Covered Entity Details

CHC24198-02 Marillac Community Health Centers (Active) - information as of 4/28/2025 11:25:52 PM

Main Details

Name

Marillac Community Health Centers

Subdivision Name

MCHC - St. Cecilia

Type

HRSA-Funded Health Center

Site ID

BPS-H80-012080

340B ID

CHC24198-02

Grant Number

H80CS24198

Additional Details

Current Program Status

Active

Registration Date

10/8/2012

Participating Start Date

1/1/2013

Participating Approval Date

11/26/2012

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Marillac Community Health Centers
Michael Griffin, President and CEO
(504) 212-9502

Primary Contact

Marillac Community Health Center
Raymond Strong, Director of Pharmacy
(504) 207-3019

Addresses

Street Address

1030 Lesseps St.
New Orleans, LA 70117

Billing Address

Marillac Community Health Centers
P.O. Box 13038
New Orleans, LA 70185-3038

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

Comments

Comment	Last Updated On
11/01/12 - Forwarded IS registration for approval. 10/16/12 - Site showing in EHB as terminated, sent AO and PO email.	11/01/2012
10/16/12 - Site showing in EHB as terminated, sent AO and PO email.	10/16/2012
10/16/12 - Delete site showing in EHB as terminated, sent AO email.	10/16/2012

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
LA	2200607,2200020,2202880,2200518,2205218,2305883,2305905,2305891,2373421,2373552,2399586,2427962,2433105,2444638,2444646,2429752,2430092,2429639	1295156362,1952459901,1417264110,1225345317,1174067730,1891046876,1629329735,1780935973,1962823211,1346659927,1386024891,1457701575,1457802332,1720512247,1093249518,1548611809,1508312265,1730632795

Shipping Addresses

Shipping Address 1

Daughters of Charity Services of New Orleans
1030 Lesseps St.
New Orleans, LA 70117

Shipping Address 2

Daughters of Charity Services of New Orleans
3201 S. Carrollton Ave.
New Orleans, LA 70118-4307

Shipping Address 3

Daughters of Charity Services of New Orleans
111 N. Causeway Blvd.
Metairie, LA 70001

Shipping Address 4

Daughters of Charity Services of New Orleans
5630 Read Blvd
New Orleans, LA 70127

Shipping Address 5

Daughters of Charity Services of New Orleans
100 Warrington Drive
New Orleans, LA 70122

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	3201 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	02/14/2013	04/01/2013	06/30/2017
Contract Detail	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	1030 LESSEPS ST.	NEW ORLEANS	LA	70117	02/14/2013	04/01/2013	06/30/2017
Contract Detail	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	111 N. CAUSEWAY BLVD.	METAIRIE	LA	70001	02/14/2013	04/01/2013	06/30/2017

