Covered Entity Details

CH08380C Midtown Community Health Center, Inc. (Active) - information as of 5/7/2025 10:40:52 PM

Main Details

Name

Midtown Community Health Center, Inc.

Subdivision Name

James Madison Elementary Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-007698

340B ID

CH08380C

Grant Number

H80CS00831

Additional Details

Current Program Status

Active

Registration Date

1/11/2013

Participating Start Date

4/1/2013

Participating Approval Date

2/16/2013

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Midtown Community Health Center
Alicia Martinez, Chief Executive Officer
(801) 334-1321

Primary Contact

Midtown Community Health Center
Braden D. Mitchell, Pharmacy Director
(801) 395-8200

Addresses

Street Address

2563 Monroe
Ogden, UT 84401-2513

Billing Address

MIDTOWN COMMUNITY HEATLH CENTER
2240 ADAMS AVENUE
OGDEN, UT 84401

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?
Yes

State	Medicaid Number	NPI Number
UT	87-0540039000	1447495981,1194831552

Shipping Addresses

Shipping Address 1

MIDTOWN COMMUNITY HEALTH CENTER
2240 ADAMS AVENUE
OGDEN, UT 84401

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
CH083800	Active	BPS-H80-003548	Midtown Community Health Center, Inc.	MIDTOWN COMMUNITY HEALTH CENTER	2240 Adams Ave	Ogden	UT
CH08380A	Active	BPS-H80-008823	Midtown Community Health Center, Inc.	Midtown Community Health Center Davis County Clinic	22 S State St	Clearfield	UT
CH08380B	Active	BPS-H80-009174	Midtown Community Health Center, Inc.	Midtown Community Health Center Children's Clinic	5285 S 400 E STE A	Washington Terrace	UT
CH08380C	Active	BPS-H80-007698	Midtown Community Health Center, Inc.	James Madison Elementary Health Center	2563 Monroe	Ogden	UT
CH08380D	Terminated	BPS-H80-010367	Midtown Community Health Center, Inc.	Midtown Community Health Center Weber Midtown Wellnes Clinic	237 26th St	Ogden	UT
CH08380F	Active	BPS-H80-037641	Midtown Community Health Center, Inc.	Midtown Community Health Center South Salt Lake	60 E 3750 S	Salt Lake City	UT
CH08380G	Active	BPS-H80-015301	MIDTOWN COMMUNITY HEALTH CENTER, INC.	Hope Clinic	269 West 3300 South	Ogden	UT
CH08380H	Terminated	BPS-H80-027010	MIDTOWN COMMUNITY HEALTH CENTER, INC.	Midtown Community Health Center Logan Clinic	550 East 1400 North	Logan	UT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH083800	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	04/01/2020	08/15/2021
CH083800	KENTUCKY CENTRAL FILL FACILITY, L-010	5594 SHEPHERDSVILLE ROAD		LOUISVILLE	KY	40228-1012	04/01/2020	08/15/2021
CH083800	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	04/01/2020	08/15/2021
CH083800	SMITH MANAGEMENT CORP	DBA SMITH'S PHARMACY #69	1174 WEST 600 NORTH	SALT LAKE CITY	UT	84116	01/01/2014	06/29/2021
CH083800	SMITH'S DRUG #44	DBA SMITHS FOOD KING #1	876 E 8TH S	SALT LAKE CITY	UT	84102	01/01/2014	06/29/2021
CH083800	SMITH'S FOOD & DRUG #72	1725 UINTA WAY		PARK CITY	UT	84098	01/01/2014	01/06/2016
