Covered Entity Details

CHC24140-02 Southern Tier Community Health Center Network (Active) - information as of 5/22/2025 11:58:55 PM

Main Details

Name

Southern Tier Community Health Center Network

Subdivision Name

Southern Tier Community Health Center Network, Houghton site

Type

HRSA-Funded Health Center

Site ID

BPS-H80-011589

340B ID

CHC24140-02

Grant Number

H80CS24140

Additional Details

Current Program Status

Active

Registration Date

2/28/2013

Participating Start Date

3/1/2013

Participating Approval Date

2/28/2013

Last Recertification Date

2/18/2025

Contacts

Authorizing Official

Southern Tier Community Health Center Network, Inc.
Brett Lawton, CEO
(716) 701-6831

Primary Contact

Southern Tier Community Health Center Network, Inc.
Allison Green, 340b Program Manager
(716) 701-6864

Addresses

Street Address

9864 Luckey Dr
Houghton, NY 14744-8706

Billing Address

Southern Tier Community Health Center Network
135 N Union St
Olean, NY 14760-2736

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

Comments

Comment	Last Updated On
3/3/13 IMMEDIATE START DATE DUE TO PUBLIC HEALTH EMERGENCY IN NY	03/01/2013

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
NY	02587231	1184654477
PA	101495756	1184654477