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC24198-00	Active	BPS-H80-012079	Marillac Community Health Centers	DCHC-Carrollton	3201 S. Carrollton Ave.	New Orleans	LA
CHC24198-01	Active	BPS-H80-012081	Marillac Community Health Centers	MCHC - Metairie	111 N. Causeway Blvd.	Metairie	LA
CHC24198-02	Active	BPS-H80-012080	Marillac Community Health Centers	MCHC - St. Cecilia	1030 Lesseps St.	New Orleans	LA
CHC24198-03	Active	BPS-H80-013835	MARILLAC COMMUNITY HEALTH CENTERS	MCHC - New Orleans East	5630 READ BLVD	NEW ORLEANS	LA
CHC24198-04	Active	BPS-H80-014157	MARILLAC COMMUNITY HEALTH CENTERS	MCHC-Gentilly	100 Warrington Drive	New Orleans	LA
CHC24198-05	Active	BPS-H80-018733	MARILLAC COMMUNITY HEALTH CENTERS	MCHC - Higgins	3303 Higgins Blvd	New Orleans	LA
CHC24198-06	Terminated	BPS-H80-018041	MARILLAC COMMUNITY HEALTH CENTERS	MCHC - Prytania	3600 Prytania St	New Orleans	LA
CHC24198-07	Terminated	BPS-H80-018109	MARILLAC COMMUNITY HEALTH CENTERS	MCHC-Homer Plessy Elementary School	2021 Pauger St	New Orleans	LA
CHC24198-08	Active	BPS-H80-018108	MARILLAC COMMUNITY HEALTH CENTERS	MCHC-St Mary Academy K-12	6905 Chef Menteur Hwy	New Orleans	LA
CHC24198-09	Terminated	BPS-H80-018107	MARILLAC COMMUNITY HEALTH CENTERS	MCHC-St Rita Catholic School K-8	65 Fountainebleau Dr.	New Orleans	LA
CHC24198-10	Active	BPS-H80-018613	MARILLAC COMMUNITY HEALTH CENTERS	Marillac Community Health Center-Kenner	3715 Williams Boulevard	Kenner	LA
CHC24198-11	Terminated	BPS-H80-019411	MARILLAC COMMUNITY HEALTH CENTERS	Daughters of Charity Health Center - Gretna	1301 Whitney Blvd.	Gretna	LA
CHC24198-12	Terminated	BPS-H80-019410	MARILLAC COMMUNITY HEALTH CENTERS	Daughters of Charity Health Center - Algiers	3215 General Myer Avenue	New Orleans	LA
CHC24198-13	Active	BPS-H80-033955	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Center – St. Charles	1523 Saint Charles Ave	New Orleans	LA
CHC24198-14	Active	BPS-H80-033030	MARILLAC COMMUNITY HEALTH CENTERS	Edna Karr High School	4400 General Meyer Ave	New Orleans	LA
CHC24198-15	Active	BPS-H80-032889	MARILLAC COMMUNITY HEALTH CENTERS	DCHC - Lakeside	3116 6th St Ste 101	Metairie	LA
CHC24198-16	Active	BPS-H80-038229	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Center - Central City	1300 Oretha Castle Haley Blvd	New Orleans	LA
CHC24198-17	Active	BPS-H80-031204	MARILLAC COMMUNITY HEALTH CENTERS	DePaul CHC - Homer A. Plessy Community School French Qtr 2nd Site	1651 N Tonti St	New Orleans	LA
CHC24198-18	Active	BPS-H80-028361	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Audubon Gentilly School	4720 Painters St	New Orleans	LA
CHC24198-19	Active	BPS-H80-035830	MARILLAC COMMUNITY HEALTH CENTERS	DCHC - St. Stephen Catholic School	1025 Napoleon Avenue	New Orleans	LA
CHC24198-20	Active	BPS-H80-027021	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - St. Leo the Great School	1501 Abundance St	New Orleans	LA
CHC24198-21	Active	BPS-H80-035992	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - St. Therese Academy	6421 W. Metairie Ave	Metairie	LA
CHC24198-22	Active	BPS-H80-024933	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - St. Augustine High School	2600 A P Tureaud Ave	New Orleans	LA
CHC24198-23	Active	BPS-H80-037368	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Center - Resurrection of Our Lord Elementary School	4861 Rosalia Dr	New Orleans	LA
CHC24198-24	Active	BPS-H80-031197	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Eleanor McMain Secondary School	5712 S Claiborne Ave	New Orleans	LA
CHC24198-25	Active	BPS-H80-031195	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Pierre Capdua Charter School	5800 Saint Roch Ave	New Orleans	LA
CHC24198-26	Active	BPS-H80-036068	MARILLAC COMMUNITY HEALTH CENTERS	Martin Behrman Charter School	715 Opelousas Ave	New Orleans	LA
CHC24198-27	Active	BPS-H80-031251	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Homer Plessy Treme Campus	1423 Saint Philip St	New Orleans	LA
CHC24198-28	Active	BPS-H80-031153	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Dwight D. Eisenhower Charter School	3700 Tall Pines Dr	New Orleans	LA
