Covered Entity Details

CH041714G Christ Community Health Services, Inc. (Active) - information as of 4/24/2025 10:13:44 PM

Main Details

Name

Christ Community Health Services, Inc.

Subdivision Name

MOBILE CLINIC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-002786

340B ID

CH041714G

Grant Number

H80CS00881

Additional Details

Current Program Status

Active

Registration Date

4/3/2012

Participating Start Date

7/1/2012

Participating Approval Date

6/19/2012

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Christ Community Health Services
Tracy McDaniel, CEO
(901) 842-2393

Primary Contact

Christ Community Health Services, Inc.
Suong Mai Le, 340B Program Manager
(901) 842-1936

Addresses

Street Address

2861 BROAD AVE
MEMPHIS, TN 38112-2903

Billing Address

Christ Community Health Services
2670 Union Avenue Extended, Suite 1000
Memphis, TN 38112

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
4/6/12 - Reviewed registration. 4/18/12 Processed registration and forwarded to IS.	04/18/2012
4/6/12 - Reviewed registration.	04/06/2012

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
TN	3707256,Q034103,Q045657,Q034253,Q035646,Q034594,Q070697	1699922401,1891837290,1982686614,1053613851,1558797613,1356749915,1730651373,1558028670

Shipping Addresses

Shipping Address 1

Christ Community Health Services, Inc.-Frayser Pharmacy
969 Frayser Boulevard
Memphis, TN 38127

Shipping Address 2

Christ Community Health SVS-Broad Ave Pharmacy
2861 Broad Ave
Memphis, TN 38112

Shipping Address 3

Christ Community Health Services, Inc.-Orange Mound Pharmacy
2569 Douglass Ave.
Memphis, TN 38114-2532

Shipping Address 4

Christ Community Health SVCS.-Hickory Hill Pharmacy
5366 Winchester Road
Memphis, TN 38115

Shipping Address 5

Christ Community Health SVCS-3rd Street Pharmacy
3362 South Third Street
Memphis, TN 38109

Shipping Address 6

Christ Community Health Services, Inc.-East Jackson Pharmacy
655 Lexington Ave
Jackson, TN 38301-5075