CH083800	SMITH'S FOOD & DRUG CENTERS	DBA: SMITH'S PHARMACY #80	828 SOUTH 900 WEST	SALT LAKE CITY	UT	84104	01/01/2014	06/29/2021
CH083800	SMITH'S FOOD & DRUG CENTERS	SMITH'S PHARMACY # 85	980 EAST FORT UNION BLVD.	MIDVALE	UT	84047	01/01/2014	06/29/2021
CH083800	SMITH'S FOOD & DRUG CTR	SMITH'S FOOD & DRUG #144	45 SOUTH STATE	OREM	UT	84057	01/01/2014	06/29/2021
CH083800	SMITH'S FOOD & DRUG CTR	SMITH'S FOOD & DRUG #140	2353 NORTH MAIN	SUNSET	UT	84015	01/01/2014	01/06/2016
CH083800	SMITH'S FOOD & DRUG CTRS	SMITH'S FOOD & DRUG #138	1634 WEST SOUTH JORDAN PKWY	SOUTH JORDAN	UT	84095	01/01/2014	01/06/2016
CH083800	SMITH'S FOOD AND DRUG CENTERS INC	SMITH'S PHARMACY 82	1080 WEST HIGHWAY 40	VERNAL	UT	84078	04/01/2016	06/29/2021
CH083800	SMITH'S FOOD KING NO 1	SMITH'S DRUG KING PHARMACY #30	4275 HARRISON BLVD	OGDEN	UT	84403	01/01/2014	06/29/2021
CH083800	SMITH'S MANAGEMENT CORP	DBA SMITH'S FOOD & DRUG #189	20 NORTH BLUFF ST	ST GEORGE	UT	84770	01/01/2014	06/29/2021
CH083800	SMITH'S MANAGEMENT CORP DBA	SMITH'S FOOD & DRUG #66	PHARMACY 4065 SOUTH REDWOOD ROAD	SALT LAKE CITY	UT	84123	01/01/2014	06/29/2021
CH083800	SMITH'S PHARMACY	SMITH'S FOOD & DRUG #42	633 S. MAIN	CEDAR CITY	UT	84720	01/01/2014	06/29/2021
CH083800	SMITH'S PHARMACY #278	565 S MALL DR.		ST. GEORGE	UT	84790-1258	04/01/2018	06/29/2021
CH083800	SMITH'S PHARMACY #28	922 E. 2100 S.		SALT LAKE CITY	UT	84106	01/01/2014	11/29/2024
CH083800	SMITH'S PHARMACY #444	555 S. 200 W.		BOUNTIFUL	UT	84010	01/01/2014	01/06/2016
CH083800	SMITH'S PHARMACY #444	555 S. 200 W.		BOUNTIFUL	UT	84010	07/01/2016	06/29/2021
CH08380A	SMITH'S PHARMACY #444	555 S. 200 W.		BOUNTIFUL	UT	84010	04/01/2016	03/31/2020
CH083800	SMITH'S PHARMACY #477	750 N. MAIN ST.		LOGAN	UT	84321	04/01/2016	07/11/2016
CH083800	SMITH'S PHARMACY #87	442 N 175 E		LOGAN	UT	84321	01/01/2014	06/20/2023
CH08380H	SMITH'S PHARMACY #87	442 N 175 E		LOGAN	UT	84321	04/01/2016	06/20/2023
CH083800	SMITH'S PHARMACY #94	455 SOUTH 500 EAST		SALT LAKE CITY	UT	84102	01/01/2014	06/29/2021
CH083800	SMITHS FOOD & DRUG #142	951 WEST 1700 SOUTH		SYRACUSE	UT	84075	01/01/2014	01/06/2016
CH083800	SMITHS FOOD & DRUG CTR INC	SMITH'S PHARMACY #147	5620 W 4100 SO	WEST VALLEY CITY	UT	84128	04/01/2016	06/29/2021
CH083800	SMITHS FOOD & DRUG CTRS	SMITH'S DRUG KING PHARMACY #75	632 SOUTH 100 WEST	PAYSON	UT	84651	01/01/2014	06/29/2021
CH083800	SMITHS FOOD & DRUG CTRS	SMITH'S PHARMACY #178	156 SOUTH MAIN	BRIGHAM CITY	UT	84302	01/01/2014	06/29/2021
CH083800	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #133	845 EAST 4500 SOUTH	SALT LAKE CITY	UT	84107	01/01/2014	06/29/2021
CH083800	SMITHS FOOD & DRUG CTRS	SMITH'S FOOD DRUG #149	1170 EAST GENTILE	LAYTON	UT	84040	01/01/2014	06/29/2021
CH083800	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #135	1316 NORTH HIGHWAY 89	FARMINGTON	UT	84025	01/01/2014	01/06/2016
CH08380A	SMITHS FOOD & DRUG CTRS	SMITH'S FOOD DRUG #149	1170 EAST GENTILE	LAYTON	UT	84040	04/01/2016	03/31/2020
CH083800	SMITHS FOOD & DRUG CTRS	SMITH'S DRUG KING PHARMACY #48	1075 EAST MAIN	PRICE	UT	84501	04/01/2018	06/29/2021