CHC24198-29	Active	BPS-H80-027272	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Delgado Community College	615 City Park Ave	New Orleans	LA
CHC24198-30	Active	BPS-H80-027357	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Andrew Wilson Charter School	3617 General Pershing St	New Orleans	LA
CHC24198-31	Active	BPS-H80-031140	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Alice M. Harte Charter School	5300 Berkley Dr	New Orleans	LA
CHC24198-32	Active	BPS-H80-038197	MARILLAC COMMUNITY HEALTH CENTERS	DCHC - The NET Charter High School: East	12000 Hayne Blvd	New Orleans	LA
CHC24198-33	Active	BPS-H80-036533	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Westbank Expressway	1629 Westbank Expy, Ste A	Harvey	LA
CHC24198-34	Active	BPS-H80-036069	MARILLAC COMMUNITY HEALTH CENTERS	L.B. Landry High School	1200 L B Landry Ave	New Orleans	LA
CHC24198-35	Active	BPS-H80-031202	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - McDonogh 35 Senior High School	4000 Cadillac St	New Orleans	LA
CHC24198-36	Active	BPS-H80-036673	MARILLAC COMMUNITY HEALTH CENTERS	MCHC-Gould	407 S Gould Ave	Gould	AR
CHC24198-37	Active	BPS-H80-024572	MARILLAC COMMUNITY HEALTH CENTERS	Mobile Medical Unit #1	3201 S Carrollton Ave	New Orleans	LA
CHC24198-38	Terminated	BPS-H80-022039	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Homer A. Plessy Community School	721 Saint Philip St	New Orleans	LA
CHC24198-39	Active	BPS-H80-024571	MARILLAC COMMUNITY HEALTH CENTERS	Tooth Bus B	5630 READ BLVD	NEW ORLEANS	LA
CHC24198-40	Active	BPS-H80-036235	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Our Lady of Perpetual Help	531 Williams Blvd	New Orleans	LA
CHC24198-41	Active	BPS-H80-038674	MARILLAC COMMUNITY HEALTH CENTERS	DePaul Community Health Centers - Algiers	2801 General De Gaulle Dr	New Orleans	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC24198-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2020
CHC24198-00	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	04/01/2020
CHC24198-00	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2020
CHC24198-00	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	01/01/2016
CHC24198-00	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	01/01/2016
CHC24198-00	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	01/01/2017
CHC24198-00	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/01/2016
CHC24198-00	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2020
CHC24198-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2020
CHC24198-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2020
CHC24198-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2020
CHC24198-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2020
CHC24198-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2020
CHC24198-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2020
CHC24198-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2020
CHC24198-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2020
CHC24198-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2020
CHC24198-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CHC24198-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CHC24198-00	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2023
CHC24198-00	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	3201 S. CARROLLTON AVE.		NEW ORLEANS	LA	70118	01/01/2013
CHC24198-00	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	1030 LESSEPS ST.		NEW ORLEANS	LA	70117	01/01/2013
CHC24198-00	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	111 N. CAUSEWAY BLVD.		METAIRIE	LA	70001	01/01/2013
CHC24198-02	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	3201 S. CARROLLTON AVE.		NEW ORLEANS	LA	70118	04/01/2013
CHC24198-02	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	1030 LESSEPS ST.		NEW ORLEANS	LA	70117	04/01/2013
CHC24198-02	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	111 N. CAUSEWAY BLVD.		METAIRIE	LA	70001	04/01/2013
CHC24198-01	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	111 N. CAUSEWAY BLVD.		METAIRIE	LA	70001	04/01/2013