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00539	415 N. UNION ST.	OLEAN	NY	14760	07/01/2024	10/01/2024		10/01/2024
Contract Detail	ECKERD CORPORATION	RITE AID #10875	265 NORTH UNION STREET	OLEAN	NY	14760	07/01/2024	10/01/2024		10/01/2024
Contract Detail	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	10/10/2014	01/01/2015		10/10/2014
Contract Detail	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	10/15/2024	01/01/2025		01/01/2025
Contract Detail	PRIZEL'S PHARMACY	535 MAIN ST		OLEAN	NY	14760	10/15/2014	01/01/2015	10/17/2017	10/17/2017
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #868	9 BROAD STREET	SALAMANCA	NY	14779	07/01/2024	10/01/2024		10/01/2024
Contract Detail	VIC VENA PHARMACY INC	D B A VENA VIC PHARMACY INC	1322 WEST STATE ST	OLEAN	NY	14760-2036	07/02/2013	10/01/2013	07/01/2020	02/03/2021
Contract Detail	WAL-MART PHARMACY 10-2159	RTE 417	1869 PLAZA DR	OLEAN	NY	14760	07/01/2024	10/01/2024		10/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC24140-00	Active	BPS-H80-012224	Southern Tier Community Health Center Network	Southern Tier Community Health Center Network, Olean site	135 N. Union St.	Olean	NY
CHC24140-01	Active	BPS-H80-011605	Southern Tier Community Health Center Network	Southern Tier Community Health Center Network, Cuba Site	132 W Main St	Cuba	NY
CHC24140-02	Active	BPS-H80-011589	Southern Tier Community Health Center Network	Southern Tier Community Health Center Network, Houghton site	9864 Luckey Dr	Houghton	NY
CHC24140-03	Active	BPS-H80-019021	Southern Tier Community Health Center Network	Southern Tier Community Health Center Network, Salamanca site	445 Broad St.	Salamanca	NY
CHC24140-04	Active	BPS-H80-028288	Southern Tier Community Health Center Network	Southern Tier Community Health Center Network, Bradford site	159 Interstate Pkwy	Bradford	PA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC24140-00	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/01/2023
CHC24140-00	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2023
CHC24140-00	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/01/2023
CHC24140-00	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/01/2023	06/30/2023
CHC24140-00	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2023
CHC24140-00	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/01/2023
CHC24140-00	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2023
CHC24140-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2025
CHC24140-00	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2024
CHC24140-00	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2024
CHC24140-00	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2024
CHC24140-00	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2024
CHC24140-00	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2024
CHC24140-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2023
CHC24140-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2023
CHC24140-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2023
CHC24140-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2023
CHC24140-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2023
CHC24140-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2023
CHC24140-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2023
CHC24140-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2023
CHC24140-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2023
CHC24140-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2023
CHC24140-00	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00539	415 N. UNION ST.	OLEAN	NY	14760	07/01/2020
CHC24140-01	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00539	415 N. UNION ST.	OLEAN	NY	14760	10/01/2024
CHC24140-02	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00539	415 N. UNION ST.	OLEAN	NY	14760	10/01/2024
CHC24140-03	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00539	415 N. UNION ST.	OLEAN	NY	14760	10/01/2024
CHC24140-04	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00539	415 N. UNION ST.	OLEAN	NY	14760	10/01/2024
CHC24140-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2023
CHC24140-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2023
CHC24140-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2023
CHC24140-00	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2025