CH083800	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #131	1485 HARRISON BLVD	OGDEN	UT	84404	07/01/2020	11/29/2024
CH083800	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	04/01/2020	08/15/2021
CH083800	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2020	07/10/2023
CH08380F	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2020	07/10/2023
CH08380F	WAL-MART PHARMACY 10-3589	350 WEST HOPE AVE		SALT LAKE CITY	UT	84115	07/01/2020	08/27/2021
CH083800	WAL-MART PHARMACY 10-3789	1959 WALL AVE		OGDEN	UT	84401	07/01/2020	07/10/2023
CH083800	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2020	07/10/2023
CH08380F	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2020	07/10/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/12/2024 12:10:07 PM	2/10/2025 12:09:22 PM	2/10/2025 12:09 PM
Details	Last Recertification Date	Update	Recertification	1/31/2023 11:21:27 AM	2/12/2024 12:10:07 PM	2/12/2024 12:10 PM
Contacts	Authorizing Official	Update	Profile Change Request	Martinez, Alicia Executive Director Midtown Community Health Center 8013341321	Martinez, Alicia Chief Executive Officer Midtown Community Health Center 8013341321	1/31/2023 12:30 PM
Details	Last Recertification Date	Update	Recertification	2/7/2022 11:06:23 AM	1/31/2023 11:21:27 AM	1/31/2023 11:21 AM
Details	Last Recertification Date	Update	Recertification	2/8/2021 9:09:10 PM	2/7/2022 11:06:23 AM	2/7/2022 11:06 AM
Details	Last Recertification Date	Update	Recertification	1/29/2020 11:34:25 AM	2/8/2021 9:09:10 PM	2/8/2021 9:09 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1194831552	1/11/2021 12:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		UT	1/11/2021 12:35 PM
Medicaid Billing	NPI: State	Update	Change Request		UT	1/11/2021 12:35 PM
Details	Last Recertification Date	Update	Recertification	2/4/2019 2:12:34 PM	1/29/2020 11:34:25 AM	1/29/2020 11:34 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	87-0540039001	87-0540039000	9/13/2019 2:03 PM
Medicaid Billing	NPI: Number	Update	Change Request	1194831552	1447495981	9/13/2019 2:03 PM
Details	Last Recertification Date	Update	Recertification	2/15/2018 12:46:05 PM	2/4/2019 2:12:34 PM	2/4/2019 2:12 PM
Contacts	Primary Contact	Update	Profile Change Request	Fitzpatrick, Roger B Pharmacy Director Midtown Community Health Center 8013958200	Mitchell, Braden D. Pharmacy Director Midtown Community Health Center 8013958200	11/13/2018 3:58 PM
Details	Last Recertification Date	Update	Recertification	2/2/2017 12:00:00 AM	2/15/2018 12:46:05 PM	2/15/2018 12:46 PM
Contacts	Authorizing Official	Update	Change Request	Martinez, Alicia Executive Director 8013341321	Martinez, Alicia Executive Director Midtown Community Health Center 8013341321	11/13/2017 2:03 PM
Contacts	Primary Contact	Update		Fitzpatrick, Roger Pharmacy Director 8013958200	Fitzpatrick, Roger B Pharmacy Director Midtown Community Health Center 8013958200	11/6/2017 9:47 AM
Contacts	Authorizing Official	Insert			Martinez, Alicia Executive Director 8013341321	2/2/2017 12:07 PM
