Covered Entity Details

CH01127Q OPTIMUS HEALTHCARE INC. (Active) - information as of 5/9/2025 10:48:08 PM

Main Details

Name

OPTIMUS HEALTHCARE INC.

Subdivision Name

OPTIMUS ON THE BOULEVARD

Type

HRSA-Funded Health Center

Site ID

BPS-H80-000649

340B ID

CH01127Q

Grant Number

H80CS00377

Additional Details

Current Program Status

Active

Registration Date

12/14/2006

Participating Start Date

1/1/2007

Participating Approval Date

12/14/2006

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Optimus Health Care, Inc.
Karen A Daley, Chief Executive Officer
(203) 608-3387

Primary Contact

Optimus Health Care
Tizita Fekredengel, Clinical Pharmacist
(203) 616-2235

Addresses

Street Address

1351 WASHINGTON BLVD
STAMFORD, CT 06902

Billing Address

OPTIMUS HEALTH CARE, INC.
982 East Main Street
Bridgeport, CT 06608

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?
Yes

State	Medicaid Number	NPI Number
CT		1669445946,1669548376,1992871875

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	SLAVINS - HANCOCK PHARMACY INC	922 WASHINGTON BLVD		STAMFORD	CT	06901	10/20/2011	07/09/2007			03/28/2013

