340B Drug Pricing Program Database


CH05064B Family Health Services of Darke County (Active) - information as of 4/29/2025 11:53:58 PM

Main Details
Family Health Services of Darke County
VERSAILLES MEDICAL CENTER SITE
HRSA-Funded Health Center
BPS-H80-002458
CH05064B
H80CS00419


Additional Details
Active
8/10/2010
10/1/2010
8/12/2010
2/17/2025

Contacts

Family Health Services of Darke County,Inc.
Jared Pollick, Executive Director
(937) 548-3806

Family Health Services of Darke County
Brenda Elaina Reitz, Pharmacy Director
(937) 548-2953

Addresses

10484 Kley Rd
Versailles, OH 45380-9561

FAMILY HEALTH SERVICES OF DARKE COUNTY, INC
5735 MEEKER RD
GREENVILLE, OH 45331


  • 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
OH3011298,22868511013244680,1386709194,1114254042,1679300982
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailKAUP PHARMACY42 W MAIN ST
VERSAILLESOH45380-121401/16/202404/01/2024  04/01/2024
Contract DetailKAUP PHARMACY102 N WAYNE ST P O BOX 605
FORT RECOVERYOH45846-805901/16/202404/01/2024  04/01/2024
Contract DetailKAUP PHARMACY, INC.366 W DEERFIELD RD
UNION CITYIN47390-103901/16/202404/01/2024  04/01/2024
Contract DetailKROGER PHARMACY #014833200 LEASE AVENUE
GREENVILLEOH4533110/13/202301/01/2024  01/01/2024
Contract DetailOHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06134 1009 EAST MAIN ST.
GREENVILLEOH4533110/13/202301/01/2024  01/01/2024
Contract DetailWAL-MART PHARMACY 10-20351501 WAGNER AVE
GREENVILLEOH4533110/13/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 10327 1000 E MAIN ST
GREENVILLEOH45331-280210/14/202301/01/2024  01/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH050640ActiveBPS-H80-002145Family Health Services of Darke CountyFAMILY HEALTH SERVICES OF DARKE COUNTY5735 Meeker Rd GreenvilleOH
CH05064AActiveBPS-H80-003418Family Health Services of Darke CountyARCANUM702 N MAIN ST ARCANUMOH
CH05064BActiveBPS-H80-002458Family Health Services of Darke CountyVERSAILLES MEDICAL CENTER SITE10484 Kley Rd VersaillesOH
CH05064CActiveBPS-H80-014086Family Health Services of Darke CountyNew Madison Medical Center101 ANDERSON ST NEW MADISONOH
CH05064DTerminatedBPS-H80-017416FAMILY HEALTH SERVICE OF DARKE COUNTY Family Health Optometry5735 Meeker Road GreenvilleOH
CH05064EActiveBPS-H80-017989Family Health Services of Darke CountyFamily Health Behavioral Health and Wellness1101 JACKSON ST STE C GreenvilleOH
CH05064FActiveBPS-H80-037903Family Health Services of Darke CountyTri-Village School District315 S Main St New MadisonOH
CH05064GActiveBPS-H80-039006Family Health Services of Darke CountyAnthony Wayne and Care-A-Lot Early Childhood Center4932 Children's Home-Bradford Road GreenvilleOH
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH050640ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/20/2022 03/21/2024
CH050640ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/20/2022 03/21/2024
CH050640ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/20/2022 03/21/2024
CH050640ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/01/2024  
CH050640ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/01/2024  
CH050640ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/01/2024  
CH050640ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/20/2022 07/01/2023
CH050640ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/20/2022 03/21/2024
CH050640ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/20/2022 03/21/2024
CH050640ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/20/2022 03/21/2024
CH050640ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/01/2024  
CH050640ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607510/01/2024  
CH050640ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/01/2024  
CH050640ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280910/01/2024  
CH050640AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291111/10/2021 10/07/2024