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH0417140	Active	BPS-H80-004787	Christ Community Health Services, Inc.	THIRD STREET HEALTH CENTER	3362 S 3rd St	MEMPHIS	TN
CH041714A	Active	BPS-H80-003914	Christ Community Health Services, Inc.	BROAD AVENUE HEALTH CENTER	2861 BROAD AVE	MEMPHIS	TN
CH041714B	Active	BPS-H80-007650	Christ Community Health Services, Inc.	Hickory Hill Health Center	5366 Winchester Rd	Memphis	TN
CH041714C	Active	BPS-H80-004568	Christ Community Health Services, Inc.	Broad Avenue Dental Center	2953 Broad Ave	MEMPHIS	TN
CH041714D	Active	BPS-H80-004266	Christ Community Health Services, Inc.	ORANGE MOUND HEALTH CENTER	2569 Douglass Ave	MEMPHIS	TN
CH041714E	Active	BPS-H80-014418	Christ Community Health Services, Inc.	FRAYSER HEALTH CENTER	969 Frayser Blvd	MEMPHIS	TN
CH041714F	Terminated	BPS-H80-010616	CHRIST COMMUNITY HEALTH SERVICES INC	CCHS University Health Center	1211 Union Ave STE 200	Memphis	TN
CH041714G	Active	BPS-H80-002786	Christ Community Health Services, Inc.	MOBILE CLINIC	2861 BROAD AVE	MEMPHIS	TN
CH041714H	Terminated	BPS-H80-012812	CHRIST COMMUNITY HEALTH SERVICES INC	Women's Health Center	2400 Poplar	Memphis	TN
CH041714J	Active	BPS-H80-014880	CHRIST COMMUNITY HEALTH SERVICES INC	Raleigh Health Center	3481 AUSTIN PEAY HWY	MEMPHIS	TN
CH041714K	Active	BPS-H80-024773	CHRIST COMMUNITY HEALTH SERVICES INC	Operation Outreach Homeless Health Center	1325 Jefferson Ave	Memphis	TN
CH041714L	Active	BPS-H80-029504	CHRIST COMMUNITY HEALTH SERVICES INC	East Jackson Health Center	655 Lexington Ave	Jackson	TN
CH041714M	Active	BPS-H80-031010	Christ Community Health Services, Inc.	Sheffield School Based Health Center	4350 Chuck Ave	Memphis	TN
CH041714N	Active	BPS-H80-031012	Christ Community Health Services, Inc.	East High School Based Health Center	3206 Poplar Ave	Memphis	TN
CH041714P	Terminated	BPS-H80-031011	Christ Community Health Services, Inc.	Westwood School Based Health Center	4480 Westmont Rd	Memphis	TN
CH041714Q	Active	BPS-H80-036288	CHRIST COMMUNITY HEALTH SERVICES INC	East Jackson Women's Health Center	1104 Whitehall	Jackson	TN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0417140	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2021
CH0417140	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2021
CH0417140	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2021
CH0417140	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2021
CH0417140	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2021
CH0417140	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2021
CH0417140	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
CH0417140	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2022
CH0417140	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2022
CH0417140	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2022
CH0417140	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2022
CH0417140	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2022
CH0417140	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2022
CH0417140	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2022
CH0417140	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2022
CH0417140	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2022
CH0417140	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2022
CH0417140	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2021
CH0417140	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2021
CH0417140	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2022
CH0417140	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2018
CH0417140	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2021