CHC24198-01	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	3201 S. CARROLLTON AVE.		NEW ORLEANS	LA	70118	04/01/2013
CHC24198-01	DAUGHTERS OF CHARITY SERVICES OF NEW ORLEANS	1030 LESSEPS ST.		NEW ORLEANS	LA	70117	04/01/2013
CHC24198-00	DCHC PHARMACY ALGIERS	2801 GENERAL DEGAULLE DR		NEW ORLEANS	LA	70114	10/01/2024
CHC24198-06	DCHC PHARMACY CARROLLTON	3201 S. CARROLLTON AVE		NEW ORLEANS	LA	70118	10/01/2016	01/01/2025
CHC24198-00	DCHC PHARMACY GENTILLY	100 WARRINGTON DR		NEW ORLEANS	LA	70122	04/01/2017
CHC24198-04	DCHC PHARMACY GENTILLY	100 WARRINGTON DR		NEW ORLEANS	LA	70122	04/01/2017
CHC24198-06	DCHC PHARMACY METAIRIE	111 N CAUSEWAY BLVD		METAIRIE	LA	70001	10/01/2016	01/01/2025
CHC24198-00	DCHC PHARMACY NOE	5630 READ BLVD		NEW ORLEANS	LA	70127	10/01/2014
CHC24198-06	DCHC PHARMACY NOE	5630 READ BLVD		NEW ORLEANS	LA	70127	10/01/2016	01/01/2025
CHC24198-06	DCHC PHARMACY ST. CECILIA	1030 LESSEPS ST		NEW ORLEANS	LA	70117	10/01/2016	01/01/2025
CHC24198-00	DCHC PHARMACY ST. CHARLES	1523 SAINT CHARLES AVE		NEW ORLEANS	LA	70130	04/01/2022
CHC24198-00	DCHC PHARMACY WESTBANK EXPRESSWAY	1629 WESTBANK EXPY STE A		HARVEY	LA	70058	07/01/2023
CHC24198-00	DUMAS FAMILY PHARMACY LLC	301 HIGHWAY 65 S		DUMAS	AR	71639	01/01/2024
CHC24198-36	DUMAS FAMILY PHARMACY LLC	301 HIGHWAY 65 S		DUMAS	AR	71639	07/01/2025
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10538	5000 NORTH CLAIBORNE AVE.	NEW ORLEANS	LA	70117	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08999	2105 CLEARY AVE.	METAIRIE	LA	70001	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #03730	3700 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10483	1600 ELYSIAN FIELDS AVE.	NEW ORLEANS	LA	70117	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08921	2831 BELLE CHASE HWY.	TERRYTOWN	LA	70056	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05340	9643-B JEFFERSON HWY	RIVER RIDGE	LA	70123	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00763	800 - B CANAL ST	NEW ORLEANS	LA	70112	04/01/2020	07/25/2023
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05441	4301 AIRLINE DRIVE	METAIRIE	LA	70001	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10220	101 DAVID DR.	METAIRIE	LA	70003	04/01/2020	06/01/2023
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #01939	1801 JEFFERSON HWY.	JEFFERSON	LA	70121	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10594	500 N. CARROLLTON AVE.	NEW ORLEANS	LA	70119	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10058	1116 LOUISIANA AVE	NEW ORLEANS	LA	70115	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05333	2242 WILLIAMS BLVD.,	KENNER	LA	70062	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10145	1401 VETERANS BLVD.	METAIRIE	LA	70005	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04752	1203 WESTBANK EXPRESSWAY	WESTWEGO	LA	70094	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05543	2850 HIGHWAY 90 WEST	AVONDALE	LA	70094	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05349	820 W. ESPLANADE AVE.	KENNER	LA	70065	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05503	4901 PRYTANIA ST	NEW ORLEANS	LA	70115	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05599	1600 LAPALCO BLVD.	HARVEY	LA	70058	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2597	2600 PARIS RD	CHALMETTE	LA	70043	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05387	3621 GENERAL DEGAULLE DR.	NEW ORLEANS	LA	70131	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05383	4950 W ESPLANADE AVE	METAIRIE	LA	70006	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05528	1313 PAUL MAILLARD RD/PO BOX 50	LULING	LA	70070	04/01/2020	03/20/2025
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05342	3535 SEVERN AVE	METAIRIE	LA	70002	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10559	939 GIROD ST., SUITE 160	NEW ORLEANS	LA	70113	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17562	1401 W ESPLANADE AVE	KENNER	LA	70065	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05442	12589 AIRLINE HWY	DESTREHAN	LA	70047	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 8266	2585 LEON C, SIMON DR.	NEW ORLEANS	LA	70122	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16783	1731 MANHATTAN BLVD	HARVEY	LA	70058	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2728	620 DECATUR ST.	NEW ORLEANS	LA	70130	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 167	4401 S CLAIBORNE AVE.	NEW ORLEANS	LA	70125	04/01/2020