CH050640AMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700304/01/2023 10/07/2024
CH050640ARP INCDBA MEDICINE AND MORE 100 FORT JEFFERSON AVE
GREENVILLEOH4533107/20/2022  
CH050640AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503411/10/2021 10/07/2024
CH050640BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CH050640BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CH050640BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2024  
CH050640BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620310/01/2024  
CH050640BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522610/01/2024  
CH050640CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/01/2021  
CH050640CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/01/2021  
CH050640CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/01/2021  
CH050640CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/01/2021  
CH050640CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/01/2021  
CH050640CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/01/2021  
CH050640CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/01/2021  
CH050640CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/01/2021  
CH050640CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/01/2021  
CH050640CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/01/2021  
CH050640CENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506907/20/2022 10/07/2024
CH050640CENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282401/01/2024 10/07/2024
CH050640CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/01/2021  
CH050640CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/01/2021  
CH050640CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/01/2021  
CH050640CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2024  
CH050640DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654104/01/2024  
CH050640ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/20/2022  
CH050640EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/20/2022  
CH050640EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/20/2022  
CH050640EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/20/2022  
CH050640GENOA HEALTHCARE LLC2009 BROWN STREET SUITE 7
ANDERSONIN46016-421610/01/2024  
CH050640GENOA HEALTHCARE LLC2458 STETZER RD RM 193
BUCYRUSOH4482010/01/2024  
CH050640GENOA HEALTHCARE LLC741 SCHOLL ROAD, STE P1
MANSFIELDOH4490710/01/2024  
CH050640GENOA HEALTHCARE LLC701 BROOKSEDGE PLAZA DR STE C
WESTERVILLEOH4308110/01/2024  
CH050640GENOA HEALTHCARE LLC6655 EAST US HIGHWAY 36
AVONIN4612310/01/2024  
CH050640HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06647 1515 EAST MAIN STREET
RICHMONDIN4737401/01/2024 03/03/2025
CH050640KAUP PHARMACY42 W MAIN ST
VERSAILLESOH45380-121407/20/2022  
CH050640KAUP PHARMACY102 N WAYNE ST P O BOX 605
FORT RECOVERYOH45846-805907/20/2022  
CH05064FKAUP PHARMACY42 W MAIN ST
VERSAILLESOH45380-121404/01/2024  
CH05064FKAUP PHARMACY102 N WAYNE ST P O BOX 605
FORT RECOVERYOH45846-805904/01/2024  
CH05064AKAUP PHARMACY42 W MAIN ST
VERSAILLESOH45380-121404/01/2024  
CH05064AKAUP PHARMACY102 N WAYNE ST P O BOX 605
FORT RECOVERYOH45846-805904/01/2024  
CH05064BKAUP PHARMACY42 W MAIN ST
VERSAILLESOH45380-121404/01/2024  
CH05064BKAUP PHARMACY102 N WAYNE ST P O BOX 605
FORT RECOVERYOH45846-805904/01/2024  
CH05064CKAUP PHARMACY42 W MAIN ST
VERSAILLESOH45380-121404/01/2024  
CH05064CKAUP PHARMACY102 N WAYNE ST P O BOX 605
FORT RECOVERYOH45846-805904/01/2024  
CH05064EKAUP PHARMACY42 W MAIN ST
VERSAILLESOH45380-121404/01/2024  
CH05064EKAUP PHARMACY102 N WAYNE ST P O BOX 605
FORT RECOVERYOH45846-805904/01/2024  
CH050640KAUP PHARMACY, INC.366 W DEERFIELD RD
UNION CITYIN47390-103907/20/2022  
CH05064FKAUP PHARMACY, INC.366 W DEERFIELD RD
UNION CITYIN47390-103904/01/2024  
CH05064AKAUP PHARMACY, INC.366 W DEERFIELD RD
UNION CITYIN47390-103904/01/2024  
CH05064BKAUP PHARMACY, INC.366 W DEERFIELD RD
