Covered Entity Details

CH06345AV PRESBYTERIAN MEDICAL SERVICES, INC. (Terminated) - information as of 6/16/2025 11:22:28 PM

Main Details

Name

PRESBYTERIAN MEDICAL SERVICES, INC.

Subdivision Name

PMS - Farmington Community Health Center Dental

Type

HRSA-Funded Health Center

Site ID

BPS-H80-009414

340B ID

CH06345AV

Grant Number

H80CS00205

Additional Details

Current Program Status

Terminated

Registration Date

4/2/2013

Participating Start Date

7/1/2013

Participating Approval Date

5/28/2013

Last Recertification Date

2/7/2017

Termination Date
Termination Reason

4/1/2017
Site closure

Contacts

Authorizing Official

Presbyterian Medical Services
Steven C. Hansen, CEO
(505) 982-5565 Ext: 3470

Primary Contact

Presbyterian Medical Services
Stephen M. Quesada, DIRECTOR OF PHARMACY
(505) 443-2634

Addresses

Street Address

2700 Farmington Ave, BLDG C, STE 1
Farmington, NM 87401-4550

Billing Address

Presbyterian Medical Services
1422 Paseo de Peralta
Santa Fe, NM 87501

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
CH063450	Active	BPS-H80-000712	PRESBYTERIAN MEDICAL SERVICES, INC.	PRESBYTERIAN MEDICAL SERVICES	1422 PASEO DE PERALTA	SANTA FE	NM
CH06345A	Active	BPS-H80-000548	PRESBYTERIAN MEDICAL SERVICES	CUBA HEALTH CENTER	6349 U.S. Highway 550	CUBA	NM
CH06345AC	Active	BPS-H80-004001	PRESBYTERIAN MEDICAL SERVICES	SACRAMENTO MOUNTAIN MEDICAL CENTER	74 JAMES CANYON HIGHWAY	CLOUDCROFT	NM
CH06345AD	Active	BPS-H80-002436	PRESBYTERIAN MEDICAL SERVICES	MOUNTAINAIR FAMILY HEALTH CENTER	105 EAST PINON	MOUNTAINAIR	NM
CH06345AE	Active	BPS-H80-001828	PRESBYTERIAN MEDICAL SERVICES	MAGDALENA AREA HEALTH CENTER	801 TENTH STREET	MAGDALENA	NM
CH06345AF	Active	BPS-H80-003180	PRESBYTERIAN MEDICAL SERVICES	TEEN HEALTH CENTER - SANTA FE HIGH SCHOOL	2100 YUCCA St.	SANTA FE	NM
CH06345AG	Active	BPS-H80-003727	PRESBYTERIAN MEDICAL SERVICES	WESTERN NEW MEXICO MEDICAL GROUP - GALLUP	610 N. 5tH ST	GALLUP	NM
CH06345AI	Terminated	BPS-H80-005039	PRESBYTERIAN MEDICAL SERVICES	SANTA FE COMMUNITY GUIDANCE CENTER	2960 RODEO PARK DR W	SANTA FE	NM
CH06345AJ	Active	BPS-H80-005231	PRESBYTERIAN MEDICAL SERVICES	SOCORRO COMMUNITY HEALTH CENTER	1300 ENTERPRISE	SOCORRO	NM
CH06345AL	Active	BPS-H80-010386	PRESBYTERIAN MEDICAL SERVICES	DEMING HEALTH CENTER	300 S. DIAMOND AVENUE	DEMING	NM
CH06345AM	Active	BPS-H80-007657	PRESBYTERIAN MEDICAL SERVICES	HOBBS FAMILY HEALTH CENTER	200 W. LEA	HOBBS	NM
CH06345AN	Active	BPS-H80-007899	PRESBYTERIAN MEDICAL SERVICES	QUEMADO HEALTH CENTER	8 OLD TOWN LOOP	QUEMADO	NM
CH06345AP	Active	BPS-H80-009479	PRESBYTERIAN MEDICAL SERVICES	CHAPARRAL FAMILY HEALTH CENTER	204 ANGELINA BLVD.	CHAPARRAL	NM
CH06345AQ	Active	BPS-H80-002255	PRESBYTERIAN MEDICAL SERVICES	WESTERN NEW MEXICO MEDICAL GROUP BEHAVIORAL HEALTH GALLUP	2025 E. AZTEC Ave	GALLUP	NM
CH06345AR	Active	BPS-H80-001666	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - TEEN HEALTH CENTER-CAPITAL HS	4851 Paseo Del Sol	Santa Fe	NM