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16781	4500 VETERANS MEMORIAL BLVD	METAIRIE	LA	70006	01/01/2021
CHC24198-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10108	5902 READ BLVD.	NEW ORLEANS	LA	70127	01/01/2021
CHC24198-00	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2020
CHC24198-00	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2020
CHC24198-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2020
CHC24198-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/01/2020
CHC24198-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2020
CHC24198-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2015
CHC24198-00	WAL-MART PHARMACY 10-0348	427 HWY 425 NORTH		MONTICELLO	AR	71655	01/01/2024
CHC24198-36	WAL-MART PHARMACY 10-0348	427 HWY 425 NORTH		MONTICELLO	AR	71655	07/01/2025
CHC24198-00	WAL-MART PHARMACY 10-0909	8101 W. JUDGE PEREZ DR.		CHALMETTE	LA	70043	07/01/2015
CHC24198-00	WAL-MART PHARMACY 10-0989	8912 VETERANS MEMORIAL BLVD		METAIRIE	LA	70003	01/01/2017	06/18/2021
CHC24198-00	WAL-MART PHARMACY 10-0989	8912 VETERANS MEMORIAL BLVD		METAIRIE	LA	70003	10/01/2021
CHC24198-00	WAL-MART PHARMACY 10-1163	4001 BEHRMAN HWY		NEW ORLEANS	LA	70114	04/01/2017
CHC24198-00	WAL-MART PHARMACY 10-1342	300 WEST ESPLANADE		KENNER	LA	70065	01/01/2017
CHC24198-00	WAL-MART PHARMACY 10-1353	5110 JEFFERSON HWY		HARAHAN	LA	70123	07/01/2015
CHC24198-00	WAL-MART PHARMACY 10-3703	3520 WILLIAMS BLVD		KENNER	LA	70065	04/01/2017	06/18/2021
CHC24198-00	WAL-MART PHARMACY 10-5022	1901 TCHOPITOULAS STREET		NEW ORLEANS	LA	70130	07/01/2015	06/18/2021
CHC24198-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02262	1100 ELYSIAN FIELDS	NEW ORLEANS	LA	70117	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15571	4501 AIRLINE DR.	METAIRIE	LA	70001	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03024	4200 CHEF MENTEUR HWY	NEW ORLEANS	LA	70126	01/01/2014	01/22/2025
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03139	1826 N BROAD ST	NEW ORLEANS	LA	70119	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #16312	5702 CROWDER BLVD	NEW ORLEANS	LA	70127	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03558	6201 ELYSIAN FIELDS AVE	NEW ORLEANS	LA	70122	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04451	4400 S.CLAIBORNE AVE.	NEW ORLEANS	LA	70125	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05358	11297 LAKE FOREST BLVD.	NEW ORLEANS	LA	70128	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #05866	2418 S. CARROLLTON AVE	NEW ORLEANS	LA	70118-3012	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10316	4001 CANAL ST	NEW ORLEANS	LA	70119	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11414	3216 GENTILLY BLVD	NEW ORLEANS	LA	70122	01/01/2014
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06672	909 DAVID DRIVE	METAIRIE	LA	70003-5134	01/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #04982	7401 READ BLVD	NEW ORLEANS	LA	70127	01/01/2015	01/29/2025
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05040	1801 SAINT CHARLES AVE	NEW ORLEANS	LA	70130	01/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03889	4110 GENERAL DEGAULLE DR	NEW ORLEANS	LA	70131	01/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05472	821 W ESPLANADE	KENNER	LA	70065	01/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07415	100 W JUDGE PEREZ DRIVE	CHALMETTE	LA	70043-5002	01/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04304	145 ELK PLACE	NEW ORLEANS	LA	70112	01/01/2015	10/20/2016