UNION CITYIN47390-103904/01/2024  
CH05064CKAUP PHARMACY, INC.366 W DEERFIELD RD
UNION CITYIN47390-103904/01/2024  
CH05064EKAUP PHARMACY, INC.366 W DEERFIELD RD
UNION CITYIN47390-103904/01/2024  
CH050640KROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321711/10/2021  
CH050640KROGER PHARMACY #014833200 LEASE AVENUE
GREENVILLEOH4533111/10/2021  
CH05064AKROGER PHARMACY #014833200 LEASE AVENUE
GREENVILLEOH4533101/01/2024  
CH05064BKROGER PHARMACY #014833200 LEASE AVENUE
GREENVILLEOH4533101/01/2024  
CH05064CKROGER PHARMACY #014833200 LEASE AVENUE
GREENVILLEOH4533101/01/2024  
CH05064EKROGER PHARMACY #014833200 LEASE AVENUE
GREENVILLEOH4533101/01/2024  
CH05064FKROGER PHARMACY #014833200 LEASE AVENUE
GREENVILLEOH4533104/01/2024  
CH05064GKROGER PHARMACY #014833200 LEASE AVENUE
GREENVILLEOH4533107/01/2025  
CH050640KROGER PHARMACY #984731 WEST MARKET STREET
TROYOH4537304/01/2025  
CH050640KROGER PHARMACY 0149321510 COVINGTON AVENUE
PIQUAOH4535601/01/2024  
CH050640LA PHARMACY LLC1048 S GARFIELD AVE STE 101
ALHAMBRACA9180111/10/2021  
CH050640M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312611/10/2021  
CH050640OHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06134 1009 EAST MAIN ST.
GREENVILLEOH4533110/01/2021  
CH050640OHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 03402 115 NORTH COLLEGE ST.,
PIQUAOH4535607/20/2022  
CH050640OHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 03457 201 S. MAIN STREET
NEW CARLISLEOH4534407/20/2022  
CH050640OHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06145 1300 NORTH BARRON STREET
EATONOH4532007/20/2022  
CH050640OHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 07694 804 W. MAIN ST.
TROYOH4537307/20/2022  
CH050640OHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 07767 124 SOUTH MAIN STREET
UNIONOH4532207/20/2022  
CH05064AOHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06134 1009 EAST MAIN ST.
GREENVILLEOH4533101/01/2024  
CH05064BOHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06134 1009 EAST MAIN ST.
GREENVILLEOH4533101/01/2024  
CH05064COHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06134 1009 EAST MAIN ST.
GREENVILLEOH4533101/01/2024  
CH05064EOHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06134 1009 EAST MAIN ST.
GREENVILLEOH4533101/01/2024  
CH05064FOHIO CVS STORES, L.L.C.DBA: CVS/PHARMACY # 06134 1009 EAST MAIN ST.
GREENVILLEOH4533104/01/2024  
CH050640OPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705810/01/2024  
CH050640OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276510/01/2024  
CH050640OPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502910/01/2024  
CH050640OPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302510/01/2024  
CH050640OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850710/01/2024  
CH050640OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713011/10/2021  
CH050640OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824910/01/2024  
CH050640OPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970510/01/2024  
CH050640OPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265510/01/2024  
CH050640OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729810/01/2024  
CH050640OPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110110/01/2024  
CH050640OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140110/01/2024  
CH050640OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508510/01/2024  
CH050640OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/01/2024  
CH050640OVERLAKE PHARMACY, LLC4124 148TH AVE NE STE JA
REDMONDWA9805211/10/2021  
CH050640PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310111/10/2021 10/07/2024
CH050640PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/01/2021  
CH050640PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/01/2021  
CH050640PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681310/01/2021  