CHC24140-00	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2024
CHC24140-00	ECKERD CORPORATION	RITE AID #10872	10 WEST MAIN STREET	CUBA	NY	14727	04/11/2013	07/24/2018
CHC24140-00	ECKERD CORPORATION	RITE AID #10875	265 NORTH UNION STREET	OLEAN	NY	14760	04/11/2013
CHC24140-00	ECKERD CORPORATION	RITE AID #10823	12208 N.Y. STATE ROUTE 16 P.O.BOX 617	YORKSHIRE	NY	14173	07/01/2024
CHC24140-01	ECKERD CORPORATION	RITE AID #10875	265 NORTH UNION STREET	OLEAN	NY	14760	10/01/2024
CHC24140-02	ECKERD CORPORATION	RITE AID #10875	265 NORTH UNION STREET	OLEAN	NY	14760	10/01/2024
CHC24140-03	ECKERD CORPORATION	RITE AID #10875	265 NORTH UNION STREET	OLEAN	NY	14760	10/01/2024
CHC24140-04	ECKERD CORPORATION	RITE AID #10875	265 NORTH UNION STREET	OLEAN	NY	14760	10/01/2024
CHC24140-00	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	01/01/2023
CHC24140-00	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/01/2023
CHC24140-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/01/2023
CHC24140-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/01/2023
CHC24140-00	FILLMORE & FISHER PHCY	DBA CUBA PHARMACY	2 CENTER ST	CUBA	NY	14727	04/03/2013	05/29/2023
CHC24140-00	FILLMORE AND FISHER PHARMACY	POST OFFICE BOX 272	10560 ROUTE 19	FILLMORE	NY	14735	04/03/2013	05/29/2023
CHC24140-00	GENOA HEALTHCARE LLC	110 CAMPUS DR RM P		BRADFORD	PA	16701	10/01/2024
CHC24140-00	INFINITY COMPOUNDING SOLUTIONS, LLC	DBA INFINITY CARE SOLUTIONS	1204 SE 28TH ST STE 2	BENTONVILLE	AR	72712-3887	07/01/2024
CHC24140-00	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	01/01/2015
CHC24140-02	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	01/01/2015
CHC24140-01	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	01/01/2015
CHC24140-03	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	10/01/2024
CHC24140-04	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	10/01/2024
CHC24140-02	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	01/01/2025
CHC24140-01	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	01/01/2025
CHC24140-04	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	01/01/2025
CHC24140-03	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	01/01/2025
CHC24140-00	J HORN LLC	DBA: DAN HORN PHARMACY & HEALTH SERVICES	111 E GREEN ST	OLEAN	NY	14760	01/01/2025
CHC24140-00	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	10/01/2024
CHC24140-00	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/01/2024
CHC24140-00	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2024
CHC24140-00	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/01/2024
CHC24140-00	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2024
CHC24140-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04270	10 DAVIS ST	BRADFORD	PA	16701	07/01/2020	04/01/2022
CHC24140-00	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04270	10 DAVIS ST	BRADFORD	PA	16701	04/01/2024
CHC24140-00	PRIZEL'S PHARMACY	535 MAIN ST		OLEAN	NY	14760	01/01/2015	10/17/2017
CHC24140-02	PRIZEL'S PHARMACY	535 MAIN ST		OLEAN	NY	14760	01/01/2015	10/17/2017
CHC24140-01	PRIZEL'S PHARMACY	535 MAIN ST		OLEAN	NY	14760	01/01/2015	10/17/2017
CHC24140-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2023
CHC24140-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2023
CHC24140-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2023
CHC24140-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2023
CHC24140-00	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2024
CHC24140-00	RITE AID OF NEW YORK, INC.	RITE AID #868	9 BROAD STREET	SALAMANCA	NY	14779	07/01/2015
CHC24140-00	RITE AID OF NEW YORK, INC.	RITE AID #1649	81 WEST MAIN STREET	GOWANDA	NY	14070	07/01/2024
CHC24140-00	RITE AID OF NEW YORK, INC.	RITE AID #3033	963 FAIRMOUNT AVENUE WE	JAMESTOWN	NY	14701	07/01/2024
CHC24140-00	RITE AID OF NEW YORK, INC.	RITE AID #3838	40 WEST MAIN STREET	SPRINGVILLE	NY	14141	07/01/2024
CHC24140-01	RITE AID OF NEW YORK, INC.	RITE AID #868	9 BROAD STREET	SALAMANCA	NY	14779	10/01/2024
CHC24140-02	RITE AID OF NEW YORK, INC.	RITE AID #868	9 BROAD STREET	SALAMANCA	NY	14779	10/01/2024
CHC24140-03	RITE AID OF NEW YORK, INC.	RITE AID #868	9 BROAD STREET	SALAMANCA	NY	14779	10/01/2024
CHC24140-04	RITE AID OF NEW YORK, INC.	RITE AID #868	9 BROAD STREET	SALAMANCA	NY	14779	10/01/2024
