| Addresses | Shipping Address | Insert | Change Request | | Wallabout Drugs
74 Wallabout Street
Brooklyn, NY 11249 | 2/26/2025 1:16 PM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2024 11:19:28 AM | 2/11/2025 9:43:14 AM | 2/11/2025 9:43 AM |
| Details | Last Recertification Date | Update | Recertification | 2/6/2023 10:42:58 AM | 2/13/2024 11:19:28 AM | 2/13/2024 11:19 AM |
| Addresses | Shipping Address | Update | Change Request | ODA Primary Health Care Network dba ODA Pharmacy
74 Wallabout Street
Brooklyn, NY 11249-7830 | ODA Primary Health Care Network, Inc. dba ODA Pharmacy
74 Wallabout Street
Brooklyn, NY 11249-7830 | 12/19/2023 11:05 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/19/2023 11:05 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 07667792 | 12/19/2023 11:05 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | NY | 12/19/2023 11:05 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1821735002 | 12/19/2023 11:05 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | NY | 12/19/2023 11:05 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1720177066 | 12/19/2023 11:05 AM |
| Medicaid Billing | NPI: State | Insert | Change Request | | NY | 12/19/2023 11:05 AM |
| Details | Entity Subname | Update | Change Request | DBA ODA PHARMACY | ODA PRIMARY HEALTH CARE CENTER, INC. | 12/19/2023 11:05 AM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2022 10:13:24 AM | 2/6/2023 10:42:58 AM | 2/6/2023 10:42 AM |
| Addresses | Shipping Address | Update | Change Request | ODA Primary Health Care Network
74 Wallabout Street
Brooklyn, NY 11249 | ODA Primary Health Care Network dba ODA Pharmacy
74 Wallabout Street
Brooklyn, NY 11249-7830 | 11/16/2022 1:22 PM |
| Details | Entity Subname | Update | Change Request | ODA PRIMARY HEALTH CARE CENTER, INC. | DBA ODA PHARMACY | 11/16/2022 1:22 PM |
| Addresses | Shipping Address | Insert | Change Request | | ODA Primary Health Care Network
74 Wallabout Street
Brooklyn, NY 11249 | 11/2/2022 10:57 AM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2021 9:02:42 AM | 2/17/2022 10:13:24 AM | 2/17/2022 10:13 AM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2020 8:50:27 AM | 2/18/2021 9:02:42 AM | 2/18/2021 9:02 AM |
| Addresses | Main Address | Update | Recertification |
14-16 HEYWARD STREET
BROOKLYN, NY 11211-7823 |
14 HEYWARD STREET
BROOKLYN, NY 11249-7823 | 2/4/2020 8:50 AM |
| Addresses | Billing Address | Update | Recertification | ODA Primary Health Care Network
14 Heyward Street
Brooklyn, NY 11249 | ODA Primary Health Care Network
74 Wallabout Street
Brooklyn, NY 11249 | 2/4/2020 8:50 AM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 9:31:52 AM | 2/4/2020 8:50:27 AM | 2/4/2020 8:50 AM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2018 11:24:51 AM | 1/29/2019 9:31:52 AM | 1/29/2019 9:31 AM |
| Contacts | Primary Contact | Update | Recertification | Deutsch, Joseph
Chief Executive Officer
ODA Primary Health Care Network
7182604600-301 | Levine, Lauren
Communications Director
ODA Primary Health Care Network
7182604600-305 | 2/12/2018 11:24 AM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2017 12:00:00 AM | 2/12/2018 11:24:51 AM | 2/12/2018 11:24 AM |
| Contacts | Authorizing Official | Update | | Deutsch, Joseph
Chief Executive Officer
7182604600-301 | Deutsch, Joseph
Chief Executive Officer
ODA Primary Health Care Network
7182604600-301 | 10/16/2017 2:11 PM |
| Contacts | Primary Contact | Update | | Deutsch, Joseph
Chief Executive Officer
7182604600-301 | Deutsch, Joseph
Chief Executive Officer
ODA Primary Health Care Network
7182604600-301 | 10/16/2017 2:11 PM |