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH011270	Active	BPS-H80-003056	OPTIMUS HEALTH CARE, INC.	OPTIMUS ON BARNUM AVENUE	471 BARNUM AVE.	Bridgeport	CT
CH01127A	Terminated	BPS-H80-002946	OPTIMUS HEALTH CARE, INC.	OPTIMUS JP MORGAN CHASE WELLNESS CENTER	1071 EAST MAIN STREET	BRIDGEPORT	CT
CH01127AA	Active	BPS-H80-010014	OPTIMUS HEALTH CARE, INC.	Bullard-havens Technical High School - SBHC	500 Palisade Ave	Bridgeport	CT
CH01127AB	Active	BPS-H80-011423	OPTIMUS HEALTH CARE, INC.	Barnum/ Waltersville School	495 Waterview Avenue	Bridgeport	CT
CH01127AC	Active	BPS-H80-013444	OPTIMUS HEALTH CARE, INC.	FAIRCHILD WHEELER INTERDISRICT MAGNET CAMPUS	840 Old Town Rd	Bridgeport	CT
CH01127AD	Terminated	BPS-H80-014377	OPTIMUS HEALTH CARE, INC.	Platt Technical High School - SBHC	600 Orange Ave.	Milford	CT
CH01127AE	Active	BPS-H80-014754	OPTIMUS HEALTH CARE, INC.	Optimus Milford Community Health Center at Bridges	949 BRIDGEPORT AVE	MILFORD	CT
CH01127AF	Active	BPS-H80-017478	OPTIMUS HEALTH CARE, INC.	Jettie S. Tisdale Elementary School SBHC	250 Hollister Ave.	Bridgeport	CT
CH01127AG	Active	BPS-H80-022080	OPTIMUS HEALTH CARE, INC.	Columbus Elementary School SBHC	275 George Street	Bridgeport	CT
CH01127AH	Terminated	BPS-H80-019230	OPTIMUS HEALTH CARE, INC.	Housatonic Community College Health Center	900 Lafayette Boulevard	Bridgeport	CT
CH01127AJ	Terminated	BPS-H80-009385	OPTIMUS HEALTH CARE, INC.	Optimus Main Street Pediatrics	3180 E Main St	Bridgeport	CT
CH01127AK	Active	BPS-H80-027279	OPTIMUS HEALTH CARE, INC.	Harry B. Flood Middle School - SBHC	490 Chapel St	Stratford	CT
CH01127AL	Terminated	BPS-H80-029973	OPTIMUS HEALTH CARE, INC.	West Haven High School - SBHC	1 Mcdonough Plz	West Haven	CT
CH01127AM	Terminated	BPS-H80-027369	OPTIMUS HEALTH CARE, INC.	OPTIMUS Smiles for Miles Mobile Dental Center	975 E Main St	Bridgeport	CT
CH01127AN	Terminated	BPS-H80-027479	OPTIMUS HEALTH CARE, INC.	OPTIMUS at Kinsella	1862 Commerce Dr	Bridgeport	CT
CH01127AP	Terminated	BPS-H80-031085	OPTIMUS HEALTH CARE, INC.	OPTIMUS at Hall Neighborhood House	52 George E Pipkin's Way	Bridgeport	CT
CH01127AQ	Active	BPS-H80-031392	OPTIMUS HEALTH CARE, INC.	OPTMUS at Recovery Counseling Services	1438 Park Ave	Bridgeport	CT
CH01127AR	Active	BPS-H80-029765	OPTIMUS HEALTH CARE, INC.	OPTIMUS on Boston Avenue	305 Boston Ave	Stratford	CT
CH01127C	Active	BPS-H80-003198	OPTIMUS HEALTH CARE, INC.	OPTIMUS on East Main	982-988 EAST MAIN STREET	BRIDGEPORT	CT
CH01127D	Active	BPS-H80-002836	OPTIMUS HEALTH CARE, INC.	OPTIMUS RALPHOLA TAYLOR COMMUNITY HEALTH CENTER	790 CENTRAL AVENUE	BRIDGEPORT	CT
CH01127E	Terminated	BPS-H80-002468	OPTIMUS HEALTH CARE, INC.	OPTIMUS STRATFORD COMMUNITY HEALTH CENTER	727 HONEYSPOT ROAD	STRATFORD	CT
CH01127F	Active	BPS-H80-007559	OPTIMUS HEALTH CARE, INC.	OPTIMUS HARBOR POINT	805 ATLANTIC STREET	STAMFORD	CT
CH01127M	Active	BPS-H80-001793	OPTIMUS HEALTH CARE, INC.	OPTIMUS PARK CITY PRIMARY CARE CENTER	64 BLACKROCK AVENUE	BRIDGEPORT	CT
CH01127P	Active	BPS-H80-000342	OPTIMUS HEALTH CARE, INC.	OPTIMUS HOLLOW COMMUNITY HEALTH CENTER	82-88 GEORGE STREET	BRIDGEPORT	CT
CH01127Q	Active	BPS-H80-000649	OPTIMUS HEALTHCARE INC.	OPTIMUS ON THE BOULEVARD	1351 WASHINGTON BLVD	STAMFORD	CT
CH01127S	Active	BPS-H80-018458	OPTIMUS HEALTH CARE, INC.	MAIN STREET PEDIATRICS	3715 MAIN STREET	BRIDGEPORT	CT
CH01127U	Active	BPS-H80-010271	Optimus Health Care, Inc.	Optimus Fairgate	138 Stillwater Avenue	Stamford	CT
CH01127V	Active	BPS-H80-010657	Optimus Health Care, Inc.	OPTIMUS at Inspirica	8 Woodland Place	Stamford	CT
CH01127W	Active	BPS-H80-004279	Optimus Health Care Inc.	OPTIMUS Pacific House Shelter	597 Pacific St.	Stamford	CT
CH01127X	Active	BPS-H80-008149	OPTIMUS HEALTH CARE, INC.	JFK Elementary School SBHC	700 Palisade Avenue	Bridgeport	CT
CH01127Y	Active	BPS-H80-008151	OPTIMUS HEALTH CARE, INC.	Luis Munoz Marin SBHC	479 Helen Street	Bridgeport	CT
CH01127Z	Active	BPS-H80-024843	OPTIMUS HEALTH CARE, INC.	Warren Harding High School - SBHC	379 Bond St	Bridgeport	CT
CHO1127AK	Terminated	BPS-H80-019178	OPTIMUS HEALTH CARE, INC.	Optimus Transitional Clinic	480 Bond Street	Bridgeport	CT
CHO1127AL	Active	BPS-H80-000688	OPTIMUS HEALTH CARE, INC.	DAVID WOOSTER MIDDLE SCHOOL - SBHC	150 LINCOLN ST	STRATFORD	CT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH011270	ALBION - HANCOCK PHARMACY, LLC	2125 FAIRFIELD AVE		BRIDGEPORT	CT	06605-2246	10/01/2023
