340B Drug Pricing Program Database


CH021770 UNDER 21 INC (Active) - information as of 5/14/2025 10:29:13 PM

Main Details
UNDER 21 INC
COVENANT HOUSE-UNDER 21
HRSA-Funded Health Center
BPS-H80-003760
CH021770
H80CS00013


Additional Details
Active
8/17/2006
10/1/2006
8/23/2006
3/7/2025

Contacts

Under 21
Shakeema North, Chief Executive Officer
(646) 421-6278

Covenant House New York
Jeanette Torres, Health Center Administrator
(646) 969-6884

Addresses

460 W 41st St
New York, NY 10036-6801

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NY007338261053588988
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH021770ActiveBPS-H80-003760UNDER 21 INCCOVENANT HOUSE-UNDER 21460 W 41st St New YorkNY
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False3/7/2025 2:37 PM
Medicaid BillingMedicaid: NumberInsertRecertification 007338263/7/2025 2:37 PM
Medicaid BillingMedicaid: StateInsertRecertification NY3/7/2025 2:37 PM
Medicaid BillingNPI: NumberInsertRecertification 10535889883/7/2025 2:37 PM
Medicaid BillingNPI: StateInsertRecertification NY3/7/2025 2:37 PM
DetailsLast Recertification DateUpdateRecertification2/7/2024 11:37:20 AM3/7/2025 2:37:24 PM3/7/2025 2:37 PM
ContactsAuthorizing OfficialUpdateAO Change RequestHawkins, Simone Chief Financial & Administrative Officer Under 21 dba Covenant House New York 6468231324North, Shakeema Chief Executive Officer Under 21 64642162783/5/2025 1:15 PM
ContactsPrimary ContactUpdateRecertificationDavis, David Medical Director Covenant House - Under 21 2126130315Torres, Jeanette Health Center Administrator Covenant House New York 64696968842/7/2024 11:37 AM
DetailsLast Recertification DateUpdateRecertification2/14/2023 12:56:12 PM2/7/2024 11:37:20 AM2/7/2024 11:37 AM
ContactsAuthorizing OfficialUpdateAO Change RequestFarber, Julie Anne Executive Director Covenant House NY 9177576919Hawkins, Simone Chief Financial & Administrative Officer Under 21 dba Covenant House New York 64682313241/30/2024 4:23 PM
DetailsLast Recertification DateUpdateRecertification2/22/2022 8:44:11 AM2/14/2023 12:56:12 PM2/14/2023 12:56 PM
ContactsAuthorizing OfficialUpdateAO Change RequestDowning, Nancy CHIEF OPERATING OFFICER Covenant House New York 2126130300-5357Farber, Julie Anne Executive Director Covenant House NY 917757691912/13/2022 3:25 PM
ContactsPrimary ContactUpdateRecertificationBRUCE, LINDA PURCHASING/ PHARMACY Covenant House New York 2126130300-5316Davis, David Medical Director Covenant House - Under 21 21261303152/22/2022 8:44 AM
DetailsLast Recertification DateUpdateRecertification2/8/2021 11:28:01 AM2/22/2022 8:44:11 AM2/22/2022 8:44 AM
DetailsLast Recertification DateUpdateRecertification2/19/2020 7:50:25 AM2/8/2021 11:28:01 AM2/8/2021 11:28 AM
DetailsLast Recertification DateUpdateRecertification1/31/2019 4:22:52 PM2/19/2020 7:50:25 AM2/19/2020 7:50 AM
DetailsLast Recertification DateUpdateRecertification2/14/2018 5:13:26 PM1/31/2019 4:22:52 PM1/31/2019 4:22 PM
