health Centers of Baltimore
4103542000-11233 | McCray, Winnie
Chief Executive Officer
Family Health Centers of Baltimore
4103542000-11233 | 7/20/2021 11:03 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1336326248 ( ) | | 3/1/2021 8:59 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1336326248 | 3/1/2021 8:59 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | MD | 3/1/2021 8:59 AM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2020 10:38:18 AM | 3/1/2021 8:59:11 AM | 3/1/2021 8:59 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/5/2020 9:47 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 960711100 | 6/5/2020 9:47 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | MD | 6/5/2020 9:47 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1336326248 | 6/5/2020 9:47 AM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2019 4:07:22 PM | 2/21/2020 10:38:18 AM | 2/21/2020 10:38 AM |
| Details | Last Recertification Date | Update | Recertification | 3/5/2018 1:34:31 PM | 2/21/2019 4:07:22 PM | 2/21/2019 4:07 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Abbott, Bernard
CEO
Family Health Centers of Balimore
4103542000-11272 | Hawkins, Brian Aoki
President and Chief Executive Officer
Family Health Centers of Baltimore
4103542001 | 2/21/2019 3:14 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Richardson, Guy
Chief Executive Officer
Family Health Centers of Baltimore
4103542000-11222 | Abbott, Bernard
CEO
Family Health Centers of Balimore
4103542000-11272 | 5/23/2018 10:27 AM |
| Contacts | Primary Contact | Update | Recertification | MCLELLAN, PAULA
CEO
4103542003 | McCray, Winnie
Health Services Administrator
Family Health Centers of Baltimore
4103542000-11233 | 3/5/2018 1:34 PM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2017 12:00:00 AM | 3/5/2018 1:34:31 PM | 3/5/2018 1:34 PM |
| Contacts | Authorizing Official | Update | AO Change Request | MCLELLAN, PAULA
CEO
4103542003 | Richardson, Guy
Chief Executive Officer
Family Health Centers of Baltimore
4103542000-11222 | 3/2/2018 3:18 PM |
| Contacts | Authorizing Official | Insert | | | MCLELLAN, PAULA
CEO
4103542003 | 4/13/2017 12:51 PM |
| Contacts | Primary Contact | Update | | MCLELLAN, PAULA
CEO
4103542003 | MCLELLAN, PAULA
CEO
4103542003 | 4/13/2017 12:51 PM |
| Addresses | Main Address | Insert | | |
3540 S Hanover Street
BALTIMORE, MD 21225 | 2/13/2017 4:54 PM |
| Details | Last Recertification Date | Update | | 2/17/2016 12:00:00 AM | 2/13/2017 12:00:00 AM | 2/13/2017 4:53 PM |
| Details | Last Recertification Date | Update | | 3/9/2015 12:00:00 AM | 2/17/2016 12:00:00 AM | 2/17/2016 3:58 PM |
| Addresses | Billing Address | Insert | | | FAMILY HEALTH CENTERS OF BALTIMORE, INC. - HEADQUARTERS
631 CHERRY HILL ROAD
BALTIMORE, MD 21225 | 9/15/2015 6:38 PM |
| Contacts | Primary Contact | Insert | | | MCLELLAN, PAULA
CEO
4103542003 | 9/14/2015 4:23 PM |
| Details | Entity Subname | Update | | BROOKLYN | FHCB-Brooklyn | 9/14/2015 4:23 PM |
| Details | Last Recertification Date | Update | | 3/12/2014 12:00:00 AM | 3/9/2015 12:00:00 AM | 3/9/2015 10:26 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/12/2014 12:00:00 AM | 3/12/2014 11:41 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/13/2013 9:03 AM |
| Details | Last Recertification Date | Insert | | | | 8/12/2005 4:29 PM |
| Details | Grant Number | Insert | | | H80CS00436 | 8/12/2005 4:29 PM |
| Details | 340B ID | Insert | | | CH03127A | 8/12/2005 4:29 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/12/2005 4:29 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/12/2005 4:29 PM |
| Details | Medicare Provider Number | Insert | | | | 8/12/2005 4:29 PM |
| Details | Entity Name | Insert | | | FAMILY HEALTH CENTERS OF BALTIMORE, INC. | 8/12/2005 4:29 PM |
| Details | Program Code | Insert | | | CH | 8/12/2005 4:29 PM |
| Details | Entity Subname | Insert | | | BROOKLYN | 8/12/2005 4:29 PM |
| Dates | Participating Approval Date | Insert | | | 6/17/2005 12:00:00 AM | 8/12/2005 4:29 PM |
| Details | State | Insert | | | Active | 8/12/2005 4:29 PM |
| Dates | Registration Date | Insert | | | 7/1/2005 12:00:00 AM | 8/12/2005 4:29 PM |
| Dates | Signed By Date | Insert | | | 5/27/2005 12:00:00 AM | 8/12/2005 4:29 PM |
| Dates | Start Date | Insert | | | 7/1/2005 12:00:00 AM | 8/12/2005 4:29 PM |
| Terminations | Termination Comments | Insert | | | | 8/12/2005 4:29 PM |
| Terminations | Termination Date | Insert | | | | 8/12/2005 4:29 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/12/2005 4:29 PM |
| Terminations | Termination Reason | Insert | | | | 8/12/2005 4:29 PM |
| Details | Comments Public | Insert | | | NEW SITE 07/01/2005 | 8/12/2005 4:29 PM |