CHC24140-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1976	207 ROUTE 6 WEST	COUDERSPORT	PA	16915	07/01/2024
CHC24140-00	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2474	59 NORTH MAIN STREET	PORT ALLEGANY	PA	16743	07/01/2024
CHC24140-00	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2024
CHC24140-00	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	07/01/2024
CHC24140-00	TOPS MARKETS, LLC	2401 W. STATE STREET		OLEAN	NY	14760	10/01/2023
CHC24140-00	VIC VENA PHARMACY INC	D B A VENA VIC PHARMACY INC	1322 WEST STATE ST	OLEAN	NY	14760-2036	10/01/2013	07/01/2020
CHC24140-02	VIC VENA PHARMACY INC	D B A VENA VIC PHARMACY INC	1322 WEST STATE ST	OLEAN	NY	14760-2036	10/01/2013	07/01/2020
CHC24140-01	VIC VENA PHARMACY INC	D B A VENA VIC PHARMACY INC	1322 WEST STATE ST	OLEAN	NY	14760-2036	10/01/2013	07/01/2020
CHC24140-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CHC24140-00	WAL-MART PHARMACY 10-2159	RTE 417	1869 PLAZA DR	OLEAN	NY	14760	04/01/2014
CHC24140-01	WAL-MART PHARMACY 10-2159	RTE 417	1869 PLAZA DR	OLEAN	NY	14760	10/01/2024
CHC24140-02	WAL-MART PHARMACY 10-2159	RTE 417	1869 PLAZA DR	OLEAN	NY	14760	10/01/2024
CHC24140-03	WAL-MART PHARMACY 10-2159	RTE 417	1869 PLAZA DR	OLEAN	NY	14760	10/01/2024
CHC24140-04	WAL-MART PHARMACY 10-2159	RTE 417	1869 PLAZA DR	OLEAN	NY	14760	10/01/2024
CHC24140-00	WAL-MART PHARMACY 10-3514	50 FOSTER BROOK BLVD		BRADFORD	PA	16701	07/01/2023
CHC24140-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CHC24140-00	WALGREEN EASTERN CO.	DBA: WALGREENS #12381	10 N. MAIN ST.	WELLSVILLE	NY	14895-1232	07/01/2024
CHC24140-00	WALGREEN EASTERN CO., INC.	WALGREENS #19310	10 W MAIN ST	CUBA	NY	14727	07/01/2018	12/07/2020
CHC24140-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17344	4175 STATE ROUTE 417	WELLSVILLE	NY	14895	07/01/2024
CHC24140-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11984	3242 ROUTE 39	YORKSHIRE	NY	14173	04/01/2025
CHC24140-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2025
CHC24140-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2025
CHC24140-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2025
CHC24140-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CHC24140-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CHC24140-00	WORTHY PHARMACY, LLC	202 MAIN ST		OLEAN	NY	14760	07/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/12/2024 8:14:15 AM	2/18/2025 2:17:50 PM	2/18/2025 2:17 PM
Addresses	Billing Address	Insert	Group Change Request		Southern Tier Community Health Center Network 135 N Union St Olean, NY 14760-2736	9/22/2024 10:34 PM
Contacts	Primary Contact	Update	Change Request	Jackson, Hope Accounting Specialist Southern Tier Community Health Center Network 7167016883	Green, Allison 340b Program Manager Southern Tier Community Health Center Network, Inc. 7167016864	4/15/2024 10:03 AM
Details	Last Recertification Date	Update	Recertification	2/16/2023 8:27:13 AM	2/12/2024 8:14:15 AM	2/12/2024 8:14 AM
Contacts	Authorizing Official	Update	Change Request	Langdon, Angela COO Southern Tier Community Health Center Network 7167016828	Lawton, Brett CEO Southern Tier Community Health Center Network, Inc. 7167016831	2/24/2023 7:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/16/2023 8:27 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		02587231	2/16/2023 8:27 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	2/16/2023 8:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/16/2023 8:27 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		101495756	2/16/2023 8:27 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	2/16/2023 8:27 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1184654477	2/16/2023 8:27 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	2/16/2023 8:27 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1184654477	2/16/2023 8:27 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	2/16/2023 8:27 AM
Contacts	Primary Contact	Update	Recertification	Lawton, Brett CEO Southern Tier Community Health Center Network, Inc. 7167016831	Jackson, Hope Accounting Specialist Southern Tier Community Health Center Network 7167016883	2/16/2023 8:27 AM
Details	Last Recertification Date	Update	Recertification	2/3/2022 12:13:30 PM	2/16/2023 8:27:13 AM	2/16/2023 8:27 AM