DetailsLast Recertification DateUpdateRecertification1/26/2017 12:00:00 AM2/14/2018 5:13:26 PM2/14/2018 5:13 PM
ContactsPrimary ContactUpdateRecertificationBRUCE, LINDA PURCHASING/ PHARMACY 2126130300-5316BRUCE, LINDA PURCHASING/ PHARMACY Covenant House New York 2126130300-53162/14/2018 5:13 PM
ContactsAuthorizing OfficialUpdate Downing, Nancy CHIEF OPERATING OFFICER 2126130300-5357Downing, Nancy CHIEF OPERATING OFFICER Covenant House New York 2126130300-53572/14/2018 5:08 PM
AddressesMain AddressInsert   460 W 41st St New York, NY 10036-68011/26/2017 8:08 AM
ContactsPrimary ContactUpdate FOLEY, ELIZABETH GRANTS DIRECTOR 2123300565BRUCE, LINDA PURCHASING/ PHARMACY 2126130300-53161/26/2017 8:08 AM
ContactsAuthorizing OfficialUpdate DRURY, CREIGHTON CHIEF OPERATING OFFICER 2126130300-5520Downing, Nancy CHIEF OPERATING OFFICER 2126130300-53571/26/2017 8:08 AM
DetailsLast Recertification DateUpdate 2/26/2016 12:00:00 AM1/26/2017 12:00:00 AM1/26/2017 8:08 AM
ContactsAuthorizing OfficialUpdate HENRY, BRUCE J. EXECUTIVE DIRECTOR 2123300560DRURY, CREIGHTON CHIEF OPERATING OFFICER 2126130300-55202/26/2016 11:54 AM
DetailsLast Recertification DateUpdate 2/19/2015 12:00:00 AM2/26/2016 12:00:00 AM2/26/2016 11:54 AM
DetailsLast Recertification DateUpdate 3/19/2014 12:00:00 AM2/19/2015 12:00:00 AM2/19/2015 5:48 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/19/2014 12:00:00 AM3/19/2014 8:42 AM
DetailsEntity NameUpdate UNDER 21 COVENANT HOUSEUNDER 21 INC3/19/2014 8:42 AM
DetailsEntity SubnameUpdate  COVENANT HOUSE-UNDER 213/19/2014 8:42 AM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/15/2013 12:36 PM
ContactsPrimary ContactInsert  FOLEY, ELIZABETH GRANTS DIRECTOR 21233005658/23/2006 7:43 AM
ContactsAuthorizing OfficialInsert  HENRY, BRUCE J. EXECUTIVE DIRECTOR 21233005608/23/2006 7:43 AM
DetailsLast Recertification DateInsert   8/23/2006 7:43 AM
DetailsGrant NumberInsert  H80CS000138/23/2006 7:43 AM
Details340B IDInsert  CH0217708/23/2006 7:43 AM
DetailsIs Authorizing Official EHB DataInsert   8/23/2006 7:43 AM
DatesLast Date That 340B Drugs PurchasedInsert   8/23/2006 7:43 AM
DetailsMedicare Provider NumberInsert   8/23/2006 7:43 AM
DetailsEntity NameInsert  UNDER 21 COVENANT HOUSE8/23/2006 7:43 AM
DetailsProgram CodeInsert  CH8/23/2006 7:43 AM
DetailsEntity SubnameInsert   8/23/2006 7:43 AM
DatesParticipating Approval DateInsert  8/23/2006 12:00:00 AM8/23/2006 7:43 AM
DetailsStateInsert  Active8/23/2006 7:43 AM
DatesRegistration DateInsert  8/17/2006 12:00:00 AM8/23/2006 7:43 AM
DatesSigned By DateInsert  6/5/2006 12:00:00 AM8/23/2006 7:43 AM
DatesStart DateInsert  10/1/2006 12:00:00 AM8/23/2006 7:43 AM
TerminationsTermination CommentsInsert   8/23/2006 7:43 AM
TerminationsTermination DateInsert   8/23/2006 7:43 AM
TerminationsTermination Effective DateInsert   8/23/2006 7:43 AM
TerminationsTermination ReasonInsert   8/23/2006 7:43 AM