| Contacts | Authorizing Official | Update | | EHRENFELD, EUGENE
CHIEF EXECUTIVE OFFICER
7182604600-310 | Deutsch, Joseph
Chief Executive Officer
7182604600-301 | 7/17/2017 4:50 PM |
| Contacts | Primary Contact | Update | | EHRENFELD, EUGENE
CHIEF EXECUTIVE OFFICER
7182604600-310 | Deutsch, Joseph
Chief Executive Officer
7182604600-301 | 7/17/2017 4:50 PM |
| Addresses | Main Address | Insert | | |
14-16 HEYWARD STREET
BROOKLYN, NY 11211-7823 | 6/28/2017 1:31 PM |
| Addresses | Billing Address | Insert | | | ODA Primary Health Care Network
14 Heyward Street
Brooklyn, NY 11249 | 6/28/2017 1:31 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 6/28/2017 1:30 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 00357548 | 6/28/2017 1:30 PM |
| Medicaid Billing | Medicaid: State | Insert | | | NY | 6/28/2017 1:30 PM |
| Details | Last Recertification Date | Update | | 3/7/2016 12:00:00 AM | 2/14/2017 12:00:00 AM | 2/14/2017 1:17 PM |
| Details | Last Recertification Date | Update | | 3/10/2015 12:00:00 AM | 3/7/2016 12:00:00 AM | 3/7/2016 3:06 PM |
| Details | Last Recertification Date | Update | | 3/23/2014 12:00:00 AM | 3/10/2015 12:00:00 AM | 3/10/2015 10:31 AM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/23/2014 12:00:00 AM | 3/23/2014 2:34 PM |
| Details | Entity Name | Update | | ODA PRIMARY HEALTH CARE NETWORK | ODA PRIMARY HEALTH CARE CENTER, INC. | 3/23/2014 2:34 PM |
| Details | Entity Subname | Update | | | ODA PRIMARY HEALTH CARE CENTER, INC. | 3/23/2014 2:34 PM |
| Contacts | Authorizing Official | Insert | | | EHRENFELD, EUGENE
CHIEF EXECUTIVE OFFICER
7182604600-310 | 4/9/2013 4:26 PM |
| Contacts | Primary Contact | Update | | Taub, Miriam
Interim Chief Executive Officer
7182604600-303 | EHRENFELD, EUGENE
CHIEF EXECUTIVE OFFICER
7182604600-310 | 4/9/2013 4:26 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/26/2013 9:21 AM |
| Contacts | Primary Contact | Update | | BRANDSDORFER, MICHAEL
FINANCE DIRECTOR
7182604600-307 | Taub, Miriam
Interim Chief Executive Officer
7182604600-303 | 12/19/2012 4:32 PM |
| Details | Entity Name | Update | | ODA PRIMARY HEALTH CARE CENTER | ODA PRIMARY HEALTH CARE NETWORK | 12/19/2012 4:32 PM |
| Contacts | Primary Contact | Insert | | | BRANDSDORFER, MICHAEL
FINANCE DIRECTOR
7182604600-307 | 12/3/2009 8:19 AM |
| Details | Last Recertification Date | Insert | | | | 12/3/2009 8:19 AM |
| Details | Grant Number | Insert | | | H80CS00064 | 12/3/2009 8:19 AM |
| Details | 340B ID | Insert | | | CHC00064-00 | 12/3/2009 8:19 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 12/3/2009 8:19 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/3/2009 8:19 AM |
| Details | Medicare Provider Number | Insert | | | | 12/3/2009 8:19 AM |
| Details | Entity Name | Insert | | | ODA PRIMARY HEALTH CARE CENTER | 12/3/2009 8:19 AM |
| Details | Program Code | Insert | | | CH | 12/3/2009 8:19 AM |
| Details | Entity Subname | Insert | | | | 12/3/2009 8:19 AM |
| Dates | Participating Approval Date | Insert | | | 12/3/2009 12:00:00 AM | 12/3/2009 8:19 AM |
| Details | State | Insert | | | Active | 12/3/2009 8:19 AM |
| Dates | Registration Date | Insert | | | 11/24/2009 12:00:00 AM | 12/3/2009 8:19 AM |
| Dates | Signed By Date | Insert | | | 11/12/2009 12:00:00 AM | 12/3/2009 8:19 AM |
| Dates | Start Date | Insert | | | 1/1/2010 12:00:00 AM | 12/3/2009 8:19 AM |
| Terminations | Termination Comments | Insert | | | | 12/3/2009 8:19 AM |
| Terminations | Termination Date | Insert | | | | 12/3/2009 8:19 AM |
| Terminations | Termination Effective Date | Insert | | | | 12/3/2009 8:19 AM |
| Terminations | Termination Reason | Insert | | | | 12/3/2009 8:19 AM |