Covered Entity Details

CH05711B 3RD STREET COMMUNITY CLINIC (Terminated) - information as of 6/24/2025 12:01:25 AM

Main Details

Name

3RD STREET COMMUNITY CLINIC

Subdivision Name

Mansfield Family Health - Admin Office

Type

HRSA-Funded Health Center

Site ID

BPS-H80-011117

340B ID

CH05711B

Grant Number

H80CS00581

Additional Details

Current Program Status

Terminated

Registration Date

1/11/2013

Participating Start Date

4/1/2013

Participating Approval Date

2/25/2013

Last Recertification Date

2/26/2021

Termination Date
Termination Reason

4/1/2022
Site closure

Contacts

Authorizing Official

Third Street Family Health Services
Brett Toward, CEO/CMO
(419) 522-6191

Primary Contact

Third Street Family Health Services
Barbara Sullinger, CFO
(419) 527-7867

Addresses

Street Address

741 Scholl Road, Suite A
Mansfield, OH 44907

Billing Address

Third Street Community Clinic
600 W Third St
Mansfield, OH 44906

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH057110	Active	BPS-H80-001276	THIRD STREET COMMUNITY CLINIC	Third Street Community Clinic, Inc	600 W 3rd St	Mansfield	OH
CH05711A	Active	BPS-H80-009440	THIRD STREET COMMUNITY CLINIC	Cornerstone OB/GYN	770 Balgreen Dr	Mansfield	OH
CH05711B	Terminated	BPS-H80-011117	3RD STREET COMMUNITY CLINIC	Mansfield Family Health - Admin Office	741 Scholl Road, Suite A	Mansfield	OH
CH05711C	ToBeTerminated	BPS-H80-012667	THIRD STREET COMMUNITY CLINIC	Hawkins Medical Center	2131 Park Avenue West	Ontario	OH
CH05711D	Active	BPS-H80-013632	THIRD STREET COMMUNITY CLINIC	Mansfield Family Health 2	270 Sterkel Blvd	Mansfield	OH
CH05711E	Active	BPS-H80-017506	THIRD STREET COMMUNITY CLINIC	Shelby Health & Wellness Center	31 E MAIN ST	SHELBY	OH
CH05711F	Terminated	BPS-H80-017242	3RD STREET COMMUNITY CLINIC	Shelby OB/GYN	199 W. Main St 2nd Floor	Shelby	OH
CH05711G	Terminated	BPS-H80-017816	3RD STREET COMMUNITY CLINIC	Shelby OB/GYN - Mobile	600 W Third St	Mansfield	OH
CH05711H	Active	BPS-H80-018573	THIRD STREET COMMUNITY CLINIC	Five Points Primary Care	200 Park Ave W	Mansfield	OH
CH05711J	Terminated	BPS-H80-018572	3RD STREET COMMUNITY CLINIC	Tyger Care	124 N. Linden Road	Mansfield	OH
CH05711K	Active	BPS-H80-029668	THIRD STREET COMMUNITY CLINIC	Malabar Care Connect	205 W. Cook Road UNIT Suite A	Mansfield	OH
CH05711L	Active	BPS-H80-030065	THIRD STREET COMMUNITY CLINIC	Bucyrus Health and Wellness Center	2458 Stetzer Rd	Bucyrus	OH
CH05711M	Active	BPS-H80-030361	THIRD STREET COMMUNITY CLINIC	Ashland Health and Wellness	309 Arthur Street	Ashland	OH
CH05711N	Active	BPS-H80-030947	THIRD STREET COMMUNITY CLINIC	9th Street Dental	431 E 9th St	Ashland	OH
CH05711P	Active	BPS-H80-036911	THIRD STREET COMMUNITY CLINIC INC	Community Counseling and Wellness Centers-Marion	320 Executive Dr	Marion	OH
CH05711Q	Active	BPS-H80-036794	THIRD STREET COMMUNITY CLINIC INC	Community Counseling and Wellness Centers-Bucyrus	2458 Stetzer Rd	Bucyrus	OH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH057110	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2024
CH057110	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/01/2024
CH057110	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/01/2024
CH057110	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/01/2024
CH057110	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/01/2024
CH057110	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2024