CH011270	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/01/2017
CH011270	BRIDGEPORT CHEMISTS	DBA HANCOCK PHARMACY	1407 FAIRFIELD AVENUE	BRIDGEPORT	CT	06605	10/01/2023
CH01127C	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	03/10/2010	11/20/2017
CH011270	BRIDGEPORT PHARMACY	978 E MAIN ST		BRIDGEPORT	CT	06608-1913	07/01/2019
CH011270	CANYON MEDICAL PHARMACY, INC.	7265 S REVERE PARKWAY, SUITE 902		CENTENNIAL	CO	80112	10/01/2017
CH011270	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2020
CH011270	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01219	229 HOPE STREET	STAMFORD	CT	06906	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17425	5065 MAIN ST STE TARGET	TRUMBULL	CT	06611	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 16872	21 BROAD ST	STAMFORD	CT	06901	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02143	3710 MAIN STREET	BRIDGEPORT	CT	06606	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01153	1875 BOSTON AVE, CVS PLAZA	BRIDGEPORT	CT	06610	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02210	1239 EAST PUTNAM AVENUE	RIVERSIDE	CT	06878	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03719	11 FOREST ST.	STAMFORD	CT	06901	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01139	2610 E MAIN ST. BRIARWOODS S/C	BRIDGEPORT	CT	06610	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02573	1425 BARNUM AVENUE	STRATFORD	CT	06614	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17072	120 HAWLEY LN	TRUMBULL	CT	06611	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 343	66 HIGH RIDGE ROAD	STAMFORD	CT	06905	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2258	537 CANAL STREET	STAMFORD	CT	06902	01/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01149	696 WEST AVE.	NORWALK	CT	06850	07/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #7856	281 CONNECTICUT AVENUE	NORWALK	CT	06854-1938	07/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01241	734 BRIDGEPORT AVE	MILFORD	CT	06460	07/01/2020
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01154	6 WILLARD RD.	NORWALK	CT	06851	04/01/2021
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00124	98 BRIDGE ST.	NAUGATUCK	CT	06770	04/01/2021
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01051	593 NEWFIELD AVENUE	STAMFORD	CT	06905	04/01/2021
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2151	330 GRASMERE AVE	FAIRFIELD	CT	06824	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17137	1191 BOSTON POST RD	MILFORD	CT	06460	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00775	2045 DIXWELL AVE.	HAMDEN	CT	06514	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11264	705 BRIDGEPORT AVENUE	SHELTON	CT	06484	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17324	20 W MAIN ST	ANSONIA	CT	06401	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00718	24 PERSHING DR # 36	ANSONIA	CT	06401-2214	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #1987	1938 W. MAIN STREET	STAMFORD	CT	06902	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 6702	644 W. PUTNAM AVENUE	GREENWICH	CT	06830	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02572	1 HAWLEY LANE	STRATFORD	CT	06614	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01775	1058 HOPE STREET	STAMFORD	CT	06907	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03373	961 BLACK ROCK TPKE.	FAIRFIELD	CT	06825	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #5881	969 HIGH RIDGE ROAD	STAMFORD	CT	06905-1608	01/01/2022
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01912	1968 BLACK ROCK TURNPIKE. FAIRWAY PLAZA	FAIRFIELD	CT	06825	01/01/2023
CH011270	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00071	989 BOSTON POST ROAD	MILFORD	CT	06460	01/01/2023
CH011270	CORNERSTONE PHARMACY	134 STILLWATER AVE		STAMFORD	CT	06902-4839	04/01/2014
CH011270	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2023
CH011270	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2023
CH011270	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	10/01/2017
CH011270	GENOA HEALTHCARE LLC	941 BRIDGEPORT AVE	SUITE M5	MILFORD	CT	06460-3142	10/01/2023
CH011270	GENOA HEALTHCARE LLC	287 MAIN STREET, SUITE A-2		EAST HARTFORD	CT	06118-1885	10/01/2023