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02640	3227 MAGAZINE ST	NEW ORLEANS	LA	70115	01/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02468	4545 WEST ESPLANADE	METAIRIE	LA	70006	07/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02469	220 W ESPLANADE AVE	KENNER	LA	70065-2460	07/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03199	1891 BARATARIA BLVD.	MARRERO	LA	70072	07/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04305	900 CANAL	NEW ORLEANS	LA	70112	07/01/2015	01/02/2025
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04450	718 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	07/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05516	4600 WESTBANK EXPRESSWAY	MARRERO	LA	70072-3065	07/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13679	1717 VETERANS MEMORIAL BLVD	METAIRIE	LA	70005-2635	07/01/2015
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15200	2001 CAROL SUE AVE	GRETNA	LA	70056-4445	01/01/2016
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15199	5518 MAGAZINE STREET	NEW ORLEANS	LA	70115-3152	01/01/2016
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06506	89 WESTBANK EXPRESSWAY	GRETNA	LA	70053-3662	01/01/2016
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #13777	1415 TULANE AVE STE 2CW07	NEW ORLEANS	LA	70112	01/01/2016
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	04/01/2017
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #16309	1401 FOUCHER ST STE C-309	NEW ORLEANS	LA	70115	04/01/2017
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15109	4327 JEFFERSON HWY.	JEFFERSON	LA	70121	07/01/2017
CHC24198-00	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #21176	925 COMMON ST STE A	NEW ORLEANS	LA	70112	07/01/2024
CHC24198-00	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2023
CHC24198-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2023
CHC24198-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2023
CHC24198-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2023
CHC24198-00	WALMART PHARMACY 10-0912	6000 BULLARD AVE		NEW ORLEANS	LA	70128-2813	07/01/2015
CHC24198-00	WALMART PHARMACY 10-3167	4301 CHEF MENTEUR HWY		NEW ORLEANS	LA	70126	07/01/2015
CHC24198-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CHC24198-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 11:55:52 AM	2/10/2025 10:37:05 AM	2/10/2025 10:37 AM
Details	Last Recertification Date	Update	Recertification	2/16/2023 6:10:08 PM	2/1/2024 11:55:52 AM	2/1/2024 11:55 AM
Contacts	Primary Contact	Update	Change Request	Marshall, Stephenie Executive Director Marillac Community Health Centers 5042129537	Strong, Raymond Director of Pharmacy Marillac Community Health Center 5042073019	4/18/2023 4:22 PM
Details	Last Recertification Date	Update	Recertification	2/10/2022 10:16:02 AM	2/16/2023 6:10:08 PM	2/16/2023 6:10 PM
Details	Last Recertification Date	Update	Recertification	2/26/2021 6:37:29 PM	2/10/2022 10:16:02 AM	2/10/2022 10:16 AM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/26/2021 6:37 PM
Details	Last Recertification Date	Update	Recertification	1/28/2020 10:13:10 AM	2/26/2021 6:37:29 PM	2/26/2021 6:37 PM
Details	Last Recertification Date	Update	Recertification	1/31/2019 12:06:44 PM	1/28/2020 10:13:10 AM	1/28/2020 10:13 AM
Details	Last Recertification Date	Update	Recertification	3/6/2018 9:01:40 AM	1/31/2019 12:06:44 PM	1/31/2019 12:06 PM
Contacts	Primary Contact	Update	Change Request	Hayes, Cheryl Gauthier Director of Pharmacy Marillac Community Health Centers 5042073019	Marshall, Stephenie Executive Director Marillac Community Health Centers 5042129537	11/9/2018 11:56 AM
Addresses	Shipping Address	Insert	Recertification		Daughters of Charity Services of New Orleans 5630 Read Blvd New Orleans, LA 70127	3/6/2018 9:01 AM
Addresses	Shipping Address	Insert	Recertification		Daughters of Charity Services of New Orleans 100 Warrington Drive New Orleans, LA 70122	3/6/2018 9:01 AM
Addresses	Shipping Address	Delete	Recertification	Daughters of Charity Services of New Orleans 3201 S. Carrollton Ave. New Orleans, LA 70118-4307		3/6/2018 9:01 AM
Addresses	Shipping Address	Delete	Recertification	Daughters of Charity Services of New Orleans 1030 Lesseps St. New Orleans, LA 70117		3/6/2018 9:01 AM
