Covered Entity Details

FQHCLA150D UNITED COMMUNITY SERVICES INC (Terminated) - information as of 5/26/2025 12:54:25 AM

Main Details

Name

UNITED COMMUNITY SERVICES INC

Subdivision Name

UCFS Plainfield Health Center

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-012291

340B ID

FQHCLA150D

Grant Number

LALCS00072

Additional Details

Current Program Status

Terminated

Registration Date

1/14/2013

Participating Start Date

4/1/2013

Participating Approval Date

2/27/2013

Last Recertification Date

2/19/2015

Termination Date
Termination Reason

1/1/2016
Change of covered entity type

Contacts

Authorizing Official

Nancy Cowser, Sr VP Strategy
(860) 822-4161

Primary Contact

Nancy Cowser, Sr VP Strategy
(860) 822-4161

Addresses

Street Address

120-122 Plainfield Road
Moosup, CT 06354

Billing Address

UCFS
34 E Town St
Norwich, CT 06360

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	Address Cont.	City	State
FQHCLA150	Terminated	BPS-LAL-009805	UNITED COMMUNITY & FAMILY SERVICES, INC.		47 TOWN STREET		NORWICH	CT
FQHCLA150A	Terminated	BPS-LAL-009807	UNITED COMMUNITY SERVICES INC	BHS Site - Satellite	212 Upton Road	Suite C	Colchester	CT
FQHCLA150B	Terminated	BPS-LAL-014762	UNITED COMMUNITY SERVICES INC	BHS Site - Satellite (New London)	351 N FRONTAGE RD, SUITE 24		New London	CT
FQHCLA150C	Terminated	BPS-LAL-009808	UNITED COMMUNITY SERVICES INC	UCFS at Griswold - Satellite	76 Main Street		Jewett City	CT
FQHCLA150D	Terminated	BPS-LAL-012291	UNITED COMMUNITY SERVICES INC	UCFS Plainfield Health Center	120-122 Plainfield Road		Moosup	CT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA150	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01027	372 WEST MAIN STREET	NORWICH	CT	06360	01/01/2015	01/01/2016
FQHCLA150	CVS PHARMACY INC	150 INDUSTRIAL DR., WRHS #2		NORTH SMITHFIELD	RI	02896	01/01/2015	01/01/2016
FQHCLA150	GENOA HEALTHCARE OF CONNECTICUT, LLC		47 TOWN STREET SUITE G	NORWICH	CT	06360-2323	04/01/2015	01/01/2016
FQHCLA150	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2015	09/14/2015
FQHCLA150	WAL-MART PHARMACY 10-2170	220 SALEM TURNPIKE		NORWICH	CT	06360	01/01/2015	09/14/2015
FQHCLA150	WAL-MART PHARMACY 10-2854	180 RIVER ROAD		LISBON	CT	06351	01/01/2015	09/14/2015
FQHCLA150	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2015	09/14/2015

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Insert		Cowser, Nancy Sr VP Strategy 8608224161	2/8/2017 2:22 PM
Contacts	Primary Contact	Insert		Cowser, Nancy Sr VP Strategy 8608224161	2/8/2017 2:22 PM
Contacts	Signed By	Insert		Smart, Joanne CFO 8608224153	8/9/2016 8:07 AM
Addresses	Main Address	Insert		120-122 Plainfield Road Moosup, CT 06354	12/31/2015 10:47 AM
Addresses	Billing Address	Insert		UCFS 34 E Town St Norwich, CT 06360	12/31/2015 10:47 AM
Details	Grant Number	Update	LAL000072	LALCS00072	12/31/2015 10:47 AM
Dates	Last Date That 340B Drugs Purchased	Update		12/31/2015 12:00:00 AM	12/31/2015 10:47 AM
Details	State	Update	Active	Terminated	12/31/2015 10:47 AM
Terminations	Termination Comments	Update		12/31/16 TERMINATED BY OPA/NOT BY ON-LINE CHANGE REQUEST, ORGANIZATION RECEIVED H80 GRANT AND CHANGED TO CH ENTITY TYPE	12/31/2015 10:47 AM
Terminations	Termination Date	Update		1/1/2016 12:00:00 AM	12/31/2015 10:47 AM
Terminations	Termination Effective Date	Update		1/1/2016 12:00:00 AM	12/31/2015 10:47 AM
Terminations	Termination Reason	Update		Change of covered entity type	12/31/2015 10:47 AM
Details	Last Recertification Date	Update	3/10/2014 12:00:00 AM	2/19/2015 12:00:00 AM	2/19/2015 4:06 PM
Details	Last Recertification Date	Update		3/10/2014 12:00:00 AM	3/10/2014 7:14 PM
Details	340B ID	Update	IS-FN-FQHCLA72E	FQHCLA150D	2/27/2013 1:43 PM
Dates	Participating Approval Date	Update		2/27/2013 12:00:00 AM	2/27/2013 1:43 PM
Details	State	Update	Pending	Active	2/27/2013 1:43 PM
Dates	Start Date	Update		4/1/2013 12:00:00 AM	2/27/2013 1:43 PM
Details	340B ID	Update	IS-FN-FQCHLA72E	IS-FN-FQHCLA72E	2/19/2013 1:13 PM
Details	340B ID	Update	ONLINE_REG	IS-FN-FQCHLA72E	2/19/2013 1:04 PM
Details	Entity Name	Update	United Community and Family Services, Inc.	UNITED COMMUNITY SERVICES INC	2/19/2013 1:04 PM
Details	Entity Subname	Update	Plainfield	UCFS Plainfield Health Center	2/19/2013 1:04 PM
Details	Last Recertification Date	Insert			1/14/2013 3:56 PM
Details	Grant Number	Insert		LAL000072	1/14/2013 3:56 PM
Details	340B ID	Insert		ONLINE_REG	1/14/2013 3:56 PM
Details	Is Authorizing Official EHB Data	Insert			1/14/2013 3:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert			1/14/2013 3:56 PM
Details	Medicare Provider Number	Insert			1/14/2013 3:56 PM
Details	Entity Name	Insert		United Community and Family Services, Inc.	1/14/2013 3:56 PM
Details	Program Code	Insert		FQHCLA	1/14/2013 3:56 PM
Details	Entity Subname	Insert		Plainfield	1/14/2013 3:56 PM
Dates	Participating Approval Date	Insert			1/14/2013 3:56 PM
Details	State	Insert		Pending	1/14/2013 3:56 PM
Dates	Registration Date	Insert		1/14/2013 12:00:00 AM	1/14/2013 3:56 PM
Dates	Signed By Date	Insert		1/14/2013 12:00:00 AM	1/14/2013 3:56 PM
Dates	Start Date	Insert			1/14/2013 3:56 PM
Terminations	Termination Comments	Insert			1/14/2013 3:56 PM
Terminations	Termination Date	Insert			1/14/2013 3:56 PM
Terminations	Termination Effective Date	Insert			1/14/2013 3:56 PM
Terminations	Termination Reason	Insert			1/14/2013 3:56 PM

340B Drug Pricing Program Database