Covered Entity Details

CH06235C IBERIA COMPRHESIVE COM HEALTH CNTR, INC. (Active) - information as of 5/6/2025 12:04:02 AM

Main Details

Name

IBERIA COMPRHESIVE COM HEALTH CNTR, INC.

Subdivision Name

Merryville Community Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-009575

340B ID

CH06235C

Grant Number

H80CS00697

Additional Details

Current Program Status

Active

Registration Date

1/11/2013

Participating Start Date

4/1/2013

Participating Approval Date

2/20/2013

Last Recertification Date

2/18/2025

Contacts

Authorizing Official

Iberia Comprehensive Community Health Center, Inc.
De'Marquis Hamilton, CEO
(337) 365-4945 Ext: 1210

Primary Contact

Iberia Comprehensive Community Health Center, Inc.
Reginald Boutte, Pharmacist In Charge
(337) 365-4945 Ext: 146

Addresses

Street Address

567 Walker
Merryville, LA 70653

Billing Address

Iberia Comprehensive Community Health Center, Inc.
806 Jefferson Terrace Blvd
New Iberia, LA 70560-5727

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
LA	1803570	1891020012

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH062350	Active	BPS-H80-002527	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER	806 Jefferson Ter	New Iberia	LA
CH06235A	Active	BPS-H80-027508	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	ABBEVILLE COMMUNITY HLTH CTR	1009 Charity Street	ABBEVILLE	LA
CH06235B	Active	BPS-H80-003599	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	St. Martin Parish Community Health Center	317 Dernier St	Saint Martinville	LA
CH06235C	Active	BPS-H80-009575	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	Merryville Community Health Center	567 Walker	Merryville	LA
CH06235D	Active	BPS-H80-011068	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	Surrey Street Community Health Center	1004 Surrey St	Lafayette	LA
CH06235E	Active	BPS-H80-010372	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	Surrey Street Community Health Center	1002 12th St	Lafayette	LA
CH06235F	Active	BPS-H80-013105	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	Sabine Comprehensive Health Clinic	1050 N Robinson St	Many	LA
CH06235G	Active	BPS-H80-027895	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	Vernon Parish Community Health Center	298 Nolan Trace Pkwy	Leesville	LA
CH06235H	Terminated	BPS-H80-032998	IBERIA COMPRHNSV COMM HEALTH CENTER	Abbeville Community Health Center School-Based Health Center	6526 Chaisson Rd Bldg H	Abbeville	LA
CH06235J	Active	BPS-H80-037129	IBERIA COMPRHNSV COMM HEALTH CENTER	Iberia Comprehensive Vision Center	1110 Angers St	New Iberia	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH062350	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2023
CH062350	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2023
CH062350	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2023
CH062350	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2023
CH062350	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2023
CH062350	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2023
CH062350	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2023
CH062350	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2023
CH062350	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2023
CH062350	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2023
CH062350	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2023
CH062350	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2023
CH062350	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2023
CH062350	GENOA HEALTHCARE LLC	5411 COLISEUM BLVD STE B		ALEXANDRIA	LA	71303	07/01/2025
CH062350	GENOA HEALTHCARE LLC	302 DULLES DR STE P-7		LAFAYETTE	LA	70506	07/01/2025
CH062350	K & B LOUISIANA CORPORATION	RITE AID #7300	2250 VETERANS MEMORIAL DRIVE	ABBEVILLE	LA	70510	01/01/2014	02/22/2018
CH062350	K & B LOUISIANA CORPORATION	RITE AID #7304	1150 WEST ST. PETER STREET	NEW IBERIA	LA	70560	01/01/2014	02/22/2018
CH062350	K & B LOUISIANA CORPORATION	RITE AID #7305	1108 EAST MAIN STREET	NEW IBERIA	LA	70560	01/01/2014	02/22/2018