CH011270	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	10/01/2023
CH01127A	MAIN STREET PHARMACY		1005 MAIN ST, SUITE 1J	BRIDGEPORT	CT	06604	03/10/2010	11/07/2017
CH011270	MAXI DRUG, INC.	RITE AID #10390	82 HOYT STREET	STAMFORD	CT	06905	01/01/2015	08/30/2024
CH011270	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	10/01/2023
CH011270	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/01/2023
CH011270	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CH011270	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/01/2023
CH011270	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	10/01/2023
CH011270	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2023
CH011270	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2020
CH011270	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/01/2017
CH011270	RITE AID OF CONNECTICUT, INC.	RITE AID #3619	1060 EAST MAIN STREET	BRIDGEPORT	CT	06608	01/01/2015	08/30/2024
CH011270	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/01/2017
CH01127D	SIRA PHARMACY LLC	DBA: THE MEDICINE SHOPPE	296 BEDFORD ST	STAMFORD	CT	06901-1720	03/31/2010	01/18/2024
CH011270	SLAVINS - HANCOCK PHARMACY INC	922 WASHINGTON BLVD		STAMFORD	CT	06901	11/01/2011
CH01127F	SLAVINS - HANCOCK PHARMACY INC	922 WASHINGTON BLVD		STAMFORD	CT	06901	07/01/2005	05/09/2017
CH01127Q	SLAVINS - HANCOCK PHARMACY INC	922 WASHINGTON BLVD		STAMFORD	CT	06901	07/09/2007
CH011270	THE PROFESSIONAL PHARMACY	STAMFORD HOSPITAL HEALTH CARE CTR	AT THE TULLY CENTER 32 STRAWBERRY HILL COURT	STAMFORD	CT	06902	10/01/2013	11/10/2017
CH011270	THE STOP & SHOP SUPERMARKET	DBA STOP & SHOP PHARMACY#639	DOCK SHOPPING CENTER 200 E MAIN ST	STRATFORD	CT	06614	01/01/2021	08/30/2024
CH011270	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #637	2200 BEDFORD STREET	STAMFORD	CT	06905	01/01/2021	08/30/2024
CH011270	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2019
CH011270	WAL-MART PHARMACY 10-2585	150 BARNUM AVENUE CUTOFF		STRATFORD	CT	06614	07/01/2019
CH011270	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2019
CH011270	WALGREEN EASTERN CO, INC.	WALGREENS #16549	ONE HOSPITAL PLAZA SUITE G 122	STAMFORD	CT	06902	07/01/2017	04/01/2022
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03359	1606 BARNUM AVE	STRATFORD	CT	06614-5301	08/09/2011
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05723	960 NORTH AVE	BRIDGEPORT	CT	06606-5741	08/09/2011	08/30/2024
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07522	4083 MAIN STREET	BRIDGEPORT	CT	06606	08/09/2011
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09521	1000 PARK AVENUE	BRIDGEPORT	CT	06604-3406	08/09/2011
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10310	780 E MAIN ST	STAMFORD	CT	06902-3832	08/09/2011
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #15358	2200 ATLANTIC ST STE 200	STAMFORD	CT	06902-6834	09/19/2012	09/15/2017
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #21268	76 HEIGHTS RD	DARIEN	CT	06820-4128	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06503	541 BRIDGEPORT AVE	MILFORD	CT	06460-4203	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06757	1333 E PUTNAM AVE	RIVERSIDE	CT	06878-1529	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07584	394 CAMPBELL AVE	WEST HAVEN	CT	06516-5012	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07602	275 MONROE TURNPIKE	MONROE	CT	06468-2125	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09612	700 BRIDGEPORT AVE STE 101	SHELTON	CT	06484	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10177	54 WEST AVE	NORWALK	CT	06854-2225	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11620	1203 HIGH RIDGE ROAD	STAMFORD	CT	06905-1214	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #16080	414 KINGS HWY E	FAIRFIELD	CT	06825-4846	01/01/2016
CH011270	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16548	300 FAIRFIELD AVE STE 103	BRIDGEPORT	CT	06604	01/01/2018
CH011270	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018
CH011270	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CH011270	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 8:57:09 AM	2/11/2025 11:32:07 AM	2/11/2025 11:32 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 12:33:29 PM	1/29/2024 8:57:09 AM	1/29/2024 8:57 AM