CH057110	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/12/2023
CH057110	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	10/01/2024
CH057110	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	10/01/2024
CH057110	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	10/01/2024
CH057110	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	10/01/2024
CH057110	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/01/2024
CH057110	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/12/2023
CH057110	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/12/2023
CH057110	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/12/2023
CH057110	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/12/2023
CH057110	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/12/2023
CH057110	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/12/2023
CH057110	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/12/2023
CH057110	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/12/2023
CH057110	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/12/2023
CH057110	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/12/2023
CH057110	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2021
CH057110	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2021
CH057110	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/12/2023
CH057110	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/12/2023
CH057110	DISCOUNT DRUG MART	219 MANSFIELD AVE		SHELBY	OH	44875	10/01/2016
CH05711H	DISCOUNT DRUG MART	219 MANSFIELD AVE		SHELBY	OH	44875	04/01/2024
CH057110	DISCOUNT DRUG MART #44	1631 CLAREMONT AVENUE		ASHLAND	OH	44805	10/01/2021
CH057110	DISCOUNT DRUG MART #59	25 BRIGGS DRIVE		ONTARIO	OH	44906	10/01/2016
CH057110	DISCOUNT DRUG MART #79	739 CARTER DRIVE		GALION	OH	44833	10/01/2021
CH057110	DISCOUNT DRUG MART INC #16	307 W WALTON ST		WILLARD	OH	44890	10/01/2021
CH057110	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	10/01/2024
CH057110	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	01/01/2024
CH057110	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/01/2024
CH057110	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/01/2024
CH057110	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/01/2024
CH057110	GENOA HEALTHCARE LLC	741 SCHOLL ROAD, STE P1		MANSFIELD	OH	44907	01/01/2020
CH057110	GENOA HEALTHCARE LLC	2458 STETZER RD RM 193		BUCYRUS	OH	44820	10/01/2021
CH057110	GENOA HEALTHCARE LLC	701 BROOKSEDGE PLAZA DR STE C		WESTERVILLE	OH	43081	10/01/2022	10/24/2022
CH057110	GENOA HEALTHCARE LLC	701 BROOKSEDGE PLAZA DR STE C		WESTERVILLE	OH	43081	12/15/2022
CH05711K	GENOA HEALTHCARE LLC	741 SCHOLL ROAD, STE P1		MANSFIELD	OH	44907	04/01/2024
CH057110	HURSH DRUG INC	90 N DIAMOND ST		MANSFIELD	OH	44902-1325	04/01/2020
CH05711L	HURSH DRUG INC	90 N DIAMOND ST		MANSFIELD	OH	44902-1325	04/01/2024
CH057110	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	07/01/2017
CH057110	KROGER PHARMACY	1060 ASHLAND ROAD		MANSFIELD	OH	44905	11/11/2008
CH05711A	KROGER PHARMACY	1060 ASHLAND ROAD		MANSFIELD	OH	44905	10/01/2010
CH05711Q	KROGER PHARMACY	1060 ASHLAND ROAD		MANSFIELD	OH	44905	04/01/2024
CH057110	KROGER PHARMACY 518	1240 PARK AVE. WEST		MANSFIELD	OH	44906	10/01/2006
CH05711A	KROGER PHARMACY 518	1240 PARK AVE. WEST		MANSFIELD	OH	44906	10/01/2010