CH06345AS	Active	BPS-H80-002393	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - CARLSBAD SCHOOL BASED HLTH CTR, THE CAVE	3000 W Church Street	Carlsbad	NM
CH06345AT	Active	BPS-H80-004615	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS- GALLUP TEEN HEALTH CENTER	1055 1/2 RICO	GALLUP	NM
CH06345AU	Terminated	BPS-H80-008163	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Healthy Tomorrows Van	2100 Yucca St	Santa Fe	NM
CH06345AV	Terminated	BPS-H80-009414	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Farmington Community Health Center Dental	2700 Farmington Ave, BLDG C, STE 1	Farmington	NM
CH06345AW	Terminated	BPS-H80-010887	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Lake Arthur School-Based Health Center	700 Broadway	Lake Arthur	NM
CH06345AX	Active	BPS-H80-011178	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Cuba School-Based Health Center	50 County Road 13	Cuba	NM
CH06345AY	Active	BPS-H80-012490	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Socorro Teen Health Center	1200 Michigan St.	Socorro	NM
CH06345AZ	Active	BPS-H80-013121	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Sandoval County Health Commons Dental Services	1500 Idalia Rd. BLDG B	Bernalillo	NM
CH06345B	Active	BPS-H80-014378	PRESBYTERIAN MEDICAL SERVICES	FARMINGTON COMMUNITY HEALTH CTR	1001 W. BROADWAY STE E	FARMINGTON	NM
CH06345BA	Active	BPS-H80-013223	PRESBYTERIAN MEDICAL SERVICES, INC.	Presbyterian Medical Services Family Health Center	2300 Grande Blvd. SE	Rio Rancho	NM
CH06345BB	Active	BPS-H80-013541	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Alamogordo Family Health Center	1501 E. 10th St.	Alamogordo	NM
CH06345BC	Active	BPS-H80-036853	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Santa Fe Family Health Center	4730 Beckner Road	Santa Fe	NM
CH06345BD	Active	BPS-H80-032663	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Alamogordo Behavioral Health Family Health Center	2360 Indian Wells Rd	Alamogordo	NM
CH06345BE	Active	BPS-H80-015218	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Deming Behavioral Health Health Center	901 W. Hickory St.	Deming	NM
CH06345BF	Active	BPS-H80-017224	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Valley Community Health Center	835 Spruce St., Suites C & D	Espanola	NM
CH06345BG	Active	BPS-H80-015303	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Ruidoso Behavioral Health Center	1400 Sudderth Dr.	Ruidoso	NM
CH06345BH	Active	BPS-H80-018621	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Espanola Family Wellness Center	1200 N Paseo de Onate	Espanola	NM
CH06345BJ	Active	BPS-H80-014771	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Carlsbad Family Health Center Behavioral Health	914 N CANAL ST	CARLSBAD	NM
CH06345BK	Active	BPS-H80-013859	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS Socorro Mental Health	1200 Highway 60 West	Socorro	NM