CH0417140	EXACT CARE PHARMACY	DDCRX, LLC	2701 HIGHPOINT OAKS DR STE 100	LEWISVILLE	TX	75067-3896	10/01/2022
CH0417140	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	10/01/2022
CH0417140	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2021
CH0417140	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2021
CH0417140	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2021
CH0417140	FRED'S PHARMACY	4280 NEW GETWELL RD		MEMPHIS	TN	38118	01/01/2017	12/05/2018
CH0417140	FRED'S PHARMACY # 2599	1290 LAMAR AVE.		MEMPHIS	TN	38104	01/01/2017	12/06/2018
CH0417140	FRED'S PHARMACY #2306	5016 SUMMER AVENUE		MEMPHIS	TN	38122	01/01/2017	11/29/2018
CH0417140	FRED'S PHARMACY #2564	6500 QUINCE RD		MEMPHIS	TN	38119-8211	01/01/2017	12/13/2018
CH0417140	GENOA HEALTHCARE LLC	8791 NORTHWEST DR		SOUTHAVEN	MS	38671	10/01/2024
CH0417140	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2017	01/16/2018
CH0417140	KROGER FOOD & DRUG 288	1977 S THIRD		MEMPHIS	TN	38109	10/01/2017	01/16/2018
CH0417140	KROGER FOOD & DRUG 439	4264 SUMMER AVENUE		MEMPHIS	TN	38122	10/01/2017
CH0417140	KROGER FOOD & PHARMACY	41 STONEBROOK PLACE		JACKSON	TN	38305	04/01/2020	12/31/2020
CH0417140	KROGER FOOD & PHARMACY #425	2632 FRAYSER BLVD		MEMPHIS	TN	38127	10/01/2017
CH0417140	KROGER FOOD & PHARMACY #438	3860 AUSTIN PEAY HWY		MEMPHIS	TN	38128	10/01/2017
CH041714J	KROGER FOOD & PHARMACY #438	3860 AUSTIN PEAY HWY		MEMPHIS	TN	38128	07/01/2023	07/31/2023
CH0417140	KROGER FOOD & PHARMACY #468	35 WEST UNIVERSITY PKWY		JACKSON	TN	38305	04/01/2020
CH041714N	KROGER FOOD & PHARMACY #468	35 WEST UNIVERSITY PKWY		JACKSON	TN	38305	07/01/2023	07/31/2023
CH0417140	KROGER FOOD AND DRUG	1366 POPLAR		MEMPHIS	TN	38104	10/01/2017
CH0417140	KROGER FOOD AND DRUG #413	2269 LAMAR		MEMPHIS	TN	38114	10/01/2017	01/16/2018
CH0417140	KROGER FOOD AND DRUG #486	1212 E SHELBY DRIVE		MEMPHIS	TN	38116	10/01/2017
CH0417140	Kroger Pharmacy	Jeffersonville Central Fill Facility	301 Logistics Ave Suite 200	Jeffersonville	IN	47130	07/01/2024
CH0417140	KROGER PHARMACY #398	941 NORTH PARKWAY		JACKSON	TN	38305	04/01/2020
CH041714M	KROGER PHARMACY #398	941 NORTH PARKWAY		JACKSON	TN	38305	07/01/2023	07/31/2023
CH0417140	KROGER PHARMACY #402	1759 UNION AVE		MEMPHIS	TN	38104	04/01/2018
CH0417140	KROGER PHARMACY #488	3444 PLAZA		MEMPHIS	TN	38111	10/01/2017
CH0417140	KROGER PHARMACY #491	799 TRUSE PKWY		MEMPHIS	TN	38117	10/01/2017	02/12/2019
CH0417140	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08994	2955 CHURCH RD E	SOUTHAVEN	MS	38671	07/01/2021
CH0417140	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03426	6040 GOODMAN RD.	WALLS	MS	38680	07/01/2021
CH0417140	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08955	55 GOODMAN ROAD WEST	SOUTHAVEN	MS	38671	07/01/2021
CH0417140	MISSISSIPPI CVS PHARMACY, L.L.C.	CVS PHARMACY # 17498	5150 GOODMAN RD	OLIVE BRANCH	MS	38654	07/01/2021
CH0417140	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08491	2945 GOODMAN ROAD EAST	SOUTHAVEN	MS	38672	07/01/2021	04/20/2023
CH0417140	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05604	5025 HWY 305	OLIVE BRANCH	MS	38654	07/01/2021
CH0417140	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07963	1502 GOODMAN RD.	HORN LAKE	MS	38637	07/01/2021	10/05/2022
CH0417140	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08954	7363 GOODMAN RD.	OLIVE BRANCH	MS	38654	07/01/2021	11/07/2023
CH0417140	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/01/2024
CH0417140	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	10/01/2024
CH0417140	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2024