CH057110	KROGER SAV-ON PHARMACY	1500 LEXINGTON AVENUE		MANSFIELD	OH	44907	11/11/2008
CH05711A	KROGER SAV-ON PHARMACY	1500 LEXINGTON AVENUE		MANSFIELD	OH	44907	10/01/2010
CH057110	LOWER LIGHTS PHARMACY	1160 W BROAD ST		COLUMBUS	OH	43222	04/01/2024
CH057110	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	10/01/2019
CH057110	MEIJER PHARMACY #126	1355 N.LEXINGTON-SPRINGMILL RD		MANSFIELD	OH	44906-1126	10/01/2019
CH057110	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	10/01/2019
CH057110	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	10/01/2019
CH057110	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06176	1049 WEST FOURTH STREET	MANSFIELD	OH	44906	07/01/2021
CH057110	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06169	1411 LEXINGTON AVENUE	MANSFIELD	OH	44907	07/01/2021
CH057110	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16720	2205 WALKER LAKE RD	MANSFIELD	OH	44903	07/01/2021
CH057110	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06175	755 ASHLAND ROAD	MANSFIELD	OH	44905	07/01/2021
CH057110	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06167	418 EAST MAIN STREET	ASHLAND	OH	44805	07/01/2021
CH057110	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03406	101 EAST CHARLES STREET	BUCYRUS	OH	44820	07/01/2021
CH05711P	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06176	1049 WEST FOURTH STREET	MANSFIELD	OH	44906	04/01/2024
CH05711M	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06169	1411 LEXINGTON AVENUE	MANSFIELD	OH	44907	04/01/2024
CH05711N	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06175	755 ASHLAND ROAD	MANSFIELD	OH	44905	04/01/2024
CH057110	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2023
CH057110	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	04/01/2024
CH057110	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/01/2024
CH057110	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/12/2023
CH057110	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/12/2023
CH057110	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/12/2023
CH057110	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/12/2023
CH057110	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/01/2024
CH057110	RITE AID OF OHIO, INC.	RITE AID #1282	11 MANSFIELD AVENUE	SHELBY	OH	44875	09/05/2012
CH057110	RITE AID OF OHIO, INC.	RITE AID #3037	1009 PARK AVENUE, WEST	MANSFIELD	OH	44906	09/05/2012	03/31/2021
CH057110	RITE AID OF OHIO, INC.	RITE AID #4010	355 EAST MAIN STREET	LEXINGTON	OH	44904	07/01/2019	08/01/2024
CH057110	RITE AID OF OHIO, INC.	RITE AID #3102	304 HARDING WAY WEST	GALION	OH	44833	07/01/2019	08/15/2024
CH057110	RITE AID OF OHIO, INC.	RITE AID #3266	117 SOUTH MAIN STREET	FREDERICKTOWN	OH	43019	04/29/2020
CH057110	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/01/2024
CH057110	THE LANE DRUG COMPANY	RITE AID #2403	875 LEXINGTON AVENUE	MANSFIELD	OH	44907	09/05/2012	07/29/2024
CH057110	THE LANE DRUG COMPANY	RITE AID #2395	1075 ASHLAND ROAD	MANSFIELD	OH	44905	07/01/2019	07/30/2024
CH057110	THE LANE DRUG COMPANY	RITE AID #2394	145 WEST MAIN STREET	CRESTLINE	OH	44827	07/01/2019
CH057110	THE LANE DRUG COMPANY	RITE AID #2397	419 CLAREMONT AVENUE	ASHLAND	OH	44805	04/29/2020
CH057110	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH057110	WAL-MART PHARMACY 10-1448	1996 EAST MAIN ST		ASHLAND	OH	44805	04/29/2020
CH05711D	WAL-MART PHARMACY 10-1448	1996 EAST MAIN ST		ASHLAND	OH	44805	04/01/2024