CH06345BL	Active	BPS-H80-027781	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Grants Family Counseling	1040 Sakelares Blvd	Grants	NM
CH06345BM	Active	BPS-H80-027320	Presbyterian Medical Services	PMS - Veguita Family Health Center	1 Salomon Griego Rd.	Veguita	NM
CH06345BN	Active	BPS-H80-001570	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - TOTAH BEHAVORIAL HLTH AUTHORITY	1615 OJO COURT	FARMINGTON	NM
CH06345BP	Active	BPS-H80-029640	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Pecos Valley Medical Center	199 NM Highway 50 BLDG A	Pecos	NM
CH06345BQ	Terminated	BPS-H80-029642	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Pecos Valley Medical Center School-Based Health Center	28 Panther Pkwy, North NM Highway 63	Pecos	NM
CH06345BR	Active	BPS-H80-028346	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - Express Care by Presbyterian Medical Services	202 W. Church St.	Carlsbad	NM
CH06345BS	Terminated	BPS-H80-031991	Presbyterian Medical Services	PMS - Hopewell Family Health Center	1775 Hopewell St	Santa Fe	NM
CH06345D	Active	BPS-H80-002575	PRESBYTERIAN MEDICAL SERVICES	QUESTA HEALTH CENTER	2573 STATE HIGHWAY 522	QUESTA	NM
CH06345E	Terminated	BPS-H80-004941	PRESBYTERIAN MEDICAL SERVICES	JEMEZ VALLEY MEDICAL CLINIC	8372 State HIGHWAY 4	Canon	NM
CH06345F	Active	BPS-H80-004995	PRESBYTERIAN MEDICAL SERVICES	CARLSBAD FAMILY HEALTH CENTER	2013 SAN JOSE BLVD	CARLSBAD	NM
CH06345G	Active	BPS-H80-001999	PRESBYTERIAN MEDICAL SERVICES	LOVING HEALTH CENTER	602 S. 4TH STREET	LOVING	NM
CH06345H	Active	BPS-H80-006116	PRESBYTERIAN MEDICAL SERVICES, INC.	PMS - COUNSELOR CLINIC	9837 U.S. HIGHWAY 550	COUNSELOR	NM
CH06345I	Active	BPS-H80-001786	PRESBYTERIAN MEDICAL SERVICES	OJO ENCINO NAVAJO CLINIC	2 OJO ENCINO CHAPTER ROAD	OJO ENCINO	NM
CH06345J	Active	BPS-H80-007449	PRESBYTERIAN MEDICAL SERVICES	TORREON HEALTH CLINIC	2500 State Highway 197	TORREON	NM
CH06345K	Active	BPS-H80-002562	PRESBYTERIAN MEDICAL SERVICES	ESPERANZA FAMILY HEALTH CENTER	903C N. 5TH STREET	ESTANCIA	NM
CH06345L	Active	BPS-H80-000110	PRESBYTERIAN MEDICAL SERVICES	CATRON COUNTY MEDICAL CENTER	1 FOSTER LANE	RESERVE	NM
CH06345O	Active	BPS-H80-002300	PRESBYTERIAN MEDICAL SERVICES	Grants Family Health Center	1217 BONITA STREET	GRANTS	NM
CH06345P	Active	BPS-H80-002930	PRESBYTERIAN MEDICAL SERVICES	WESTERN NEW MEXICO MEDICAL GROUP - THOREAU	15 EAST NAVARRE BLVD	THOREAU	NM
CH06345Q	Active	BPS-H80-000538	PRESBYTERIAN MEDICAL SERVICES	PMS - Artesia Family Health Center	1105 MEMORIAL DRIVE	ARTESIA	NM
CH06345R	Active	BPS-H80-001226	PRESBYTERIAN MEDICAL SERVICES	ORTIZ MOUNTAIN HEALTH CENTER	06B MAIN STREET	CERRILLOS	NM
CH06345S	Active	BPS-H80-000235	PRESBYTERIAN MEDICAL SERVICES	RIO RANCHO FAMILY HEALTH CENTER	184 UNSER BLVD NE	RIO RANCHO	NM
CH06345V	Active	BPS-H80-003952	PRESBYTERIAN MEDICAL SERVICES	QUAY COUNTY FAMILY HEALTH CENTER	1302 EAST MAIN STREET	TUCUMCARI	NM
CH06345Y	Active	BPS-H80-002596	PRESBYTERIAN MEDICAL SERVICES	TULAROSA MEDICAL CENTER	111 CENTRAL AVENUE	TULAROSA	NM