Contacts	Signed By	Insert			Nichols, Lisa Executive Director 8017100973	2/2/2017 12:07 PM
Contacts	Primary Contact	Insert			Fitzpatrick, Roger Pharmacy Director 8013958200	2/2/2017 12:07 PM
Addresses	Main Address	Insert			2563 Monroe Ogden, UT 84401-2513	2/2/2017 12:07 PM
Details	Last Recertification Date	Update		2/17/2016 12:00:00 AM	2/2/2017 12:00:00 AM	2/2/2017 12:07 PM
Addresses	Billing Address	Insert			MIDTOWN COMMUNITY HEATLH CENTER 2240 ADAMS AVENUE OGDEN, UT 84401	5/12/2016 1:53 PM
Addresses	Shipping Address	Insert			MIDTOWN COMMUNITY HEALTH CENTER 2240 ADAMS AVENUE OGDEN, UT 84401	5/12/2016 1:53 PM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/17/2016 12:00:00 AM	2/17/2016 4:34 PM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 11:35 AM
Details	Entity Name	Update		MIDTOWN COMMUNITY HEALTH CENTER	Midtown Community Health Center, Inc.	3/31/2014 4:25 PM
Details	Last Recertification Date	Update			2/10/2014 12:00:00 AM	2/10/2014 8:30 AM
Details	340B ID	Update		IS-FN-CH08380C	CH08380C	2/16/2013 12:04 PM
Details	Medicare Provider Number	Update		461825		2/16/2013 12:04 PM
Dates	Participating Approval Date	Update			2/16/2013 12:00:00 AM	2/16/2013 12:04 PM
Details	State	Update		Pending	Active	2/16/2013 12:04 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	2/16/2013 12:04 PM
Details	340B ID	Update		ONLINE_REG	IS-FN-CH08380C	2/6/2013 5:43 PM
Details	Entity Subname	Update		JAMES MADISON ELEMENTARY SCHOOL BASED HEALTH CENTER	James Madison Elementary Health Center	2/6/2013 5:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/11/2013 11:56 AM
Medicaid Billing	Medicaid: Number	Insert			87-0540039001	1/11/2013 11:56 AM
Medicaid Billing	Medicaid: State	Insert			UT	1/11/2013 11:56 AM
Medicaid Billing	NPI: Number	Insert			1194831552	1/11/2013 11:56 AM
Details	Last Recertification Date	Insert				1/11/2013 11:56 AM
Details	Grant Number	Insert			H80CS00831	1/11/2013 11:56 AM
Details	340B ID	Insert			ONLINE_REG	1/11/2013 11:56 AM
Details	Is Authorizing Official EHB Data	Insert				1/11/2013 11:56 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/11/2013 11:56 AM
Details	Medicare Provider Number	Insert			461825	1/11/2013 11:56 AM
Details	Entity Name	Insert			MIDTOWN COMMUNITY HEALTH CENTER	1/11/2013 11:56 AM
Details	Program Code	Insert			CH	1/11/2013 11:56 AM
Details	Entity Subname	Insert			JAMES MADISON ELEMENTARY SCHOOL BASED HEALTH CENTER	1/11/2013 11:56 AM
Dates	Participating Approval Date	Insert				1/11/2013 11:56 AM
Details	State	Insert			Pending	1/11/2013 11:56 AM
Dates	Registration Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 11:56 AM
Dates	Signed By Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 11:56 AM
Dates	Start Date	Insert				1/11/2013 11:56 AM
Terminations	Termination Comments	Insert				1/11/2013 11:56 AM
Terminations	Termination Date	Insert				1/11/2013 11:56 AM
Terminations	Termination Effective Date	Insert				1/11/2013 11:56 AM
Terminations	Termination Reason	Insert				1/11/2013 11:56 AM

340B Drug Pricing Program Database