CH057110	WAL-MART PHARMACY 10-1539	359 LEXINGTON SPRINGMILL		MANSFIELD	OH	44906	10/01/2016
CH05711A	WAL-MART PHARMACY 10-1539	359 LEXINGTON SPRINGMILL		MANSFIELD	OH	44906	04/01/2024
CH057110	WAL-MART PHARMACY 10-2613	1875 EAST MANSFIELD		BUCYRUS	OH	44820	07/01/2021
CH057110	WAL-MART PHARMACY 10-5471	2485 POSSUM RUN ROAD		MANSFIELD (S)	OH	44903	10/01/2018
CH05711C	WAL-MART PHARMACY 10-5471	2485 POSSUM RUN ROAD		MANSFIELD (S)	OH	44903	04/01/2024	07/01/2025
CH057110	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH057110	WALGREEN CO.	DBA: WALGREENS # 09047	1000 PARK AVE WEST	MANSFIELD	OH	44906	10/01/2021
CH057110	WALGREEN CO.	DBA: WALGREENS #10295	1321 DELAWARE AVE.	MARION	OH	43302-6421	01/01/2024
CH057110	WALGREEN CO.	DBA: WALGREENS # 06485	19 LONDON RD	DELAWARE	OH	43015	01/01/2024
CH05711E	WALGREEN CO.	DBA: WALGREENS # 09047	1000 PARK AVE WEST	MANSFIELD	OH	44906	04/01/2024
CH057110	WALGREEN CO.	DBA: WALGREENS #13680	1040 DELAWARE AVENUE STE A	MARION	OH	43302	04/01/2025
CH057110	WALGREEN CO.	DBA: WALGREENS # 07523	5690 W BROAD STREET	GALLOWAY	OH	43119	04/01/2025
CH057110	WALGREEN CO.	DBA: WALGREENS #11966	180 COLEMANS XING	MARYSVILLE	OH	43040	04/01/2025
CH057110	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CH057110	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/12/2023
CH057110	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/12/2023
CH057110	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/12/2023
CH057110	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	03/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		2/6/2022 12:00:00 AM	2/8/2022 10:05 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/8/2022 10:05 AM
Terminations	Termination Date	Update	Recertification		4/1/2022 12:00:00 AM	2/8/2022 10:05 AM
Terminations	Termination Effective Date	Update	Recertification		2/6/2022 12:00:00 AM	2/8/2022 10:05 AM
Terminations	Termination Reason	Update	Recertification		Site closure	2/8/2022 10:05 AM
Details	Last Recertification Date	Update	Recertification	2/4/2020 8:27:43 AM	2/26/2021 1:17:05 PM	2/26/2021 1:17 PM
Contacts	Authorizing Official	Update	AO Change Request	Toward, Brett Interim CEO Third Street Family Health Services 4195267880	Toward, Brett CEO/CMO Third Street Family Health Services 4195226191	2/4/2020 11:44 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 7:06:46 AM	2/4/2020 8:27:43 AM	2/4/2020 8:27 AM
Contacts	Authorizing Official	Update	Profile Change Request	POLLICK, JARED CEO Third Street Family Health Services 4195267880	Toward, Brett Interim CEO Third Street Family Health Services 4195267880	10/4/2019 9:58 AM
Contacts	Signed By	Update	Profile Change Request	POLLICK, JARED CEO Third Street Family Health Services 4195267880	Toward, Brett Interim CEO Third Street Family Health Services 4195267880	10/4/2019 9:58 AM
Details	Last Recertification Date	Update	Recertification	2/9/2018 10:16:04 AM	1/29/2019 7:06:46 AM	1/29/2019 7:06 AM
Contacts	Primary Contact	Update	Change Request	Heflin, Mary Director of Nursing Third Street Community Clinic 4195267879	Sullinger, Barbara CFO Third Street Family Health Services 4195277867	10/25/2018 3:13 PM
Details	Entity Subname	Update	Change Request	Mansfield Family Health	Mansfield Family Health - Admin Office	10/25/2018 3:13 PM
Details	Last Recertification Date	Update	Recertification	2/9/2017 12:00:00 AM	2/9/2018 10:16:04 AM	2/9/2018 10:16 AM