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH063450	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2021
CH063450	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2021
CH063450	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2021
CH063450	ACCREDO HEALTH GROUP INC	4343 W ROYAL LN STE 124		IRVING	TX	75063-2299	10/01/2024
CH063450	ACCREDO HEALTH GROUP INC	520 ELMWOOD PARK BLVD STE 100		NEW ORLEANS	LA	70123-6826	10/01/2024
CH063450	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/01/2021	08/01/2024
CH063450	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2021
CH063450	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2021
CH063450	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2024
CH063450	ACCREDO HEALTH GROUP, INC.	677 ALA MOANA BLVD STE 404		HONOLULU	HI	96813-5412	10/01/2024
CH063450	ALBERTSONS MARKET PHARMACY #665	202 W CHURCH ST		CARLSBAD	NM	88220	10/01/2018
CH063450	ALBERTSONS MARKET PHARMACY #680	2402 N. GRIMES		HOBBS	NM	88240	10/01/2018	02/22/2020
CH063450	ALBERTSONS MARKET PHARMACY #681	1300 EAST 10TH STEET		ALAMOGORDO	NM	88310	10/01/2018
CH063450	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	10/01/2021	08/31/2024
CH063450	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	10/01/2021	08/31/2024
CH063450	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2024
CH063450	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/01/2024
CH063450	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	01/01/2024	08/01/2024
CH063450	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	10/01/2024
CH063450	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	10/01/2024
CH063450	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2024
CH063450	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2024
CH063450	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2024
CH063450	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2024
CH063450	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2024
CH063450	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2024
CH063450	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2024
CH063450	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2024
CH063450	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH063450	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2024
CH063450	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	04/01/2024
CH063450	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	04/01/2024
CH063450	CORAM ALTERNATE SITE SERVICES, INC	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	12310 WORLD TRADE DRIVE SUITE 100	SAN DIEGO	CA	92128	07/01/2025
CH063450	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	2345 WATERS DRIVE	MENDOTA HEIGHTS	MN	55120	07/01/2025
CH063450	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	10/01/2023
CH063450	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2023
CH063450	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CH063450	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CH063450	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 5994	1202 N. RIVERSIDE DR.	ESPANOLA	NM	87532	10/01/2021
CH063450	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07552	1001 NEW MEXICO HWY 528, SE	RIO RANCHO	NM	87124	10/01/2021
CH063450	CVS PHARMACY, INC.	CVS/PHARMACY # 10448	801 N. CANAL ST.	CARLSBAD	NM	88220	10/01/2021
CH063450	CVS PHARMACY, INC.	DBA CVS/PHARMACY #10148	715 WEST BENDER BLVD.	HOBBS	NM	88240	10/01/2021
CH063450	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 7319	10700 UNSER BLVD., NW	ALBUQUERQUE	NM	87114	01/01/2024
CH063450	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10227	2907 CERRILLOS RD.	SANTA FE	NM	87507	01/01/2024
CH063450	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2024
CH063450	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	01/01/2024	08/01/2024
CH063450	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2023