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01579	6800 JOHNSTON ST.	LAFAYETTE	LA	70503	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05511	3754 MOSS ST	LAFAYETTE	LA	70507	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05282	100 S. CUSHING AVE.	KAPLAN	LA	70548	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05299	185 N. LEWIS ST..	NEW IBERIA	LA	70563	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00016	2910 E. MILTON AVE	YOUNGSVILLE	LA	70592	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05560	3604 PINHOOK RD.	BROUSSARD	LA	70518	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08958	5044 AMBASSADOR CAFFREY RD.	LAFAYETTE	LA	70508	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05284	705 BERTRAND DRIVE	LAFAYETTE	LA	70506	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05443	1920 KALISTE SALOOM	LAFAYETTE	LA	70508	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05296	1730 S MAIN ST	SAINT MARTINVILLE	LA	70582	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05554	111 WESTGATE RD.	LAFAYETTE	LA	70506	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05285	1315 MOSS ST EXT	LAFAYETTE	LA	70501	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08957	1326 W. PINHOOK RD.	LAFAYETTE	LA	70503	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05275	1100 VETERANS MEMORIAL DR	ABBEVILLE	LA	70510	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16805	4313 AMBASSADOR CAFFERY PKWY	LAFAYETTE	LA	70508	04/01/2023
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05283	4406 JOHNSTON ST	LAFAYETTE	LA	70503	04/01/2023	04/03/2024
CH062350	LOUISIANA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17441	3225 LOUISIANA AVE	LAFAYETTE	LA	70501	04/01/2023
CH062350	MULA FAMILY PHARMACY	2619 CHARITY ST		ABBEVILLE	LA	70510-4024	01/01/2018	04/13/2022
CH062350	MULA FAMILY PHARMACY	2619 CHARITY ST		ABBEVILLE	LA	70510-4024	04/01/2024
CH062350	NEW IBERIA MEDICINE SHOPPE, INC	DELAUNE'S PHARMACY & HOME MEDICAL	308 N LEWIS ST	NEW IBERIA	LA	70563-2843	04/01/2024
CH062350	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/01/2025
CH062350	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2025
CH062350	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2023
CH062350	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/01/2023
CH062350	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2023
CH062350	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2023
CH062350	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2751	426 S. HENDERSON STREET	FORT WORTH	TX	76104	07/01/2024
CH062350	SOILEAU'S PHARMACY	805 CENTER ST		NEW IBERIA	LA	70560-7056	07/01/2024	05/28/2024
CH062350	SOILEAU'S PHARMACY	J&J RX SOLUTIONS LLC	805 CENTER ST	NEW IBERIA	LA	70560	07/01/2024
CH062350	SUPER 1 PHARMACY #638	2210 VETERANS MEMORIAL DR.		ABBEVILLE	LA	70510	07/05/2018
CH062350	SUPER 1 PHARMACY #645	1500 BONIN ROAD		YOUNGSVILLE	LA	70592	04/01/2022
CH062350	SUPER 1 PHARMACY #646	924 REES STREET		BREAUX BRIDGE	LA	70517	07/05/2018
CH062350	SUPER ONE PHARMACY	939 S LEWIS		NEW IBERIA	LA	70560	07/01/2018
CH062350	SUPER ONE PHARMACY #627	215 W. WILLOW STREET		LAFAYETTE	LA	70501	04/01/2022
CH062350	THRIFTY WAY PHARMACY OF ST. MARTINVILLE	1620 S. MAIN ST.		ST MARTINVLLE	LA	70582	04/01/2024
CH062350	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018
CH062350	WAL-MART PHARMACY 10-0001	2110 WEST WALNUT		ROGERS	AR	72756	01/01/2022	07/01/2022
CH062350	WAL-MART PHARMACY 10-0309	3005 VETERANS MEMORIAL DRIVE		ABBEVILLE	LA	70510-4140	01/01/2018
CH062350	WAL-MART PHARMACY 10-0402	1932 REES STREET		BREAUX BRIDGE	LA	70517	01/01/2018	07/01/2022
CH062350	WAL-MART PHARMACY 10-0505	1125 N PINE		DE RIDDER	LA	70634	10/01/2022
CH062350	WAL-MART PHARMACY 10-0531	3142 AMBASSADOR CAFFERY PKWY		LAFAYETTE	LA	70506	10/01/2022
CH062350	WAL-MART PHARMACY 10-0533	1205 E ADMIRAL DOYLE		NEW IBERIA	LA	70560	07/01/2014
CH062350	WAL-MART PHARMACY 10-0534	1229 NW EVANGELINE THRUWAY		LAFAYETTE	LA	70501	01/01/2018	03/31/2019
CH062350	WAL-MART PHARMACY 10-0876	25800 HWY 171		MANY	LA	71449	01/01/2018
