Covered Entity Details

CH05306AH Sixteenth Street Community Health Centers, Inc. (Active) - information as of 4/25/2025 9:21:29 PM

Main Details

Name

Sixteenth Street Community Health Centers, Inc.

Subdivision Name

Sixteenth Street Community Health Centers-Waukesha

Type

HRSA-Funded Health Center

Site ID

BPS-H80-012900

340B ID

CH05306AH

Grant Number

H80CS00593

Additional Details

Current Program Status

Active

Registration Date

6/28/2012

Participating Start Date

10/1/2012

Participating Approval Date

8/29/2012

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Sixteenth Street Community Health Centers
Liz Claudio, Vice President, Operations
(414) 897-5165

Primary Contact

Sixteenth Street Community Health Centers
Jason A Jenders, Director of Pharmacy
(414) 897-5497

Addresses

Street Address

309 E North St
Waukesha, WI 53188-3718

Billing Address

Sixteenth Street Community Health Centers, Inc.
1337 S CESAR E CHAVEZ DRIVE
Milwaukee, WI 53204

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?
No

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	WALGREEN CO.	DBA: WALGREENS # 05636	230 MADISON STREET	WAUKESHA	WI	53188	07/12/2022	10/01/2022			10/01/2022
Contract Detail	WAUKESHA HEALTH SERVICES	725 AMERICAN AVE		WAUKESHA	WI	53188-5031	02/22/2013	04/01/2013		03/01/2016	04/03/2016