CH0417140	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/01/2024
CH0417140	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	10/01/2024
CH0417140	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	10/01/2024
CH0417140	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/01/2024
CH0417140	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2024
CH0417140	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2018	10/01/2022
CH0417140	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2022
CH0417140	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2022
CH0417140	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2022
CH0417140	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2022
CH0417140	PROCARE PHARMACY, L.L.C.	CVS/PHARMACY #10994	60 MARKET CENTER DRIVE SUITE 103	COLLIERVILLE	TN	38017	07/01/2023
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	CVS PHARMACY # 17525	5959 POPLAR AVE	MEMPHIS	TN	38119	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2386	1405 N. HIGHLAND AVENUE	JACKSON	TN	38301	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	CVS PHARMACY # 16023	601 COLONIAL RD	MEMPHIS	TN	38117	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07619	9861 US HIGHWAY 64	ARLINGTON	TN	38002	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 6304	6116 QUINCE RD	MEMPHIS	TN	38119	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	CVS PHARMACY # 16204	9235 POPLAR AVE	GERMANTOWN	TN	38138	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08427	6620 WINCHESTER RD.	MEMPHIS	TN	38115	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 6628	786 GERMANTOWN PKWY.	CORDOVA	TN	38018	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #7144	6670 STAGE ROAD	BARTLETT	TN	38134	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	CVS PHARMACY # 16417	7989 US HIGHWAY 64	MEMPHIS	TN	38133	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 4992	2115 UNION AVE.	MEMPHIS	TN	38104	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 4990	3502 PARK AVE.	MEMPHIS	TN	38111	07/01/2021	05/21/2023
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04928	5055 STAGE RD.	MEMPHIS	TN	38128	07/01/2021	03/25/2025
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	CVS PHARMACY # 16345	93 STONEBROOK PL	JACKSON	TN	38305	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10204	4155 ELVIS PRESLEY BLVD	MEMPHIS	TN	38116	07/01/2021
CH0417140	TENNESSEE CVS PHARMACY, L.L.C.	CVS PHARMACY # 17026	325 NEW BYHALIA RD	COLLIERVILLE	TN	38017	07/01/2021
CH0417140	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH0417140	WAL-MART PHARMACY 10-0094	8445 HWY 51 NORTH		MILLINGTON	TN	38053	07/01/2016	10/07/2017
CH0417140	WAL-MART PHARMACY 10-0335	2196 EMPORIUM DRIVE		JACKSON	TN	38305	04/01/2020
CH0417140	WAL-MART PHARMACY 10-0950	8400 HIGHWAY 64		BARTLETT	TN	38133	07/01/2016	10/07/2017
CH0417140	WAL-MART PHARMACY 10-1248	7525 WINCHESTER ROAD		MEMPHIS (SE)	TN	38125	07/01/2022
CH0417140	WAL-MART PHARMACY 10-1561	3950 AUSTIN PEAY HWY		MEMPHIS	TN	38128	07/01/2016
CH041714P	WAL-MART PHARMACY 10-1561	3950 AUSTIN PEAY HWY		MEMPHIS	TN	38128	07/01/2023	07/31/2023
CH0417140	WAL-MART PHARMACY 10-2322	577 GERMANTOWN PKWY		CORDOVA	TN	38018	07/01/2016
CH0417140	WAL-MART PHARMACY 10-5043	6990 SHELBY DRIVE		MEMPHIS	TN	38125	07/01/2016	02/15/2019
CH0417140	WAL-MART PHARMACY 10-5122	2856 HICKORY HILL EXT		MEMPHIS	TN	38115	07/01/2016
CH0417140	WAL-MART PHARMACY 10-5196	5255 ELVIS PERSLEY BLVD		MEMPHIS(ELVIS HOLMES)	TN	38116	07/01/2016
CH0417140	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH0417140	WALGREEN CO	DBA: WALGREENS	28727 OREGON ROAD	PERRYSBURG	OH	43551	04/01/2013	06/24/2015