Contacts	Primary Contact	Update	Profile Change Request	Fekredengel, Tizita Clinical Pharmacist Optimus Health Care 2036963260-3471	Fekredengel, Tizita Clinical Pharmacist Optimus Health Care 2036162235	1/18/2024 1:52 PM
Details	Last Recertification Date	Update	Recertification	2/2/2022 10:55:47 AM	1/31/2023 12:33:29 PM	1/31/2023 12:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1669445946	1/27/2023 9:15 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	1/27/2023 9:15 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1669548376	1/27/2023 9:15 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	1/27/2023 9:15 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1992871875	1/27/2023 9:15 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	1/27/2023 9:15 AM
Details	Last Recertification Date	Update	Recertification	2/23/2021 9:26:06 AM	2/2/2022 10:55:47 AM	2/2/2022 10:55 AM
Contacts	Authorizing Official	Update	AO Change Request	SPINELLI, LUDWIG M. CEO Optimus Health Care, Inc 2036963260-3349	Daley, Karen A Chief Executive Officer Optimus Health Care, Inc. 2036083387	8/9/2021 10:20 AM
Details	Last Recertification Date	Update	Recertification	2/3/2020 12:07:33 PM	2/23/2021 9:26:06 AM	2/23/2021 9:26 AM
Details	Last Recertification Date	Update	Recertification	2/5/2019 2:38:26 PM	2/3/2020 12:07:33 PM	2/3/2020 12:07 PM
Details	Entity Name	Update	Recertification	OPTIMUS HEALTH CARE, INC.	OPTIMUS HEALTHCARE INC.	2/3/2020 12:07 PM
Details	Entity Subname	Update	Recertification	1351 Washington Blvd.	OPTIMUS ON THE BOULEVARD	2/3/2020 12:07 PM
Details	Last Recertification Date	Update	Recertification	2/20/2018 9:44:10 AM	2/5/2019 2:38:26 PM	2/5/2019 2:38 PM
Addresses	Billing Address	Update	Recertification	OPTIMUS HEALTH CARE, INC. 471 BARNUM AVENUE BRIDGEPORT, CT 06608	OPTIMUS HEALTH CARE, INC. 982 East Main Street Bridgeport, CT 06608	2/20/2018 9:44 AM
Details	Last Recertification Date	Update	Recertification	1/31/2017 12:00:00 AM	2/20/2018 9:44:10 AM	2/20/2018 9:44 AM
Details	Entity Subname	Update	Recertification	STAMFORD COMMUNITY HEALTH CENTER	1351 Washington Blvd.	2/20/2018 9:44 AM
Contacts	Primary Contact	Insert	Change Request		Fekredengel, Tizita Clinical Pharmacist Optimus Health Care 2036963260-3471	10/6/2017 2:59 PM
Contacts	Authorizing Official	Update		SPINELLI, LUDWIG M. CEO 2036963260-3349	SPINELLI, LUDWIG M. CEO Optimus Health Care, Inc 2036963260-3349	10/6/2017 11:20 AM
Contacts	Authorizing Official	Insert			SPINELLI, LUDWIG M. CEO 2036963260-3349	7/13/2017 11:39 AM
Addresses	Main Address	Insert			1351 WASHINGTON BLVD STAMFORD, CT 06902	1/31/2017 4:29 PM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	1/31/2017 12:00:00 AM	1/31/2017 4:29 PM
Details	Last Recertification Date	Update		3/2/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 9:50 AM
Details	Last Recertification Date	Update		3/15/2014 12:00:00 AM	3/2/2015 12:00:00 AM	3/2/2015 11:00 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/15/2014 12:00:00 AM	3/15/2014 8:43 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/15/2013 6:55 AM
Addresses	Billing Address	Insert			OPTIMUS HEALTH CARE, INC. 471 BARNUM AVENUE BRIDGEPORT, CT 06608	12/14/2006 6:42 PM
Details	Last Recertification Date	Insert				12/14/2006 6:42 PM
Details	Grant Number	Insert			H80CS00377	12/14/2006 6:42 PM
Details	340B ID	Insert			CH01127Q	12/14/2006 6:42 PM
Details	Is Authorizing Official EHB Data	Insert				12/14/2006 6:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/14/2006 6:42 PM
Details	Medicare Provider Number	Insert				12/14/2006 6:42 PM
Details	Entity Name	Insert			OPTIMUS HEALTH CARE, INC.	12/14/2006 6:42 PM
Details	Program Code	Insert			CH	12/14/2006 6:42 PM
Details	Entity Subname	Insert			STAMFORD COMMUNITY HEALTH CENTER	12/14/2006 6:42 PM
Dates	Participating Approval Date	Insert			12/14/2006 12:00:00 AM	12/14/2006 6:42 PM
Details	State	Insert			Active	12/14/2006 6:42 PM
Dates	Registration Date	Insert			12/14/2006 12:00:00 AM	12/14/2006 6:42 PM
Dates	Signed By Date	Insert			12/12/2006 12:00:00 AM	12/14/2006 6:42 PM
Dates	Start Date	Insert			1/1/2007 12:00:00 AM	12/14/2006 6:42 PM
Terminations	Termination Comments	Insert				12/14/2006 6:42 PM
Terminations	Termination Date	Insert				12/14/2006 6:42 PM
Terminations	Termination Effective Date	Insert				12/14/2006 6:42 PM
Terminations	Termination Reason	Insert				12/14/2006 6:42 PM

340B Drug Pricing Program Database