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH053060	Active	BPS-H80-001579	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-Chavez	1032 S Cesar E Chavez Dr	MILWAUKEE	WI
CH05306AG	Active	BPS-H80-004241	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-20th Street	2906 S 20th St	MILWAUKEE	WI
CH05306AH	Active	BPS-H80-012900	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-Waukesha	309 E North St	Waukesha	WI
CH05306AJ	Active	BPS-H80-010972	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-UCC Senior Center	730 W Washington St	Milwaukee	WI
CH05306AK	Active	BPS-H80-017011	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Center-St Anthony School-High	4807 S 2nd St	Milwaukee	WI
CH05306AL	Active	BPS-H80-036063	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-St Anthony School-Middle	4801 S 2nd Street RM 312	Milwaukee	WI
CH05306AM	Terminated	BPS-H80-016961	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-St Anthony School-Elementary-1	1747 S 9th St	Milwaukee	WI
CH05306AN	Active	BPS-H80-016956	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-St Anthony School-K3	1644 S 9th St	Milwaukee	WI
CH05306AP	Active	BPS-H80-036162	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-St Anthony School	1727 S 9th St RM Exam1-3	Milwaukee	WI
CH05306AQ	Active	BPS-H80-016931	Sixteenth Street Community Health Centers, Inc.	16th St Comm Hlth Cntr-St Anthony School-Elementary-2	1669 S 5th St	Milwaukee	WI
CH05306AR	Active	BPS-H80-021727	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers- Augustine Prep Academy	2607 S 5th St, Ste B	Milwaukee	WI
CH05306AS	Terminated	BPS-H80-001579	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-Chavez	1032 S Cesar E Chavez Dr	Milwaukee	WI
CH05306AT	Active	BPS-H80-021953	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-Layton	4570 S 27th St	Milwaukee	WI
CH05306AU	Active	BPS-H80-002516	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers-Adm/Environmental Hlth/WIC	1337 S Cesar E Chavez Dr	Milwaukee	WI
CH05306AV	Terminated	BPS-H80-024934	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - UCC Childcare and Early Learning Center	2210 W Becher St RM 101	Milwaukee	WI
CH05306AW	Active	BPS-H80-030202	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - Mental Health Support Center	1635 W National Ave	Milwaukee	WI
CH05306AX	Active	BPS-H80-031472	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - Cristo Rey High School	1818 W National Ave RM 100 HLTH	Milwaukee	WI
CH05306AY	Active	BPS-H80-032684	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - United Community Center-Bruce-Guadalupe Community School	1028 S 9th St Rm Llhc	Milwaukee	WI
CH05306AZ	Active	BPS-H80-032676	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - Carmen Schools-Stellar Elementary	2431 S 10th St Rm B24	Milwaukee	WI
CH05306BA	Active	BPS-H80-032678	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - United Community Center-Bruce-Guadalupe Middle School	920 S 9th St Rm 140	Milwaukee	WI
CH05306BB	Active	BPS-H80-032681	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - Carmen Schools-South Middle School	2433 S 15th St Rm 104B	Milwaukee	WI
CH05306BC	Active	BPS-H80-032683	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - United Community Center-Acosta Middle School	1038 S 6th St Rm 210	Milwaukee	WI
CH05306BD	Active	BPS-H80-032685	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - Carmen Schools-South High School	1712 S 32nd St Rm 308	Milwaukee	WI
CH05306BE	Active	BPS-H80-032675	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - Carmen Schools-Southeast High School	2500 W Oklahoma Ave Rm 124	Milwaukee	WI