Addresses	Shipping Address	Delete	Recertification	Daughters of Charity Services of New Orleans 111 N. Causeway Blvd. Metairie, LA 70001		3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2205218	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2305883	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2305905	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2305891	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2373421	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2373552	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2399586	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2427962	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2433105	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2444638	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2444646	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2429752	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2430092	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2429639	3/6/2018 9:01 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1174067730	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1891046876	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1629329735	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1780935973	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1962823211	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1346659927	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1386024891	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1457701575	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1457802332	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1720512247	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1093249518	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548611809	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508312265	3/6/2018 9:01 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1730632795	3/6/2018 9:01 AM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	3/6/2018 9:01:40 AM	3/6/2018 9:01 AM
Contacts	Primary Contact	Update	Change Request	Griffin, Michael President and CEO Marillac Community Health Centers 5042129502	Hayes, Cheryl Gauthier Director of Pharmacy Marillac Community Health Centers 5042073019	1/5/2018 6:32 PM
Contacts	Authorizing Official	Update		Griffin, Michael President and CEO 5042129502	Griffin, Michael President and CEO Marillac Community Health Centers 5042129502	1/5/2018 5:35 PM
Contacts	Primary Contact	Update		Griffin, Michael President and CEO 5042129502	Griffin, Michael President and CEO Marillac Community Health Centers 5042129502	1/5/2018 5:35 PM
Contacts	Signed By	Update	Profile Change Request	Griffin, Michael President & CEO Marillac Community Heath Center 5042129501	Griffin, Michael President & CEO Marillac Community Heath Centers 5042129501	10/3/2017 11:24 AM
Contacts	Signed By	Update		Griffin, Michael President & CEO 5042129501	Griffin, Michael President & CEO Marillac Community Heath Center 5042129501	10/3/2017 10:54 AM
Contacts	Authorizing Official	Insert			Griffin, Michael President and CEO 5042129502	7/13/2017 3:35 PM
Contacts	Primary Contact	Update		Griffin, Michael President & CEO 5042129501	Griffin, Michael President and CEO 5042129502	7/13/2017 3:35 PM
Addresses	Main Address	Insert			1030 Lesseps St. New Orleans, LA 70117	6/30/2017 7:49 PM
Addresses	Billing Address	Insert			Marillac Community Health Centers P.O. Box 13038 New Orleans, LA 70185-3038	6/30/2017 7:49 PM
Addresses	Shipping Address	Insert			Daughters of Charity Services of New Orleans 111 N. Causeway Blvd. Metairie, LA 70001	6/30/2017 7:49 PM
Addresses	Shipping Address	Insert			Daughters of Charity Services of New Orleans 3201 S. Carrollton Ave. New Orleans, LA 70118-4307	6/30/2017 7:49 PM
Addresses	Shipping Address	Insert			Daughters of Charity Services of New Orleans 3201 S. Carrollton Ave. New Orleans, LA 70118-4307	6/30/2017 7:49 PM
Addresses	Shipping Address	Insert			Daughters of Charity Services of New Orleans 1030 Lesseps St. New Orleans, LA 70117	6/30/2017 7:49 PM