CH0417140	WALGREEN CO		DBA WALGREENS 5100 LAKE TERRACE NE	MOUNT VERNON	IL	62864	04/01/2013	06/24/2015
CH0417140	WALGREEN CO.	DBA: WALGREENS # 10103	5080 STAGE RD	MEMPHIS	TN	38128-5004	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 13108	2655 FRAYSER BLVD	MEMPHIS	TN	38127	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS #15287	5190 POPLAR AVENUE	MEMPHIS	TN	38117	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 02161	2471 JACKSON AVE	MEMPHIS	TN	38108-3318	06/22/2012	11/13/2024
CH0417140	WALGREEN CO.	DBA: WALGREENS # 02775	4155 S 3RD ST	MEMPHIS	TN	38109	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 02892	3360 N WATKINS	MEMPHIS	TN	38127	06/22/2012	03/20/2019
CH0417140	WALGREEN CO.	DBA: WALGREENS # 02940	1130 S BELLEVUE	MEMPHIS	TN	38106	06/22/2012	11/10/2022
CH0417140	WALGREEN CO.	DBA: WALGREENS # 03013	4653 ELVIS PRESLEY	MEMPHIS	TN	38116	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 03176	4154 ELVIS PRESLEY BLVD	MEMPHIS	TN	38116	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 03227	3381 POPLAR AVENUE	MEMPHIS	TN	38111	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 03323	1501 GOODMAN RD WEST	HORN LAKE	MS	38637	06/22/2012	03/21/2023
CH0417140	WALGREEN CO.	DBA: WALGREENS # 03465	3489 RAMILL	MEMPHIS	TN	38128	06/22/2012	11/07/2024
CH0417140	WALGREEN CO.	DBA: WALGREENS # 03473	1863 UNION AVE	MEMPHIS	TN	38104	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 03866	1489 AIRWAYS BLVD	MEMPHIS	TN	38114	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 04232	8046 MACON RD	CORDOVA	TN	38018	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 04455	35 STATELINE RD WEST	SOUTHAVEN	MS	38671	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 04600	3445 ELVIS PRESLEY BLVD.	MEMPHIS	TN	38116	06/22/2012	04/21/2025
CH0417140	WALGREEN CO.	DBA: WALGREENS # 04628	987 UNION AVE.	MEMPHIS	TN	38104	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 04735	3670 RIVERDALE ROAD	MEMPHIS	TN	38115	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 05317	3502 SUMMER AVENUE	MEMPHIS	TN	38122-3628	06/22/2012	11/12/2019
CH0417140	WALGREEN CO.	DBA: WALGREENS # 05318	5828 US HIGHWAY 70	MEMPHIS	TN	38134	06/22/2012	11/13/2019
CH0417140	WALGREEN CO.	DBA: WALGREENS # 05345	2891 KIRBY ROAD	MEMPHIS	TN	38119	06/22/2012	04/29/2025
CH0417140	WALGREEN CO.	DBA: WALGREENS # 05654	6770 MACON ROAD	MEMPHIS	TN	38134	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 05676	1359 POPLAR AVE	MEMPHIS	TN	38104	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 00586	2 N MAIN	MEMPHIS	TN	38103	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 06465	6697 STAGE ROAD	BARTLETT	TN	38134-2849	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 06644	4625 SUMMER AVENUE	MEMPHIS	TN	38122-4137	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 06754	4028 GOODMAN ROAD WEST	HORN LAKE	MS	38637	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 06769	8035 E SHELBY DRIVE	MEMPHIS	TN	38125-3202	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 06858	5900 KNIGHT ARNOLD	MEMPHIS	TN	38115	06/22/2012	04/29/2025
CH0417140	WALGREEN CO.	DBA: WALGREENS # 06881	1201 GETWELL RD	MEMPHIS	TN	38111-7315	06/22/2012	11/13/2019
CH0417140	WALGREEN CO.	DBA: WALGREENS # 06882	3177 S PERKINS	MEMPHIS	TN	38118-4354	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS #15928	6939 EAST SHELBY DRIVE	MEMPHIS	TN	38141	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 07613	3515 PARK AVENUE	MEMPHIS	TN	38111-5621	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 07808	6310 POPLAR AVENUE	MEMPHIS	TN	38119-4734	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 09174	1845 S 3RD ST	MEMPHIS	TN	38109-7717	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS # 09719	3100 THOMAS ST	MEMPHIS	TN	38127-6005	06/22/2012