CH05306BF	Active	BPS-H80-034031	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - United Community Center-Early Learning Academy	2130 W Becher St Rm clinic1	Milwaukee	WI
CH05306BG	Active	BPS-H80-034843	Sixteenth Street Community Health Centers, Inc.	Sixteenth Street Community Health Centers - South Division High School	1515 W Lapham Blvd RM 155	Milwaukee	WI
CH05306BH	Active	BPS-H80-038829	SIXTEENTH STREET COMMUNITY HEALTH CENTER	Sixteenth Street Community Health Centers - St. Joseph Academy	1600 W Oklahoma Ave	Milwaukee	WI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH053060	ALTSCRIPTS SPECIALTY PHARMACY	1636 MILLER PARK WAY		WEST MILWAUKEE	WI	53214-3604	07/01/2019
CH05306AQ	ALTSCRIPTS SPECIALTY PHARMACY	1636 MILLER PARK WAY		WEST MILWAUKEE	WI	53214-3604	04/01/2023
CH05306AG	AURORA PHARMACY INC	DBA: AURORA PHARMACY	2906 S. 20TH STREET	MILWAUKEE	WI	53215	07/01/2006
CH053060	AURORA PHARMACY INC	DBA: AURORA PHARMACY	2906 S. 20TH STREET	MILWAUKEE	WI	53215	10/01/2019
CH053060	AURORA SPECIALTY PHARMACY	N93W14575 WHITTAKER WAY		MENOMONEE FALLS	WI	53051-1652	12/18/2020
CH05306BC	AURORA SPECIALTY PHARMACY	N93W14575 WHITTAKER WAY		MENOMONEE FALLS	WI	53051-1652	10/01/2022
CH053060	HAYAT PHARMACY 6	HAYAT PHARMACY 6	4931 S 27TH ST STE 400	GREENFIELD	WI	53221-2653	07/01/2020
CH05306AT	HAYAT PHARMACY 6	HAYAT PHARMACY 6	4931 S 27TH ST STE 400	GREENFIELD	WI	53221-2653	10/01/2022
CH053060	MEDICAL CENTER PHARMACY	1111 DELAFIELD ST STE 109		WAUKESHA	WI	53188-3402	04/01/2020	11/30/2021
CH053060	PICK N SAVE PHARMACY #6864	1818 W NATIONAL AVE		MILWAUKEE	WI	53204	12/01/1996	07/26/2016
CH053060	VIVENT PHARMACY LLC	DBA VIVENT PHARMACY	1311 N 6TH ST STE 101	MILWAUKEE	WI	53212	12/08/2011
CH05306AJ	VIVENT PHARMACY LLC	DBA VIVENT PHARMACY	1311 N 6TH ST STE 101	MILWAUKEE	WI	53212	10/01/2022
CH05306AG	WALGREEN CO	DBA: WALGREENS #10963	6101 W GREENFIELD AVE	WEST ALLIS	WI	53214	01/01/2018	10/01/2022
CH053060	WALGREEN CO	DBA: WALGREENS #10963	6101 W GREENFIELD AVE	WEST ALLIS	WI	53214	01/01/2018
CH05306BF	WALGREEN CO	DBA: WALGREENS #10963	6101 W GREENFIELD AVE	WEST ALLIS	WI	53214	10/01/2022
CH053060	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	01/24/2023
CH05306AG	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	01/24/2023
CH05306AY	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	07/01/2024
CH053060	WALGREEN CO.	DBA: WALGREENS # 09066	3201 E LAYTON AVE	CUDAHY	WI	53110	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 03615	21325 E. MORELAND BLVD.	WAUKESHA	WI	53186	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 03883	221 E SUNSET DR	WAUKESHA	WI	53189	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 05466	601 MEADOWBROOK RD	WAUKESHA	WI	53188	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 05636	230 MADISON STREET	WAUKESHA	WI	53188	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 07730	2700 N GRANDVIEW BLVD	WAUKESHA	WI	53188-1611	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS #11237	1433 W. BURNHAM ST.	MILWAUKEE	WI	53204	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 07809	2625 W NATIONAL AVE	MILWAUKEE	WI	53204-1068	10/19/2012	11/04/2024
CH053060	WALGREEN CO.	DBA: WALGREENS # 04253	2656 N WAUWATOSA AVE	WAUWATOSA	WI	53213	10/19/2012	09/30/2019
CH053060	WALGREEN CO.	DBA: WALGREENS # 03509	620 W OKLAHOMA AVE	MILWAUKEE	WI	53215	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 04350	3233 SOUTH 27TH ST	MILWAUKEE	WI	53215	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 07661	2410 W FOREST HOME AVE	MILWAUKEE	WI	53215-2527	10/19/2012	10/10/2023
CH053060	WALGREEN CO.	DBA: WALGREENS # 05601	4730 S 27TH STREET	MILWAUKEE	WI	53221	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 07370	6442 N 76TH STREET	MILWAUKEE	WI	53223-6102	10/19/2012