Addresses	Shipping Address	Insert			Daughters of Charity Services of New Orleans 1030 Lesseps St. New Orleans, LA 70117	6/30/2017 7:49 PM
Addresses	Shipping Address	Insert			Daughters of Charity Services of New Orleans 111 N. Causeway Blvd. Metairie, LA 70001	6/30/2017 7:49 PM
Contacts	Signed By	Insert			Griffin, Michael President & CEO 5042129501	6/30/2017 7:49 PM
Details	Last Recertification Date	Update		2/29/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 8:47 PM
Details	Last Recertification Date	Update		2/12/2015 12:00:00 AM	2/29/2016 12:00:00 AM	2/29/2016 12:46 PM
Contacts	Primary Contact	Insert			Griffin, Michael President & CEO 5042129501	1/7/2016 6:24 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: Number	Insert			2202880	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: State	Insert			LA	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: Number	Insert			2200518	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: State	Insert			LA	2/12/2015 11:12 AM
Medicaid Billing	NPI: Number	Insert			1295156362	2/12/2015 11:12 AM
Medicaid Billing	NPI: Number	Insert			1952459901	2/12/2015 11:12 AM
Medicaid Billing	NPI: Number	Insert			1417264110	2/12/2015 11:12 AM
Medicaid Billing	NPI: Number	Insert			1225345317	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: Number	Insert			2200607	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: State	Insert			LA	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: Number	Insert			2200020	2/12/2015 11:12 AM
Medicaid Billing	Medicaid: State	Insert			LA	2/12/2015 11:12 AM
Details	Last Recertification Date	Update		3/6/2014 12:00:00 AM	2/12/2015 12:00:00 AM	2/12/2015 11:12 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/6/2014 12:00:00 AM	3/6/2014 7:05 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/4/2013 8:30 AM
Details	340B ID	Update		IS-FF-CHC24198-02	CHC24198-02	11/26/2012 3:04 PM
Dates	Participating Approval Date	Update			11/26/2012 12:00:00 AM	11/26/2012 3:04 PM
Details	State	Update		Pending	Active	11/26/2012 3:04 PM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	11/26/2012 3:04 PM
Details	340B ID	Update		FF-CHC24198-02	IS-FF-CHC24198-02	11/1/2012 12:08 PM
Details	Comments Public	Insert			11/01/12 - Forwarded IS registration for approval. 10/16/12 - Site showing in EHB as terminated, sent AO and PO email.	11/1/2012 12:08 PM
Details	340B ID	Update		Delete FF 10.16ONLINE_REG	FF-CHC24198-02	10/16/2012 2:17 PM
Details	State	Update		Rejected	Pending	10/16/2012 2:17 PM
Details	Comments Public	Insert			10/16/12 - Site showing in EHB as terminated, sent AO and PO email.	10/16/2012 2:17 PM
Details	340B ID	Update		Delete ONLINE_REG	Delete FF 10.16ONLINE_REG	10/16/2012 8:39 AM
Details	340B ID	Update		ONLINE_REG	Delete ONLINE_REG	10/16/2012 8:37 AM
Details	State	Update		Pending	Rejected	10/16/2012 8:37 AM
Details	Comments Public	Insert			10/16/12 - Delete site showing in EHB as terminated, sent AO email.	10/16/2012 8:37 AM
Details	Last Recertification Date	Insert				10/8/2012 3:07 PM
Details	Grant Number	Insert			H80CS24198	10/8/2012 3:07 PM
Details	340B ID	Insert			ONLINE_REG	10/8/2012 3:07 PM
Details	Is Authorizing Official EHB Data	Insert				10/8/2012 3:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/8/2012 3:07 PM
Details	Medicare Provider Number	Insert				10/8/2012 3:07 PM
Details	Entity Name	Insert			Marillac Community Health Centers	10/8/2012 3:07 PM
Details	Program Code	Insert			CH	10/8/2012 3:07 PM
Details	Entity Subname	Insert			MCHC - St. Cecilia	10/8/2012 3:07 PM
Dates	Participating Approval Date	Insert				10/8/2012 3:07 PM
Details	State	Insert			Pending	10/8/2012 3:07 PM
Dates	Registration Date	Insert			10/8/2012 12:00:00 AM	10/8/2012 3:07 PM
Dates	Signed By Date	Insert			10/8/2012 12:00:00 AM	10/8/2012 3:07 PM
Dates	Start Date	Insert				10/8/2012 3:07 PM
Terminations	Termination Comments	Insert				10/8/2012 3:07 PM
Terminations	Termination Date	Insert				10/8/2012 3:07 PM
Terminations	Termination Effective Date	Insert				10/8/2012 3:07 PM
Terminations	Termination Reason	Insert				10/8/2012 3:07 PM

340B Drug Pricing Program Database