Contacts	Authorizing Official	Update		POLLICK, JARED CEO 4195267880	POLLICK, JARED CEO Third Street Family Health Services 4195267880	2/9/2018 10:11 AM
Contacts	Signed By	Update		POLLICK, JARED CEO 4195267880	POLLICK, JARED CEO Third Street Family Health Services 4195267880	2/9/2018 10:11 AM
Contacts	Primary Contact	Update		Heflin, Mary Director of Nursing 4195267879	Heflin, Mary Director of Nursing Third Street Community Clinic 4195267879	2/8/2018 8:32 AM
Contacts	Authorizing Official	Insert			POLLICK, JARED CEO 4195267880	7/25/2017 3:16 PM
Contacts	Signed By	Insert			POLLICK, JARED CEO 4195267880	7/25/2017 3:16 PM
Addresses	Main Address	Insert			741 Scholl Road, Suite A Mansfield, OH 44907	2/9/2017 3:14 PM
Contacts	Primary Contact	Insert			Heflin, Mary Director of Nursing 4195267879	2/9/2017 3:14 PM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	2/9/2017 12:00:00 AM	2/9/2017 3:14 PM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 1:55 PM
Details	Last Recertification Date	Update		2/12/2014 12:00:00 AM	2/3/2015 12:00:00 AM	2/3/2015 1:21 PM
Details	Entity Name	Update		THIRD STREET COMMUNITY CLINIC	3RD STREET COMMUNITY CLINIC	3/31/2014 4:25 PM
Details	Last Recertification Date	Update			2/12/2014 12:00:00 AM	2/12/2014 2:05 PM
Addresses	Billing Address	Insert			Third Street Community Clinic 600 W Third St Mansfield, OH 44906	2/25/2013 4:43 PM
Details	340B ID	Update		IS-FN-CH05711B	CH05711B	2/25/2013 4:43 PM
Details	Entity Name	Update		3RD STREET COMMUNITY CLINIC	THIRD STREET COMMUNITY CLINIC	2/25/2013 4:43 PM
Dates	Participating Approval Date	Update			2/25/2013 12:00:00 AM	2/25/2013 4:43 PM
Details	State	Update		Pending	Active	2/25/2013 4:43 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	2/25/2013 4:43 PM
Details	340B ID	Update		FN?-CHC00581-00	IS-FN-CH05711B	2/20/2013 1:37 PM
Details	340B ID	Update		IS-FN-CHC00581-00	FN?-CHC00581-00	2/20/2013 12:27 PM
Details	Grant Number	Update			H80CS00581	2/11/2013 5:37 PM
Details	340B ID	Update		ONLINE_REG	IS-FN-CHC00581-00	2/11/2013 5:37 PM
Details	Entity Name	Update		Mansfield Family Health	3RD STREET COMMUNITY CLINIC	2/11/2013 5:37 PM
Details	Entity Subname	Update			Mansfield Family Health	2/11/2013 5:37 PM
Details	Last Recertification Date	Insert				1/11/2013 2:00 PM
Details	Grant Number	Insert				1/11/2013 2:00 PM
Details	340B ID	Insert			ONLINE_REG	1/11/2013 2:00 PM
Details	Is Authorizing Official EHB Data	Insert				1/11/2013 2:00 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/11/2013 2:00 PM
Details	Medicare Provider Number	Insert				1/11/2013 2:00 PM
Details	Entity Name	Insert			Mansfield Family Health	1/11/2013 2:00 PM
Details	Program Code	Insert			CH	1/11/2013 2:00 PM
Details	Entity Subname	Insert				1/11/2013 2:00 PM
Dates	Participating Approval Date	Insert				1/11/2013 2:00 PM
Details	State	Insert			Pending	1/11/2013 2:00 PM
Dates	Registration Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 2:00 PM
Dates	Signed By Date	Insert			1/11/2013 12:00:00 AM	1/11/2013 2:00 PM
Dates	Start Date	Insert				1/11/2013 2:00 PM
Terminations	Termination Comments	Insert				1/11/2013 2:00 PM
Terminations	Termination Date	Insert				1/11/2013 2:00 PM
Terminations	Termination Effective Date	Insert				1/11/2013 2:00 PM
Terminations	Termination Reason	Insert				1/11/2013 2:00 PM

340B Drug Pricing Program Database