CH050640PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/01/2021  
CH050640PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #11338 10160 INTERNATIONAL BLVD.
WEST CHESTEROH4524607/01/2025  
CH050640RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255004/01/2024  
CH050640RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2024  
CH050640SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2024  
CH050640TRUEPILL3121 DIABLO AVE
HAYWARDCA9454511/10/2021 01/11/2024
CH050640TRUEPILL NY LLC850 3RD AVE STE 404
BROOKLYNNY11232-152311/10/2021 01/11/2024
CH050640WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738611/10/2021  
CH050640WAL-MART PHARMACY 10-20351501 WAGNER AVE
GREENVILLEOH4533111/10/2021  
CH05064AWAL-MART PHARMACY 10-20351501 WAGNER AVE
GREENVILLEOH4533101/01/2024  
CH05064BWAL-MART PHARMACY 10-20351501 WAGNER AVE
GREENVILLEOH4533101/01/2024  
CH05064CWAL-MART PHARMACY 10-20351501 WAGNER AVE
GREENVILLEOH4533101/01/2024  
CH05064EWAL-MART PHARMACY 10-20351501 WAGNER AVE
GREENVILLEOH4533101/01/2024  
CH05064FWAL-MART PHARMACY 10-20351501 WAGNER AVE
GREENVILLEOH4533104/01/2024  
CH050640WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283711/10/2021  
CH050640WALGREEN CO.DBA: WALGREENS # 10327 1000 E MAIN ST
GREENVILLEOH45331-280201/01/2024  
CH05064AWALGREEN CO.DBA: WALGREENS # 10327 1000 E MAIN ST
GREENVILLEOH45331-280201/01/2024  
CH05064BWALGREEN CO.DBA: WALGREENS # 10327 1000 E MAIN ST
GREENVILLEOH45331-280201/01/2024  
CH05064CWALGREEN CO.DBA: WALGREENS # 10327 1000 E MAIN ST
GREENVILLEOH45331-280201/01/2024  
CH05064EWALGREEN CO.DBA: WALGREENS # 10327 1000 E MAIN ST
GREENVILLEOH45331-280201/01/2024  
CH05064FWALGREEN CO.DBA: WALGREENS # 10327 1000 E MAIN ST
GREENVILLEOH45331-280204/01/2024  
CH050640WALGREEN CO.DBA: WALGREENS # 07331 20 W MARKET STREET
TROYOH4537304/01/2025  
CH050640Walgreens Central Fill #213994132Plainfield Rd
Ste 110
IndianapolisIN46231-702101/01/2024  
CH050640WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2024  
CH050640WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2024  
CH050640WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2024  
CH050640WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/01/2023  
CH050640Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsEntity NameUpdateGroup Change RequestFAMILY HEALTH SERVICE OF DARKE COUNTY INCFamily Health Services of Darke County4/17/2025 10:42 AM
DetailsLast Recertification DateUpdateRecertification2/6/2024 10:29:20 AM2/17/2025 10:03:40 AM2/17/2025 10:03 AM
Medicaid BillingNPI: NumberInsertChange Request 111425404210/8/2024 11:01 AM
Medicaid BillingNPI: StateInsertChange Request OH10/8/2024 11:01 AM
Medicaid BillingNPI: NumberInsertChange Request 167930098210/8/2024 11:01 AM
Medicaid BillingNPI: StateInsertChange Request OH10/8/2024 11:01 AM
DetailsLast Recertification DateUpdateRecertification2/6/2023 10:07:29 AM2/6/2024 10:29:20 AM2/6/2024 10:29 AM
DetailsLast Recertification DateUpdateRecertification2/7/2022 8:35:01 AM2/6/2023 10:07:29 AM2/6/2023 10:07 AM
DetailsLast Recertification DateUpdateRecertification2/5/2021 11:13:53 AM2/7/2022 8:35:01 AM2/7/2022 8:35 AM
Medicaid BillingNPI: StateUpdateRecertification OH2/5/2021 11:13 AM
Medicaid BillingNPI: StateUpdateRecertification OH2/5/2021 11:13 AM
DetailsLast Recertification DateUpdateRecertification1/31/2020 3:51:33 PM2/5/2021 11:13:53 AM2/5/2021 11:13 AM
ContactsAuthorizing OfficialUpdateChange RequestYoung, Jean E Executive Director Family Health Services of Darke County, Inc. 9375483806-1031Pollick, Jared Executive Director Family Health Services of Darke County,Inc. 93754838065/11/2020 2:06 PM
DetailsLast Recertification DateUpdateRecertification2/4/2019 10:00:05 AM1/31/2020 3:51:33 PM1/31/2020 3:51 PM
ContactsPrimary ContactUpdateProfile Change RequestReitz, Brenda Elaina pharamcist Family Health Services of Darke County 9375482953Reitz, Brenda Elaina Pharmacy Director Family Health Services of Darke County 937548295312/3/2019 4:33 PM