Contacts	Primary Contact	Update	Recertification	Eyring, Amanda Executive Assistant Southern Tier Community Health Center Network 7167016846	Lawton, Brett CEO Southern Tier Community Health Center Network, Inc. 7167016831	2/3/2022 12:13 PM
Details	Last Recertification Date	Update	Recertification	2/3/2021 7:12:28 AM	2/3/2022 12:13:30 PM	2/3/2022 12:13 PM
Details	Last Recertification Date	Update	Recertification	1/30/2020 2:28:28 PM	2/3/2021 7:12:28 AM	2/3/2021 7:12 AM
Details	Last Recertification Date	Update	Recertification	2/14/2019 1:11:01 PM	1/30/2020 2:28:28 PM	1/30/2020 2:28 PM
Details	Last Recertification Date	Update	Recertification	2/13/2018 12:04:21 PM	2/14/2019 1:11:01 PM	2/14/2019 1:11 PM
Contacts	Authorizing Official	Update	AO Change Request	Zimmermann, AnnMarie Medical Director Southern Tier Community Health Center Network 7163757500	Langdon, Angela COO Southern Tier Community Health Center Network 7167016828	2/14/2019 8:19 AM
Contacts	Primary Contact	Update	Recertification	Zimmermann, AnnMarie Medical Director 7163757500	Eyring, Amanda Executive Assistant Southern Tier Community Health Center Network 7167016846	2/13/2018 12:04 PM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/13/2018 12:04:21 PM	2/13/2018 12:04 PM
Contacts	Authorizing Official	Update	AO Change Request	Mayeaux, Gail Speedy Executive Director Southern Tier Community Health Center Network, Inc. 7163757500-6831	Zimmermann, AnnMarie Medical Director Southern Tier Community Health Center Network 7163757500	2/12/2018 11:08 AM
Contacts	Authorizing Official	Update		Mayeaux, Gail Speedy Executive Director 7163757500-6831	Mayeaux, Gail Speedy Executive Director Southern Tier Community Health Center Network, Inc. 7163757500-6831	9/21/2017 11:09 AM
Contacts	Authorizing Official	Insert			Mayeaux, Gail Speedy Executive Director 7163757500-6831	7/14/2017 11:42 AM
Addresses	Main Address	Insert			9864 Luckey Dr Houghton, NY 14744-8706	2/1/2017 9:19 AM
Contacts	Signed By	Insert			Speedy, Gail C. Executive Director 7163757500-6831	2/1/2017 9:19 AM
Contacts	Primary Contact	Insert			Zimmermann, AnnMarie Medical Director 7163757500	2/1/2017 9:19 AM
Details	Last Recertification Date	Update		2/25/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 9:19 AM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	2/25/2016 12:00:00 AM	2/25/2016 1:27 PM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	2/10/2015 12:00:00 AM	2/10/2015 3:36 PM
Details	Entity Name	Update		Southern Tier Community Health Center Network, Inc.	Southern Tier Community Health Center Network	3/31/2014 4:25 PM
Details	Entity Subname	Update		Houghton Site	Southern Tier Community Health Center Network, Houghton site	3/31/2014 4:25 PM
Details	Last Recertification Date	Update			2/10/2014 12:00:00 AM	2/10/2014 7:51 AM
Dates	Start Date	Update		4/1/2013 12:00:00 AM	3/1/2013 12:00:00 AM	3/1/2013 12:34 PM
Details	Comments Public	Insert			3/3/13 IMMEDIATE START DATE DUE TO PUBLIC HEALTH EMERGENCY IN NY	3/1/2013 12:34 PM
Details	340B ID	Update		ONLINE_REG	CHC24140-02	2/28/2013 5:37 PM
Dates	Participating Approval Date	Update			2/28/2013 12:00:00 AM	2/28/2013 5:37 PM
Details	State	Update		Pending	Active	2/28/2013 5:37 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	2/28/2013 5:37 PM
Details	Last Recertification Date	Insert				2/28/2013 3:11 PM
Details	Grant Number	Insert			H80CS24140	2/28/2013 3:11 PM
Details	340B ID	Insert			ONLINE_REG	2/28/2013 3:11 PM
Details	Is Authorizing Official EHB Data	Insert				2/28/2013 3:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert				2/28/2013 3:11 PM
Details	Medicare Provider Number	Insert				2/28/2013 3:11 PM
Details	Entity Name	Insert			Southern Tier Community Health Center Network, Inc.	2/28/2013 3:11 PM
Details	Program Code	Insert			CH	2/28/2013 3:11 PM
Details	Entity Subname	Insert			Houghton Site	2/28/2013 3:11 PM
Dates	Participating Approval Date	Insert				2/28/2013 3:11 PM
Details	State	Insert			Pending	2/28/2013 3:11 PM
Dates	Registration Date	Insert			2/28/2013 12:00:00 AM	2/28/2013 3:11 PM
Dates	Signed By Date	Insert			2/28/2013 12:00:00 AM	2/28/2013 3:11 PM
Dates	Start Date	Insert				2/28/2013 3:11 PM
Terminations	Termination Comments	Insert				2/28/2013 3:11 PM
Terminations	Termination Date	Insert				2/28/2013 3:11 PM
Terminations	Termination Effective Date	Insert				2/28/2013 3:11 PM
Terminations	Termination Reason	Insert				2/28/2013 3:11 PM

340B Drug Pricing Program Database