CH063450	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2023
CH063450	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2023
CH063450	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2023
CH063450	LA PHARMACY LLC	1048 S GARFIELD AVE	STE 101	ALHAMBRA	CA	91801	10/01/2021	08/31/2024
CH063450	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	10/01/2021	08/31/2024
CH063450	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	01/01/2024
CH063450	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	01/01/2024
CH063450	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	10/01/2022
CH063450	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
CH063450	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/01/2024
CH063450	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/01/2024
CH063450	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2022
CH063450	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/01/2022
CH063450	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/01/2022
CH063450	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	10/01/2022
CH063450	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	01/01/2024
CH063450	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
CH063450	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
CH063450	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2022
CH063450	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	10/01/2021	08/31/2024
CH063450	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	10/01/2021	08/01/2024
CH063450	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2024
CH063450	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2024
CH063450	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2024
CH063450	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/01/2024	08/01/2024
CH063450	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/01/2024	08/01/2024
CH063450	SAFEWAY INC	SAFEWAY PHARMACY #2004	3540 E MAIN STREET	FARMINGTON	NM	87402-5329	10/01/2018
CH063450	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	01/01/2024	08/01/2024
CH063450	SMITH'S DRUG #409	SMITH'S FOOD KING NO 1	600 EAST 20TH ST	FARMINGTON	NM	87401	10/01/2020	01/01/2024
CH063450	SMITH'S FOOD & DRUG CTRS INC	SMITH'S PHARMACY #491	2110 S PACHECO ST	SANTA FE	NM	87505	10/01/2020	01/01/2024
CH063450	SMITH'S FOOD KING NO 1	SMITH'S DRUG #413	1000 RIO RANCHO DRIVE	RIO RANCHO	NM	87124	10/01/2020
CH063450	SMITH'S PHARMACY	02-B HIGHWAY 344		EDGEWOOD	NM	87015	10/01/2020	10/28/2024
CH063450	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	10/01/2021	01/01/2024
CH063450	TRUEPILL NY LLC	850 3RD AVE STE 404		BROOKLYN	NY	11232-1523	10/01/2021	01/01/2024
CH063450	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH063450	WAL-MART PHARMACY 10-0549	3800 NO. LOVINGTON HWY.		HOBBS	NM	88240	10/01/2017
CH063450	WAL-MART PHARMACY 10-0611	4500 A NORTH MAIN		ROSWELL	NM	88201	10/01/2017	03/27/2018
CH063450	WAL-MART PHARMACY 10-0826	4600 E MAIN STREET		FARMINGTON	NM	87402	10/01/2017
CH063450	WAL-MART PHARMACY 10-0829	3251 CERRILLOS ROAD		SANTA FE	NM	87507	10/01/2017
CH063450	WAL-MART PHARMACY 10-0868	2401 SOUTH CANAL ST		CARLSBAD	NM	88220	10/01/2017
CH063450	WAL-MART PHARMACY 10-0873	926 PASEO DEL PUEBLO SUR		TAOS	NM	87571	10/01/2017	03/27/2018
CH063450	WAL-MART PHARMACY 10-0906	1650WEST MALONEY AVENUE		GALLUP	NM	87301	10/01/2017
CH063450	WAL-MART PHARMACY 10-1306	233 S NEW YORK AVENUE		ALAMOGORDO	NM	88310	10/01/2017
CH063450	WAL-MART PHARMACY 10-1324	100 WEST WHITE PARK DR		NOGALES	AZ	85621	10/01/2017	03/27/2018
CH063450	WAL-MART PHARMACY 10-1414	1 I-25 BYPASS		BELEN	NM	87002	10/01/2017	03/27/2018
CH063450	WAL-MART PHARMACY 10-2652	1000 ROBERTS DRIVE		GRANTS	NM	87020	10/01/2018
CH063450	WAL-MART PHARMACY 10-2656	1610 N RIVERSIDE DRIVE		ESPANOLA	NM	87532	10/01/2017	12/31/2018
CH063450	WAL-MART PHARMACY 10-3423	5701 HERRERA DRIVE		SANTA FE	NM	87507	10/01/2017