ContactsPrimary ContactUpdateChange RequestClaudy, Janell Pharmacy Director Family Health Services 9375483806-3100Reitz, Brenda Elaina pharamcist Family Health Services of Darke County 937548295312/3/2019 9:36 AM
DetailsLast Recertification DateUpdateRecertification2/8/2018 11:47:11 AM2/4/2019 10:00:05 AM2/4/2019 10:00 AM
DetailsLast Recertification DateUpdateRecertification1/25/2017 12:00:00 AM2/8/2018 11:47:11 AM2/8/2018 11:47 AM
ContactsAuthorizing OfficialUpdateAO Change RequestYoung, Jean Executive Director 9375483806-1031Young, Jean E Executive Director Family Health Services of Darke County, Inc. 9375483806-10312/8/2018 10:05 AM
ContactsPrimary ContactUpdate Claudy, Janell Pharmacy Director 9375483806-3100Claudy, Janell Pharmacy Director Family Health Services 9375483806-31009/21/2017 12:55 PM
ContactsPrimary ContactUpdate Claudy, Janell Director of Pharmacy 9375482953-287Claudy, Janell Pharmacy Director 9375483806-31005/2/2017 7:59 AM
AddressesMain AddressInsert   10484 Kley Rd Versailles, OH 45380-95611/25/2017 4:44 PM
ContactsAuthorizing OfficialUpdate BOROFF, COY CFO 9375472304Young, Jean Executive Director 9375483806-10311/25/2017 4:44 PM
DetailsLast Recertification DateUpdate 2/12/2016 12:00:00 AM1/25/2017 12:00:00 AM1/25/2017 4:44 PM
AddressesBilling AddressInsert  FAMILY HEALTH SERVICES OF DARKE COUNTY, INC 5735 MEEKER RD GREENVILLE, OH 453317/28/2016 11:28 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False2/12/2016 2:56 PM
Medicaid BillingMedicaid: NumberInsert  22868512/12/2016 2:56 PM
Medicaid BillingMedicaid: StateInsert  OH2/12/2016 2:56 PM
Medicaid BillingNPI: NumberInsert  13867091942/12/2016 2:56 PM
ContactsPrimary ContactUpdate BOROFF, COY CFO 9375472304Claudy, Janell Director of Pharmacy 9375482953-2872/12/2016 2:56 PM
DetailsLast Recertification DateUpdate 1/28/2015 12:00:00 AM2/12/2016 12:00:00 AM2/12/2016 2:56 PM
DetailsLast Recertification DateUpdate 3/17/2014 12:00:00 AM1/28/2015 12:00:00 AM1/28/2015 10:13 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/17/2014 12:00:00 AM3/17/2014 4:01 AM
DetailsEntity NameUpdate FAMILY HEALTH SERVICES OF DARKE COUNTY, INCFAMILY HEALTH SERVICE OF DARKE COUNTY INC3/17/2014 4:01 AM
DetailsEntity SubnameUpdate  VERSAILLES MEDICAL CENTER SITE3/17/2014 4:01 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/17/2013 4:44 PM
Medicaid BillingMedicaid: NumberInsert  301129810/17/2013 4:44 PM
Medicaid BillingMedicaid: StateInsert  OH10/17/2013 4:44 PM
Medicaid BillingNPI: NumberInsert  101324468010/17/2013 4:44 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/27/2013 3:05 PM
ContactsAuthorizing OfficialInsert  BOROFF, COY CFO 93754723048/12/2010 9:21 AM
ContactsPrimary ContactInsert  BOROFF, COY CFO 93754723048/12/2010 9:21 AM
DetailsLast Recertification DateInsert   8/12/2010 9:21 AM
DetailsGrant NumberInsert  H80CS004198/12/2010 9:21 AM
Details340B IDInsert  CH05064B8/12/2010 9:21 AM
DetailsIs Authorizing Official EHB DataInsert   8/12/2010 9:21 AM
DatesLast Date That 340B Drugs PurchasedInsert   8/12/2010 9:21 AM
DetailsMedicare Provider NumberInsert   8/12/2010 9:21 AM
DetailsEntity NameInsert  FAMILY HEALTH SERVICES OF DARKE COUNTY, INC8/12/2010 9:21 AM
DetailsProgram CodeInsert  CH8/12/2010 9:21 AM
DetailsEntity SubnameInsert   8/12/2010 9:21 AM
DatesParticipating Approval DateInsert  8/12/2010 12:00:00 AM8/12/2010 9:21 AM
DetailsStateInsert  Active8/12/2010 9:21 AM
DatesRegistration DateInsert  8/10/2010 12:00:00 AM8/12/2010 9:21 AM
DatesSigned By DateInsert  7/28/2010 12:00:00 AM8/12/2010 9:21 AM
DatesStart DateInsert  10/1/2010 12:00:00 AM8/12/2010 9:21 AM
TerminationsTermination CommentsInsert   8/12/2010 9:21 AM
TerminationsTermination DateInsert   8/12/2010 9:21 AM
TerminationsTermination Effective DateInsert   8/12/2010 9:21 AM
TerminationsTermination ReasonInsert   8/12/2010 9:21 AM