CH053060	WALGREEN CO.	DBA: WALGREENS # 03578	2275 NORTH MAYFAIR ROAD	WAUWATOSA	WI	53226	10/19/2012
CH053060	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15322	826 N PLANKINTON AVE STE 100	MILWAUKEE	WI	53203	05/07/2013
CH05306AG	WALGREEN CO.	DBA: WALGREENS # 09839	6241 S PACKARD AVE	CUDAHY	WI	53110	01/01/2018	10/01/2022
CH05306AG	WALGREEN CO.	DBA: WALGREENS # 06020	6030 W OKLAHOMA AVE	MILWAUKEE	WI	53219	01/01/2018	10/01/2022
CH05306AG	WALGREEN CO.	DBA: WALGREENS # 03732	2985 S CHICAGO AVE	SOUTH MILWAUKEE	WI	53172	01/01/2018	10/01/2022
CH05306AG	WALGREEN CO.	DBA: WALGREENS # 03813	3522 W WISCONSIN	MILWAUKEE	WI	53208	01/01/2018	10/01/2022
CH05306AG	WALGREEN CO.	DBA: WALGREENS # 02911	6292 S 27TH STREET	MILWAUKEE	WI	53221	01/01/2018	10/01/2022
CH053060	WALGREEN CO.	DBA: WALGREENS # 09839	6241 S PACKARD AVE	CUDAHY	WI	53110	01/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 03732	2985 S CHICAGO AVE	SOUTH MILWAUKEE	WI	53172	01/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 06020	6030 W OKLAHOMA AVE	MILWAUKEE	WI	53219	01/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 03813	3522 W WISCONSIN	MILWAUKEE	WI	53208	01/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 02911	6292 S 27TH STREET	MILWAUKEE	WI	53221	01/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 01685	1400 EAST BRADY	MILWAUKEE	WI	53202	01/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 00649	3701 S HOWELL AVE	MILWAUKEE	WI	53207	01/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 00665	1600 W WISCONSIN	MILWAUKEE	WI	53233	01/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 06058	4296 S 76TH STREET	GREENFIELD	WI	53220	07/01/2018
CH053060	WALGREEN CO.	DBA: WALGREENS # 04887	9449 S HOWELL AVE	OAK CREEK	WI	53154	10/01/2019
CH05306BB	WALGREEN CO.	DBA: WALGREENS #11237	1433 W. BURNHAM ST.	MILWAUKEE	WI	53204	10/01/2022
CH05306AW	WALGREEN CO.	DBA: WALGREENS # 07809	2625 W NATIONAL AVE	MILWAUKEE	WI	53204-1068	10/01/2022	11/04/2024
CH05306BD	WALGREEN CO.	DBA: WALGREENS # 07661	2410 W FOREST HOME AVE	MILWAUKEE	WI	53215-2527	10/01/2022	10/10/2023
CH05306AZ	WALGREEN CO.	DBA: WALGREENS # 03509	620 W OKLAHOMA AVE	MILWAUKEE	WI	53215	10/01/2022
CH05306BE	WALGREEN CO.	DBA: WALGREENS # 04350	3233 SOUTH 27TH ST	MILWAUKEE	WI	53215	10/01/2022
CH05306AU	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15322	826 N PLANKINTON AVE STE 100	MILWAUKEE	WI	53203	10/01/2022
CH05306AR	WALGREEN CO.	DBA: WALGREENS # 05601	4730 S 27TH STREET	MILWAUKEE	WI	53221	10/01/2022
CH05306AM	WALGREEN CO.	DBA: WALGREENS # 02911	6292 S 27TH STREET	MILWAUKEE	WI	53221	10/01/2022	04/01/2023
CH05306AL	WALGREEN CO.	DBA: WALGREENS # 06058	4296 S 76TH STREET	GREENFIELD	WI	53220	10/01/2022
CH05306AN	WALGREEN CO.	DBA: WALGREENS # 06020	6030 W OKLAHOMA AVE	MILWAUKEE	WI	53219	10/01/2022
CH05306AQ	WALGREEN CO.	DBA: WALGREENS # 04887	9449 S HOWELL AVE	OAK CREEK	WI	53154	10/01/2022
CH05306AK	WALGREEN CO.	DBA: WALGREENS # 09066	3201 E LAYTON AVE	CUDAHY	WI	53110	10/01/2022
CH05306AX	WALGREEN CO.	DBA: WALGREENS # 03883	221 E SUNSET DR	WAUKESHA	WI	53189	10/01/2022
CH05306AH	WALGREEN CO.	DBA: WALGREENS # 05636	230 MADISON STREET	WAUKESHA	WI	53188	10/01/2022
CH05306AP	WALGREEN CO.	DBA: WALGREENS # 04887	9449 S HOWELL AVE	OAK CREEK	WI	53154	10/01/2022
CH05306BA	WALGREEN CO.	DBA: WALGREENS # 07730	2700 N GRANDVIEW BLVD	WAUKESHA	WI	53188-1611	10/01/2022
CH05306AY	WALGREEN CO.	DBA: WALGREENS # 03732	2985 S CHICAGO AVE	SOUTH MILWAUKEE	WI	53172	10/01/2022
CH05306AH	WAUKESHA HEALTH SERVICES	725 AMERICAN AVE		WAUKESHA	WI	53188-5031	04/01/2013	03/01/2016