CH0417140	WALGREEN CO.	DBA: WALGREENS #15287	5190 POPLAR AVENUE	MEMPHIS	TN	38117	06/22/2012	07/15/2016
CH0417140	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15317	1424 UNION AVE	MEMPHIS	TN	38104	04/01/2015
CH0417140	WALGREEN CO.	DBA: WALGREENS # 07059	4015 AUSTIN PEAY HWY	MEMPHIS	TN	38128	04/01/2015
CH0417140	WALGREEN CO.	DBA: WALGREENS # 07792	7994 US HWY 51 N	MILLINGTON	TN	38053-1909	01/01/2018
CH0417140	WALGREEN CO.	RITE AID #07193	1810 UNION AVENUE	MEMPHIS	TN	38104	10/01/2018	11/07/2018
CH0417140	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #11600	601 SKYLINE DR.	JACKSON	TN	38301	04/01/2020
CH0417140	WALGREEN CO.	DBA: WALGREENS # 12718	3144 N. HIGHLAND AVE.	JACKSON	TN	38305-3483	04/01/2020
CH0417140	WALGREEN CO.	DBA: WALGREENS # 03175	1405 S. HIGHLAND AVE	JACKSON	TN	38301	04/01/2020
CH0417140	WALGREEN CO.	DBA: WALGREENS # 09835	384 OIL WELL RD	JACKSON	TN	38305	04/01/2020
CH0417140	WALGREEN CO.	DBA: WALGREENS # 13659	1332 N HIGHLAND AVE.	JACKSON	TN	38301-4019	04/01/2020
CH0417140	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21215	309C 22ND AVE N	NASHVILLE	TN	37203	01/01/2023
CH0417140	WALGREEN CO.	36DBA: WALGREENS # 04083	5950 STAGE ROAD	BARTLETT	TN	38134	04/01/2024
CH0417140	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2022
CH0417140	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	06/24/2015
CH0417140	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	06/24/2015
CH0417140	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2018	10/01/2021
CH0417140	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2018
CH0417140	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2018
CH0417140	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2018
CH0417140	WALMART PHARMACY #10-6807	6727 RALEIGH LAGRANGE RD.		MEMPHIS	TN	38133	07/01/2022
CH0417140	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH0417140	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 8:15:22 AM	2/12/2025 2:39:13 PM	2/12/2025 2:39 PM
Contacts	Authorizing Official	Update	Group Change Request	Olson, David Interim CEO Christ Community Health Services 9018422393	McDaniel, Tracy CEO Christ Community Health Services 9018422393	9/23/2024 7:45 AM
Addresses	Billing Address	Update	Group Change Request	CCHS Mobile Clinic 2595 Central Ave. Memphis, TN 38104-5905	Christ Community Health Services 2670 Union Avenue Extended, Suite 1000 Memphis, TN 38112	4/30/2024 10:52 AM
Contacts	Authorizing Official	Update	Group Change Request	Leatherwood, Shantelle CEO Christ Community Health Services 9018422393	Olson, David Interim CEO Christ Community Health Services 9018422393	3/6/2024 12:48 PM
Details	Last Recertification Date	Update	Recertification	2/4/2023 8:07:10 PM	1/29/2024 8:15:22 AM	1/29/2024 8:15 AM
Contacts	Authorizing Official	Update	Group Change Request	Peterson, Talia Chief Financial Officer Christ Community Health Services 9018423160	Leatherwood, Shantelle CEO Christ Community Health Services 9018422393	7/27/2023 5:26 PM
Details	Last Recertification Date	Update	Recertification	2/2/2022 1:47:26 PM	2/4/2023 8:07:10 PM	2/4/2023 8:07 PM
Details	Last Recertification Date	Update	Recertification	2/5/2021 6:25:05 PM	2/2/2022 1:47:26 PM	2/2/2022 1:47 PM
