Covered Entity Details

CH062910E COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE (Active) - information as of 6/6/2025 12:41:00 PM

Main Details

Name

COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE

Subdivision Name

Community Health Center of Lubbock Dental Mobile Unit

Type

HRSA-Funded Health Center

Site ID

BPS-H80-003419

340B ID

CH062910E

Grant Number

H80CS00766

Additional Details

Current Program Status

Active

Registration Date

4/15/2013

Participating Start Date

7/1/2013

Participating Approval Date

5/28/2013

Last Recertification Date

3/4/2025

Contacts

Authorizing Official

Community Health Center of Lubbock, Inc.
Michael Sullivan, CEO
(806) 765-2611 Ext: 1110

Primary Contact

Community Health Center of Lubbock, Inc.
Liz Lopez, CDO
(806) 765-2611 Ext: 1110

Addresses

Street Address

1610 5th Street
Lubbock, TX 79401

Billing Address
Same as Street Address

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
CH062910	Active	BPS-H80-002119	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE		1610 5th Street	LUBBOCK	TX
CH062910A	Active	BPS-H80-003370	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	PARKWAY COMMUNITY HEALTH CENTER	406 Martin Luther King Blvd	Lubbock	TX
CH062910B	Active	BPS-H80-000039	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	Arnett Benson Medical & Dental Clinic	3301 Clovis Road	Lubbock	TX
CH062910C	Active	BPS-H80-001279	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	CHATMAN COMMUNITY HEALTH CENTER	2301 CEDAR AVE	LUBBOCK	TX
CH062910D	Active	BPS-H80-002668	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	Community Health Center of Lubbock Medical Mobile Unit	1610 5th Street	Lubbock	TX
CH062910E	Active	BPS-H80-003419	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	Community Health Center of Lubbock Dental Mobile Unit	1610 5th Street	Lubbock	TX
CH062910F	Active	BPS-H80-011110	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	CHCL 96 West	2401 Fulton Ave. #B	Lubbock	TX
CH062910G	Active	BPS-H80-011252	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	CHCL West Medical and Dental Clinic	5424 19th St STE 200	Lubbock	TX
CH062910H	Active	BPS-H80-010409	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	CHCL Community Dental Clinic (Parkway Plaza Strip Center)	1826 Parkway Dr	Lubbock	TX
CH062910J	Active	BPS-H80-017025	COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	CHCL Medical Plaza	3502 9th Street, Suite 280	Lubbock	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH062910	AMIGOS PHARMACY #503	112 NORTH UNIVERSITY AVENUE		LUBBOCK	TX	79415	07/01/2015	06/30/2015
CH062910	AMIGOS PHARMACY #503	112 NORTH UNIVERSITY AVENUE		LUBBOCK	TX	79415	07/01/2020
CH062910	HEB PHARMACY #728	1702 11TH ST		HUNTSVILLE	TX	77340	07/01/2025
CH062910	HEB PHARMACY #772	4405 114TH ST		LUBBOCK	TX	79424	07/01/2025
CH062910	HEB PHARMACY WAREHOUSE 208	H-E-B, LP	5311 DIETRICH RD STE 100	SAN ANTONIO	TX	78219	07/01/2025
CH062910	HEB SPECIALTY PHARMACY #701	3503 FREDERICKSBURG RD	STE 450	SAN ANTONIO	TX	78201	07/01/2025
CH062910	MARKET STREET PHARMACY #502	3405 50TH STREET		LUBBOCK	TX	79413	07/01/2015	06/30/2015
CH062910	MARKET STREET PHARMACY #553	4425 19TH STREET		LUBBOCK	TX	79407	07/01/2015	06/30/2015
CH062910	UNITED COALITION PHARMACY	1610 5TH ST		LUBBOCK	TX	79401	08/07/1995
CH062910	UNITED PHARMACY #501	2630 PARKWAY DRIVE		LUBBOCK	TX	79403	07/01/2015	06/30/2015
CH062910	UNITED PHARMACY #501	2630 PARKWAY DRIVE		LUBBOCK	TX	79403	07/01/2020
CH062910	UNITED PHARMACY #505	401 SLIDE ROAD		LUBBOCK	TX	79416	07/01/2015	06/30/2015
CH062910	UNITED PHARMACY #506	1701 50TH STREET		LUBBOCK	TX	79412	07/01/2015	06/30/2015
CH062910	UNITED PHARMACY #537	2703 82ND STREET		LUBBOCK	TX	79423	07/01/2015	06/30/2015
CH062910	WALGREEN CO.	DBA: WALGREENS # 04820	1619 50TH STREET	LUBBOCK	TX	79412	01/01/2014
CH062910	WALGREEN CO.	DBA: WALGREENS #11233	602 AVENUE Q	LUBBOCK	TX	79401-2614	01/01/2014	05/01/2025