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/5/2024 2:48:22 PM	2/11/2025 2:52:01 PM	2/11/2025 2:52 PM
Addresses	Billing Address	Update	Recertification	Sixteenth Street Community Health Centers, Inc. 1337 S. Cesar E. Chavez Drive Milwaukee, WI 53204	Sixteenth Street Community Health Centers, Inc. 1337 S CESAR E CHAVEZ DRIVE Milwaukee, WI 53204	2/5/2024 2:48 PM
Details	Last Recertification Date	Update	Recertification	2/21/2023 2:10:03 PM	2/5/2024 2:48:22 PM	2/5/2024 2:48 PM
Details	Last Recertification Date	Update	Recertification	2/16/2022 11:42:01 AM	2/21/2023 2:10:03 PM	2/21/2023 2:10 PM
Details	Entity Subname	Update	Recertification	Waukesha Community Health Center	Sixteenth Street Community Health Centers-Waukesha	2/21/2023 2:10 PM
Details	Last Recertification Date	Update	Recertification	2/22/2021 2:59:44 PM	2/16/2022 11:42:01 AM	2/16/2022 11:42 AM
Details	Last Recertification Date	Update	Recertification	2/6/2020 11:18:37 AM	2/22/2021 2:59:44 PM	2/22/2021 2:59 PM
Details	Last Recertification Date	Update	Recertification	2/20/2019 4:05:45 PM	2/6/2020 11:18:37 AM	2/6/2020 11:18 AM
Contacts	Authorizing Official	Update	Change Request	Maschek, Michael Vice President Finance and Strategy Sixteenth Street Community Health Center 4148975156	Claudio, Liz Vice President, Operations Sixteenth Street Community Health Centers 4148975165	1/8/2020 12:57 PM
Details	Entity Name	Update	Change Request	16TH STREET COMMUNITY HEALTH CENTER, INC.	Sixteenth Street Community Health Centers, Inc.	6/4/2019 7:16 AM
Contacts	Primary Contact	Update	Change Request	RAJU, JAYANTHI FINANCIAL ANALYST SIXTEENTH STREET COMMUNITY HEALTH CENTERS 4148975543	Jenders, Jason A Director of Pharmacy Sixteenth Street Community Health Centers 4148975497	4/11/2019 10:37 AM
Details	Last Recertification Date	Update	Recertification	2/13/2018 11:44:06 AM	2/20/2019 4:05:45 PM	2/20/2019 4:05 PM
Contacts	Authorizing Official	Update	Change Request	Spahiu, Betsy Vice President Finance Sixteenth Street Community Health Centers 4148975153	Maschek, Michael Vice President Finance and Strategy Sixteenth Street Community Health Center 4148975156	4/16/2018 9:10 AM
Contacts	Primary Contact	Update	Recertification	Spahiu, Betsy Vice President Finance Sixteenth Street Community Health Centers 4148975153	RAJU, JAYANTHI FINANCIAL ANALYST SIXTEENTH STREET COMMUNITY HEALTH CENTERS 4148975543	2/13/2018 11:44 AM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/13/2018 11:44:06 AM	2/13/2018 11:44 AM
Contacts	Authorizing Official	Update		Spahiu, Betsy Vice President Finance 4148975153	Spahiu, Betsy Vice President Finance Sixteenth Street Community Health Centers 4148975153	10/10/2017 11:21 AM
Contacts	Primary Contact	Update		Spahiu, Betsy Vice President Finance 4148975153	Spahiu, Betsy Vice President Finance Sixteenth Street Community Health Centers 4148975153	10/10/2017 11:21 AM
Contacts	Signed By	Update		Spahiu, Betsy Vice President Finance 4148975153	Spahiu, Betsy Vice President Finance Sixteenth Street Community Health Centers 4148975153	10/10/2017 11:21 AM
Addresses	Main Address	Insert			309 E North St Waukesha, WI 53188-3718	2/13/2017 5:52 PM
Contacts	Authorizing Official	Insert			Spahiu, Betsy Vice President Finance 4148975153	2/13/2017 5:52 PM
Contacts	Primary Contact	Insert			Spahiu, Betsy Vice President Finance 4148975153	2/13/2017 5:52 PM
Contacts	Signed By	Insert			Spahiu, Betsy Vice President Finance 4148975153	2/13/2017 5:52 PM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	2/13/2017 12:00:00 AM	2/13/2017 5:52 PM
Addresses	Billing Address	Insert			Sixteenth Street Community Health Centers, Inc. 1337 S. Cesar E. Chavez Drive Milwaukee, WI 53204	3/1/2016 1:44 PM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 1:44 PM
Details	Last Recertification Date	Update		3/10/2014 12:00:00 AM	2/10/2015 12:00:00 AM	2/10/2015 3:29 PM
Details	Entity Name	Update		16TH STREET COMMMUNITY HEALTH CENTER	16TH STREET COMMUNITY HEALTH CENTER, INC.	6/13/2014 10:15 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/10/2014 12:00:00 AM	3/10/2014 3:14 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/4/2013 9:42 AM
Details	340B ID	Update		IS-FF-CH05306AH	CH05306AH	8/29/2012 5:51 PM
Dates	Participating Approval Date	Update			8/29/2012 12:00:00 AM	8/29/2012 5:51 PM
Details	State	Update		Pending	Active	8/29/2012 5:51 PM
Dates	Start Date	Update			10/1/2012 12:00:00 AM	8/29/2012 5:51 PM
Details	340B ID	Update		FF-CH05306AH	IS-FF-CH05306AH	8/28/2012 3:37 PM
Details	340B ID	Update		FF 8.7.12 ONLINE_REG	FF-CH05306AH	8/17/2012 4:33 PM
Details	340B ID	Update		ONLINE_REG	FF 8.7.12 ONLINE_REG	8/10/2012 4:17 PM
Details	Last Recertification Date	Insert				6/28/2012 1:18 PM
Details	Grant Number	Insert			H80CS00593	6/28/2012 1:18 PM
Details	340B ID	Insert			ONLINE_REG	6/28/2012 1:18 PM
Details	Is Authorizing Official EHB Data	Insert				6/28/2012 1:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/28/2012 1:18 PM
Details	Medicare Provider Number	Insert				6/28/2012 1:18 PM
Details	Entity Name	Insert			16TH STREET COMMMUNITY HEALTH CENTER	6/28/2012 1:18 PM
Details	Program Code	Insert			CH	6/28/2012 1:18 PM
Details	Entity Subname	Insert			Waukesha Community Health Center	6/28/2012 1:18 PM
Dates	Participating Approval Date	Insert				6/28/2012 1:18 PM
Details	State	Insert			Pending	6/28/2012 1:18 PM
Dates	Registration Date	Insert			6/28/2012 12:00:00 AM	6/28/2012 1:18 PM
Dates	Signed By Date	Insert			6/28/2012 12:00:00 AM	6/28/2012 1:18 PM
Dates	Start Date	Insert				6/28/2012 1:18 PM
Terminations	Termination Comments	Insert				6/28/2012 1:18 PM
Terminations	Termination Date	Insert				6/28/2012 1:18 PM
Terminations	Termination Effective Date	Insert				6/28/2012 1:18 PM
Terminations	Termination Reason	Insert				6/28/2012 1:18 PM

340B Drug Pricing Program Database