Addresses	Shipping Address	Insert	Group Change Request		Christ Community Health Services, Inc.-East Jackson Pharmacy 655 Lexington Ave Jackson, TN 38301-5075	1/11/2022 6:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	1/11/2022 6:33 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		Q070697	1/11/2022 6:33 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		TN	1/11/2022 6:33 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1558028670	1/11/2022 6:33 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TN	1/11/2022 6:33 AM
Contacts	Authorizing Official	Update	Group Change Request	Guy, David Patrick CFO Christ Community Health Services, Inc. 9018423150	Peterson, Talia Chief Financial Officer Christ Community Health Services 9018423160	11/15/2021 6:55 AM
Details	Last Recertification Date	Update	Recertification	2/4/2020 12:59:35 AM	2/5/2021 6:25:05 PM	2/5/2021 6:25 PM
Medicaid Billing	NPI: State	Update	Change Request		TN	1/14/2021 9:58 AM
Medicaid Billing	NPI: State	Update	Change Request		TN	1/14/2021 9:58 AM
Medicaid Billing	NPI: State	Update	Change Request		TN	1/14/2021 9:58 AM
Medicaid Billing	NPI: State	Update	Change Request		TN	1/14/2021 9:58 AM
Medicaid Billing	NPI: State	Update	Change Request		TN	1/14/2021 9:58 AM
Medicaid Billing	NPI: State	Update	Change Request		TN	1/14/2021 9:58 AM
Medicaid Billing	NPI: State	Update	Change Request		TN	1/14/2021 9:58 AM
Contacts	Authorizing Official	Update	Change Request	Leatherwood, Shantelle CEO Christ Community Health Services 9012608500	Guy, David Patrick CFO Christ Community Health Services, Inc. 9018423150	1/11/2021 1:14 PM
Contacts	Primary Contact	Update	Change Request	Encalade, Jacqueline M. Director of Pharmacy Christ Community Health Services, Inc. 9012716379	Le, Suong Mai 340B Program Manager Christ Community Health Services, Inc. 9018421936	1/11/2021 1:14 PM
Details	Last Recertification Date	Update	Recertification	2/5/2019 1:32:25 PM	2/4/2020 12:59:35 AM	2/4/2020 12:59 AM
Details	Last Recertification Date	Update	Recertification	2/20/2018 1:35:44 PM	2/5/2019 1:32:25 PM	2/5/2019 1:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q034103	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q045657	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q034253	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q035646	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		Q034594	1/28/2019 1:51 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	1/28/2019 1:51 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1730651373	1/28/2019 1:51 PM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/20/2018 1:35:44 PM	2/20/2018 1:35 PM
Contacts	Authorizing Official	Update		Leatherwood, Shantelle CEO 9012608500	Leatherwood, Shantelle CEO Christ Community Health Services 9012608500	10/10/2017 9:51 PM
Contacts	Primary Contact	Update		Encalade, Jacqueline M. Director of Pharmacy 9012716379	Encalade, Jacqueline M. Director of Pharmacy Christ Community Health Services, Inc. 9012716379	9/20/2017 4:22 PM
Contacts	Authorizing Official	Update		Makris, Paul CFO 9012608500	Leatherwood, Shantelle CEO 9012608500	7/17/2017 11:32 PM
Contacts	Primary Contact	Insert			Encalade, Jacqueline M. Director of Pharmacy 9012716379	2/13/2017 11:36 AM
Addresses	Main Address	Insert			2861 BROAD AVE MEMPHIS, TN 38112-2903	2/13/2017 11:36 AM
Contacts	Signed By	Insert			Waller, Burt CEO 9012608550	2/13/2017 11:36 AM
Details	Last Recertification Date	Update		2/22/2016 12:00:00 AM	2/13/2017 12:00:00 AM	2/13/2017 11:36 AM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/22/2016 12:00:00 AM	2/22/2016 7:33 AM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 8:52 AM
Addresses	Billing Address	Insert			CCHS Mobile Clinic 2595 Central Ave. Memphis, TN 38104-5905	1/20/2015 8:20 AM
Addresses	Shipping Address	Insert			Christ Community Health SVS-Broad Ave Pharmacy 2861 Broad Ave Memphis, TN 38112	1/20/2015 8:20 AM