CH062350	WAL-MART PHARMACY 10-2938	2428 WEST PINHOOK ROAD		LAFAYETTE (S)	LA	70508	01/01/2022
CH062350	WAL-MART PHARMACY 10-415	123 SAINT NAZAIRE RD		BROUSSARD	LA	70518	01/01/2018
CH062350	WAL-MART PHARMACY 10-5260	4208 PLEASANT CROSSING BLVD.		ROGERS	AR	72758	01/01/2022	07/01/2022
CH062350	WAL-MART PHARMACY 10-5773	1201 PARKVIEW DRIVE		NEW IBERIA	LA	70563	01/01/2022
CH062350	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2018
CH062350	WAL-MART PHARMACY 10-7301	3810 NE EVANGELINE THRUWAY		CARENCRO	LA	70520-5966	01/01/2022
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04192	1017 E. ADMIRAL DOYLE DR.	NEW IBERIA	LA	70560	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04566	2700 JOHNSTON ST.	LAFAYETTE	LA	70503	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04626	2517 KALISTE SALOOM ROAD	LAFAYETTE	LA	70508	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05629	2822 AMBASSADOR CAFFERY PKWY	LAFAYETTE	LA	70506	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05747	3747 MOSS STREET	LAFAYETTE	LA	70507	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07166	1102 PARKVIEW DRIVE	NEW IBERIA	LA	70563-2883	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07393	2201 VETERANS MEMORIAL DR	ABBEVILLE	LA	70510-4004	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07696	1401 REES STREET	BREAUX BRIDGE	LA	70517-4307	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10126	105 SAINT NAZAIRE RD	BROUSSARD	LA	70518	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10537	916 N. PINE ST.	DERIDDER	LA	70634-2816	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13761	2820 E. MILTON AVE.	YOUNGSVILLE	LA	70592-5349	01/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12306	280 SAN ANTONIO AVENUE	MANY	LA	71449	07/01/2014
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13134	6130 JOHNSTON ST.	LAFAYETTE	LA	70503	01/01/2017
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11997	5416 CAMERON ST	SCOTT	LA	70583	01/01/2017
CH062350	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12428	920 W. GLORIA SWITCH RD	LAFAYETTE	LA	70507	01/01/2017
CH062350	WALGREEN LOUISIANA CO., INC.	WALGREENS #17524	1150 W SAINT PETER ST	NEW IBERIA	LA	70560-3558	04/01/2018
CH062350	WALGREEN LOUISIANA CO., INC.	RITE AID #07300	2250 VETERANS MEMORIAL DR	ABBEVILLE	LA	70510-4005	04/01/2018	07/12/2018
CH062350	WALGREEN LOUISIANA CO., INC.	RITE AID #07305	1108 E MAIN ST	NEW IBERIA	LA	70560-3920	04/01/2018	07/16/2018
CH062350	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	10/01/2023
CH062350	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2014	07/01/2015
CH062350	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH062350	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH062350	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 1549	924 REES ST	BREAUX BRIDGE	LA	70517	07/01/2014	04/23/2018
CH062350	WINN DIXIE PHARMACY #1456	1104 E MAIN ST		NEW IBERIA	LA	70560	07/01/2014	04/21/2018
CH062350	WINN DIXIE PHARMACY #1558	2210 VETERANS MEMORIAL DR		ABBEVILLE	LA	70510	07/01/2014	04/23/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/5/2024 3:35:01 PM	2/18/2025 12:11:44 PM	2/18/2025 12:11 PM
Contacts	Authorizing Official	Update	AO Change Request	CAMPBELL, RODERICK C. CEO Iberia Comprehensive Community Health Center Inc. 3373654945-128	Hamilton, De'Marquis CEO Iberia Comprehensive Community Health Center, Inc. 3373654945-1210	2/18/2025 8:11 AM
Details	Last Recertification Date	Update	Recertification	2/6/2023 6:15:03 PM	2/5/2024 3:35:01 PM	2/5/2024 3:35 PM
Details	Last Recertification Date	Update	Recertification	2/7/2022 1:00:42 PM	2/6/2023 6:15:03 PM	2/6/2023 6:15 PM
Details	Last Recertification Date	Update	Recertification	2/19/2021 4:37:21 PM	2/7/2022 1:00:42 PM	2/7/2022 1:00 PM
Medicaid Billing	NPI: State	Update	Recertification		LA	2/19/2021 4:37 PM
Details	Last Recertification Date	Update	Recertification	2/10/2020 4:16:52 PM	2/19/2021 4:37:21 PM	2/19/2021 4:37 PM
Details	Last Recertification Date	Update	Recertification	1/28/2019 8:01:48 PM	2/10/2020 4:16:52 PM	2/10/2020 4:16 PM