CH063450	WAL-MART PHARMACY 10-3427	604 NORTH 26TH STREET		ARTESIA	NM	88210	10/01/2017
CH063450	WAL-MART PHARMACY 10-3428	1400 WEST MAIN ST.		FARMINGTON	NM	87401	10/01/2017
CH063450	WAL-MART PHARMACY 10-3732	901 UNSER BLVD SE		RIO RANCHO(W)	NM	87124	10/01/2017
CH063450	WAL-MART PHARMACY 10-4201	66 STATE ROUTE #344		EDGEWOOD	NM	87015	10/01/2017
CH063450	WAL-MART PHARMACY 10-5166	1021 E PINE ST		DEMING	NM	88030	10/01/2017
CH063450	WAL-MART PHARMACY 10-5492	700 NORTH 6TH STREET		SOCORRO	NM	87801	10/01/2017
CH063450	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH063450	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	10/01/2021
CH063450	WALGREEN CO.	DBA: WALGREENS # 03934	3298 CERRILLOS RD	SANTA FE	NM	87507	04/01/2019
CH063450	WALGREEN CO.	WALGREENS #02349	1225 N TURNER STREET	HOBBS	NM	88240	04/01/2019
CH063450	WALGREEN CO.	WALGREENS #02900	1096 S SAINT FRANCIS DR	SANTA FE	NM	87505	04/01/2019
CH063450	WALGREEN CO.	WALGREENS #04187	1941 SOUTHERN BOULEVARD SE	RIO RANCHO	NM	87124	04/01/2019
CH063450	WALGREEN CO.	WALGREENS #04510	4221 E MAIN	FARMINGTON	NM	87402	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS # 05157	1115 N. RIVERSIDE DR.	ESPANOLA	NM	87532	04/01/2019
CH063450	WALGREEN CO.	WALGREENS #05158	4051 SOUTHERN BOULEVARD SE	RIO RANCHO	NM	87124	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS # 05732	7850 ENCHANTED HILLS BLVD. NE	RIO RANCHO	NM	87144-8623	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS # 06346	525 W ZIA ROAD	SANTA FE	NM	87505	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS # 07930	1401 W PIERCE STREET	CARLSBAD	NM	88220	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS # 09007	1870 E HISTORIC HWY 66	GALLUP	NM	87301	04/01/2019
CH063450	WALGREEN CO.	WALGREENS #09067	701 E 20TH	FARMINGTON	NM	87401	04/01/2019
CH063450	WALGREEN CO.	WALGREENS #09991	955 N WHITE SANDS BOULEVARD	ALAMOGORDO	NM	88310	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS #12005	5721 AIRPORT RD.	SANTA FE	NM	87507	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS #12270	2101 NORTHERN BLVD. NE	RIO RANCHO	NM	87124	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS #12793	801 W. JOE HARVEY BLVD.	HOBBS	NM	88240	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS #15603	122 NORTH GOLD AVENUE	DEMING	NM	88030	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS #15607	1509 E SANTA FE AVENUE	GRANTS	NM	87020	04/01/2019
CH063450	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16544	933 SAN MATEO BLVD NE STE 501	ALBUQUERQUE	NM	87108	04/01/2019
CH063450	WALGREEN CO.	DBA: WALGREENS #12407	10800 UNSER BLVD. NW	ALBUQUERQUE	NM	87114	10/01/2020
CH063450	WALGREEN CO.	DBA: WALGREENS # 02026	100 E HWY 550	BERNALILLO	NM	87004-5967	04/01/2024
CH063450	WALGREEN CO.	DBA: WALGREENS # 02053	6565 PARADISE BLVD NW	ALBUQUERQUE	NM	87114	04/01/2024
CH063450	WALGREEN CO.	WALGREENS #04651	10236 COORS BYPASS NW	ALBUQUERQUE	NM	87114	04/01/2024
CH063450	WALGREEN CO.	DBA: WALGREENS # 05731	9500 GOLF COURSE ROAD NW	ALBUQUERQUE	NM	87114	04/01/2024
CH063450	WALGREEN CO.	DBA: WALGREENS # 07735	6605 4TH ST NW	LOS RANCHOS DE ALBUQUERQUE	NM	87107-6112	04/01/2024
CH063450	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2019
CH063450	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2019	11/05/2021
CH063450	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2019
CH063450	WALMART PHARMACY 10-3517	1115 NM HIGHWAY 528 SE		RIO RANCHO	NM	87124	10/01/2017
CH063450	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024
CH063450	WALMART PHARMACY 10-5726	2401 INDIAN WELLS ROAD		ALAMOGORDO	NM	88310	10/01/2017
CH063450	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Quesada, Stephen M. DIRECTOR OF PHARMACY Presbyterian Medical Services 5054432643	Quesada, Stephen M. DIRECTOR OF PHARMACY Presbyterian Medical Services 5054432634	12/7/2023 8:33 AM