Addresses	Shipping Address	Insert			Christ Community Health SVCS.-Hickory Hill Pharmacy 5366 Winchester Road Memphis, TN 38115	1/20/2015 8:20 AM
Addresses	Shipping Address	Insert			Christ Community Health SVCS-3rd Street Pharmacy 3362 South Third Street Memphis, TN 38109	1/20/2015 8:20 AM
Addresses	Shipping Address	Insert			Christ Community Health Services, Inc.-Orange Mound Pharmacy 2569 Douglass Ave. Memphis, TN 38114-2532	1/20/2015 8:20 AM
Addresses	Shipping Address	Insert			Christ Community Health Services, Inc.-Frayser Pharmacy 969 Frayser Boulevard Memphis, TN 38127	1/20/2015 8:20 AM
Contacts	Authorizing Official	Update		Donlon, Richard N. CEO 9012608500	Makris, Paul CFO 9012608500	1/15/2015 1:38 PM
Medicaid Billing	NPI: Number	Insert			1356749915	1/5/2015 1:59 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/10/2014 12:00:00 AM	2/10/2014 10:51 AM
Medicaid Billing	NPI: Number	Insert			1558797613	10/17/2013 4:07 PM
Contacts	Authorizing Official	Insert			Donlon, Richard N. CEO 9012608500	10/17/2013 4:07 PM
Medicaid Billing	NPI: Number	Insert			1891837290	2/11/2013 11:48 AM
Medicaid Billing	NPI: Number	Insert			1982686614	2/11/2013 11:48 AM
Medicaid Billing	NPI: Number	Insert			1053613851	2/11/2013 11:48 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/11/2013 11:48 AM
Details	Entity Name	Update		Christ Community Health Services	Christ Community Health Services, Inc.	11/21/2012 6:30 AM
Medicaid Billing	Medicaid: Number	Update		9014609	3707256	11/16/2012 1:45 PM
Details	Entity Subname	Update		Mobile Clinic	MOBILE CLINIC	11/16/2012 1:45 PM
Details	340B ID	Update		IS-FF-CH041714G	CH041714G	6/19/2012 3:46 PM
Dates	Participating Approval Date	Update			6/19/2012 12:00:00 AM	6/19/2012 3:46 PM
Details	State	Update		Pending	Active	6/19/2012 3:46 PM
Dates	Start Date	Update			7/1/2012 12:00:00 AM	6/19/2012 3:46 PM
Details	340B ID	Update		FF-4.6.12	IS-FF-CH041714G	4/18/2012 12:13 PM
Details	Comments Public	Insert			4/6/12 - Reviewed registration. 4/18/12 Processed registration and forwarded to IS.	4/18/2012 12:13 PM
Details	340B ID	Update		ONLINE_REG	FF-4.6.12	4/6/2012 2:57 PM
Details	Comments Public	Insert			4/6/12 - Reviewed registration.	4/6/2012 2:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/3/2012 2:48 PM
Medicaid Billing	Medicaid: Number	Insert			9014609	4/3/2012 2:48 PM
Medicaid Billing	Medicaid: State	Insert			TN	4/3/2012 2:48 PM
Medicaid Billing	NPI: Number	Insert			1699922401	4/3/2012 2:48 PM
Details	Last Recertification Date	Insert				4/3/2012 2:48 PM
Details	Grant Number	Insert			H80CS00881	4/3/2012 2:48 PM
Details	340B ID	Insert			ONLINE_REG	4/3/2012 2:48 PM
Details	Is Authorizing Official EHB Data	Insert				4/3/2012 2:48 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/3/2012 2:48 PM
Details	Medicare Provider Number	Insert				4/3/2012 2:48 PM
Details	Entity Name	Insert			Christ Community Health Services	4/3/2012 2:48 PM
Details	Program Code	Insert			CH	4/3/2012 2:48 PM
Details	Entity Subname	Insert			Mobile Clinic	4/3/2012 2:48 PM
Dates	Participating Approval Date	Insert				4/3/2012 2:48 PM
Details	State	Insert			Pending	4/3/2012 2:48 PM
Dates	Registration Date	Insert			4/3/2012 12:00:00 AM	4/3/2012 2:48 PM
Dates	Signed By Date	Insert			4/3/2012 12:00:00 AM	4/3/2012 2:48 PM
Dates	Start Date	Insert				4/3/2012 2:48 PM
Terminations	Termination Comments	Insert				4/3/2012 2:48 PM
Terminations	Termination Date	Insert				4/3/2012 2:48 PM
Terminations	Termination Effective Date	Insert				4/3/2012 2:48 PM
Terminations	Termination Reason	Insert				4/3/2012 2:48 PM

340B Drug Pricing Program Database