Details	Last Recertification Date	Update	Recertification	2/7/2018 1:36:47 PM	1/28/2019 8:01:48 PM	1/28/2019 8:01 PM
Details	Last Recertification Date	Update	Recertification	2/2/2017 12:00:00 AM	2/7/2018 1:36:47 PM	2/7/2018 1:36 PM
Contacts	Primary Contact	Update	Recertification	Boutte, Reginald Pharmacist In Charge 3373654945-146	Boutte, Reginald Pharmacist In Charge Iberia Comprehensive Community Health Center, Inc. 3373654945-146	2/7/2018 1:33 PM
Contacts	Signed By	Update	Recertification	Boutte, Reginald Pharmacist In Charge 3373654945-146	Boutte, Reginald Pharmacist In Charge Iberia Comprehensive Community Health Center, Inc. 3373654945-146	2/7/2018 1:33 PM
Contacts	Authorizing Official	Update		CAMPBELL, RODERICK C. CEO 3373654945-128	CAMPBELL, RODERICK C. CEO Iberia Comprehensive Community Health Center Inc. 3373654945-128	10/16/2017 11:20 AM
Addresses	Main Address	Insert			567 Walker Merryville, LA 70653	2/2/2017 12:47 PM
Contacts	Primary Contact	Insert			Boutte, Reginald Pharmacist In Charge 3373654945-146	2/2/2017 12:47 PM
Contacts	Signed By	Insert			Boutte, Reginald Pharmacist In Charge 3373654945-146	2/2/2017 12:47 PM
Contacts	Authorizing Official	Insert			CAMPBELL, RODERICK C. CEO 3373654945-128	2/2/2017 12:47 PM
Details	Last Recertification Date	Update		2/26/2016 12:00:00 AM	2/2/2017 12:00:00 AM	2/2/2017 12:47 PM
Details	Last Recertification Date	Update		2/11/2015 12:00:00 AM	2/26/2016 12:00:00 AM	2/26/2016 4:37 PM
Addresses	Billing Address	Insert			Iberia Comprehensive Community Health Center, Inc. 806 Jefferson Terrace Blvd New Iberia, LA 70560-5727	12/10/2015 1:33 PM
Medicaid Billing	Medicaid: Number	Update		1225711	1803570	12/10/2015 1:33 PM
Medicaid Billing	NPI: Number	Update		1881871333	1891020012	12/10/2015 1:33 PM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	2/11/2015 12:00:00 AM	2/11/2015 10:30 AM
Details	Entity Name	Update		IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER	IBERIA COMPRHESIVE COM HEALTH CNTR, INC.	3/31/2014 4:25 PM
Details	Entity Subname	Update		MERRYVILLE COMMUNITY HEALTH CENTER	Merryville Community Health Center	3/31/2014 4:25 PM
Details	Last Recertification Date	Update			2/10/2014 12:00:00 AM	2/10/2014 1:03 PM
Details	340B ID	Update		IS-FN-CH06235C	CH06235C	2/20/2013 10:32 AM
Dates	Participating Approval Date	Update			2/20/2013 12:00:00 AM	2/20/2013 10:32 AM
Details	State	Update		Pending	Active	2/20/2013 10:32 AM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	2/20/2013 10:32 AM
Details	340B ID	Update		FN-CH06235C	IS-FN-CH06235C	2/13/2013 1:30 PM
Details	340B ID	Update		ONLINE_REG	FN-CH06235C	2/5/2013 12:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/11/2013 12:03 PM
Medicaid Billing	Medicaid: Number	Insert			1225711	1/11/2013 12:03 PM
Medicaid Billing	Medicaid: State	Insert			LA	1/11/2013 12:03 PM
Medicaid Billing	NPI: Number	Insert			1881871333	1/11/2013 12:03 PM
Details	Last Recertification Date	Insert				1/11/2013 12:03 PM
Details	Grant Number	Insert			H80CS00697	1/11/2013 12:03 PM
Details	340B ID	Insert			ONLINE_REG	1/11/2013 12:03 PM
Details	Is Authorizing Official EHB Data	Insert				1/11/2013 12:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/11/2013 12:03 PM
Details	Medicare Provider Number	Insert				1/11/2013 12:03 PM
Details	Entity Name	Insert			IBERIA COMPREHENSIVE COMMUNITY HEALTH CENTER	1/11/2013 12:03 PM
Details	Program Code	Insert			CH	1/11/2013 12:03 PM
Details	Entity Subname	Insert			MERRYVILLE COMMUNITY HEALTH CENTER	1/11/2013 12:03 PM
Dates	Participating Approval Date	Insert				1/11/2013 12:03 PM
Details	State	Insert			Pending	1/11/2013 12:03 PM
Dates	Registration Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 12:03 PM
Dates	Signed By Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 12:03 PM
Dates	Start Date	Insert				1/11/2013 12:03 PM
Terminations	Termination Comments	Insert				1/11/2013 12:03 PM
Terminations	Termination Date	Insert				1/11/2013 12:03 PM
Terminations	Termination Effective Date	Insert				1/11/2013 12:03 PM
Terminations	Termination Reason	Insert				1/11/2013 12:03 PM

340B Drug Pricing Program Database