Contacts	Primary Contact	Update	Profile Change Request	Quesada, Stephen M. DIRECTOR OF PHARMACY Presbyterian Medical Services 5058203491	Quesada, Stephen M. DIRECTOR OF PHARMACY Presbyterian Medical Services 5054432643	11/10/2023 3:03 PM
Contacts	Authorizing Official	Update		Hansen, Steven C. CEO 5059825565-3470	Hansen, Steven C. CEO Presbyterian Medical Services 5059825565-3470	10/13/2017 11:07 AM
Contacts	Primary Contact	Update		Quesada, Stephen M. DIRECTOR OF PHARMACY 5058203491	Quesada, Stephen M. DIRECTOR OF PHARMACY Presbyterian Medical Services 5058203491	9/29/2017 10:15 AM
Contacts	Authorizing Official	Insert			Hansen, Steven C. CEO 5059825565-3470	7/20/2017 12:54 PM
Contacts	Primary Contact	Update		Quesada, Stephen M. DIRECTOR OF PHARMACY 5058203491	Quesada, Stephen M. DIRECTOR OF PHARMACY 5058203491	5/22/2017 3:10 PM
Contacts	Signed By	Insert			Hansen, Steven C. CEO 5059825565-470	4/26/2017 12:59 PM
Addresses	Main Address	Insert			2700 Farmington Ave, BLDG C, STE 1 Farmington, NM 87401-4550	2/9/2017 12:53 PM
Addresses	Billing Address	Insert			Presbyterian Medical Services 1422 Paseo de Peralta Santa Fe, NM 87501	2/9/2017 12:53 PM
Dates	Last Date That 340B Drugs Purchased	Update			1/5/2017 12:00:00 AM	2/9/2017 12:53 PM
Details	State	Update		Active	Terminated	2/9/2017 12:53 PM
Terminations	Termination Comments	Update			Consolidation of services within the new Community Health Center	2/9/2017 12:53 PM
Terminations	Termination Date	Update			4/1/2017 12:00:00 AM	2/9/2017 12:53 PM
Terminations	Termination Effective Date	Update			1/5/2017 12:00:00 AM	2/9/2017 12:53 PM
Terminations	Termination Reason	Update			Site closure	2/9/2017 12:53 PM
Details	Last Recertification Date	Update		2/22/2016 12:00:00 AM	2/7/2017 12:00:00 AM	2/7/2017 11:36 AM
Details	Last Recertification Date	Update		2/11/2015 12:00:00 AM	2/22/2016 12:00:00 AM	2/22/2016 11:37 AM
Details	Last Recertification Date	Update		3/17/2014 12:00:00 AM	2/11/2015 12:00:00 AM	2/11/2015 10:36 AM
Contacts	Primary Contact	Update		Langner, Wesley Director of Pharmacy 5058203491	Quesada, Stephen M. DIRECTOR OF PHARMACY 5058203491	11/7/2014 5:25 PM
Details	Is Authorizing Official EHB Data	Update			False	9/12/2014 6:51 AM
Contacts	Primary Contact	Insert			Langner, Wesley Director of Pharmacy 5058203491	6/18/2014 4:46 PM
Details	Last Recertification Date	Update			3/17/2014 12:00:00 AM	3/17/2014 11:29 AM
Details	340B ID	Update		IS-FN-CH06345AV	CH06345AV	5/28/2013 3:33 PM
Dates	Participating Approval Date	Update			5/28/2013 12:00:00 AM	5/28/2013 3:33 PM
Details	State	Update		Pending	Active	5/28/2013 3:33 PM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	5/28/2013 3:33 PM
Details	340B ID	Update		ONLINE_REG	IS-FN-CH06345AV	4/27/2013 2:02 PM
Details	Last Recertification Date	Insert				4/2/2013 2:52 PM
Details	Grant Number	Insert			H80CS00205	4/2/2013 2:52 PM
Details	340B ID	Insert			ONLINE_REG	4/2/2013 2:52 PM
Details	Is Authorizing Official EHB Data	Insert				4/2/2013 2:52 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/2/2013 2:52 PM
Details	Medicare Provider Number	Insert				4/2/2013 2:52 PM
Details	Entity Name	Insert			PRESBYTERIAN MEDICAL SERVICES, INC.	4/2/2013 2:52 PM
Details	Program Code	Insert			CH	4/2/2013 2:52 PM
Details	Entity Subname	Insert			PMS - Farmington Community Health Center Dental	4/2/2013 2:52 PM
Dates	Participating Approval Date	Insert				4/2/2013 2:52 PM
Details	State	Insert			Pending	4/2/2013 2:52 PM
Dates	Registration Date	Insert			4/2/2013 12:00:00 AM	4/2/2013 2:52 PM
Dates	Signed By Date	Insert			4/2/2013 12:00:00 AM	4/2/2013 2:52 PM
Dates	Start Date	Insert				4/2/2013 2:52 PM
Terminations	Termination Comments	Insert				4/2/2013 2:52 PM
Terminations	Termination Date	Insert				4/2/2013 2:52 PM
Terminations	Termination Effective Date	Insert				4/2/2013 2:52 PM
Terminations	Termination Reason	Insert				4/2/2013 2:52 PM

340B Drug Pricing Program Database