CH062910	WALGREEN CO.	DBA: WALGREENS # 04819	5206 4TH STREET	LUBBOCK	TX	79416	01/01/2014
CH062910	WALGREEN CO.	DBA: WALGREENS # 04822	4847 SLIDE ROAD	LUBBOCK	TX	79414	01/01/2014
CH062910	WALGREEN CO.	DBA: WALGREENS # 05996	2417 82ND ST	LUBBOCK	TX	79423	01/01/2014
CH062910	WALGREEN CO.	DBA: WALGREENS # 04821	3404 INDIANA AVENUE	LUBBOCK	TX	79413	01/01/2014
CH062910	WALGREEN CO.	DBA: WALGREENS # 10283	6420 82ND STREET	LUBBOCK	TX	79424	01/01/2014
CH062910	WALGREEN CO.	DBA: WALGREENS # 07853	5115 98TH STREET	LUBBOCK	TX	79424	01/01/2014
CH062910	WALGREEN CO.	DBA: WALGREENS #15105	3009 SLIDE RD.	LUBBOCK	TX	79407	04/01/2016	11/14/2019
CH062910	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	01/01/2022
CH062910	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2014	07/07/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/23/2024 5:36:46 PM	3/4/2025 6:13:34 PM	3/4/2025 6:13 PM
Details	Last Recertification Date	Update	Recertification	2/8/2023 4:41:00 PM	2/23/2024 5:36:46 PM	2/23/2024 5:36 PM
Details	Last Recertification Date	Update	Recertification	2/24/2022 7:11:11 PM	2/8/2023 4:41:00 PM	2/8/2023 4:41 PM
Details	Last Recertification Date	Update	Recertification	2/25/2021 9:41:15 AM	2/24/2022 7:11:11 PM	2/24/2022 7:11 PM
Details	Last Recertification Date	Update	Recertification	2/21/2020 12:56:02 PM	2/25/2021 9:41:15 AM	2/25/2021 9:41 AM
Contacts	Authorizing Official	Update	Profile Change Request	Sullivan, Michael CEO Community Health Center of Lubbock, Inc. 8067652611-1029	Sullivan, Michael CEO Community Health Center of Lubbock, Inc. 8067652611-1110	1/27/2021 11:58 AM
Contacts	Signed By	Update	Profile Change Request	Sullivan, Michael CEO Community Health Center of Lubbock, Inc. 8067652611-1029	Sullivan, Michael CEO Community Health Center of Lubbock, Inc. 8067652611-1110	1/27/2021 11:58 AM
Details	Last Recertification Date	Update	Recertification	2/22/2019 10:17:46 PM	2/21/2020 12:56:02 PM	2/21/2020 12:56 PM
Details	Last Recertification Date	Update	Recertification	3/5/2018 4:08:26 PM	2/22/2019 10:17:46 PM	2/22/2019 10:17 PM
Details	Last Recertification Date	Update	Recertification	2/8/2017 12:00:00 AM	3/5/2018 4:08:26 PM	3/5/2018 4:08 PM
Contacts	Primary Contact	Update		Lopez, Liz CDO 8067652611-1110	Lopez, Liz CDO Community Health Center of Lubbock, Inc. 8067652611-1110	1/24/2018 1:39 PM
Contacts	Authorizing Official	Update		Sullivan, Michael CEO 8067652611-1029	Sullivan, Michael CEO Community Health Center of Lubbock, Inc. 8067652611-1029	1/9/2018 4:09 PM
Contacts	Signed By	Update		Sullivan, Michael CEO 8067652611-1029	Sullivan, Michael CEO Community Health Center of Lubbock, Inc. 8067652611-1029	1/9/2018 4:09 PM
Contacts	Primary Contact	Insert			Lopez, Liz CDO 8067652611-1110	3/10/2017 12:25 PM
Contacts	Authorizing Official	Insert			Sullivan, Michael CEO 8067652611-1029	3/10/2017 12:25 PM
Contacts	Signed By	Insert			Sullivan, Michael CEO 8067652611-1029	3/10/2017 12:25 PM
Addresses	Main Address	Insert			1610 5th Street Lubbock, TX 79401	2/8/2017 2:41 PM
Details	Last Recertification Date	Update		3/4/2016 12:00:00 AM	2/8/2017 12:00:00 AM	2/8/2017 2:41 PM
Details	Last Recertification Date	Update		3/10/2015 12:00:00 AM	3/4/2016 12:00:00 AM	3/4/2016 2:59 PM
Details	Last Recertification Date	Update		3/18/2014 12:00:00 AM	3/10/2015 12:00:00 AM	3/10/2015 4:11 PM
Details	Is Authorizing Official EHB Data	Update			False	3/10/2015 4:11 PM
Details	Last Recertification Date	Update			3/18/2014 12:00:00 AM	3/18/2014 4:52 PM
Details	340B ID	Update		IS-FN-CH062910E	CH062910E	5/28/2013 4:52 PM
Dates	Participating Approval Date	Update			5/28/2013 12:00:00 AM	5/28/2013 4:52 PM
Details	State	Update		Pending	Active	5/28/2013 4:52 PM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	5/28/2013 4:52 PM
Details	340B ID	Update		ONLINE_REG	IS-FN-CH062910E	5/2/2013 3:34 PM
Details	Last Recertification Date	Insert				4/15/2013 5:24 PM
Details	Grant Number	Insert			H80CS00766	4/15/2013 5:24 PM
Details	340B ID	Insert			ONLINE_REG	4/15/2013 5:24 PM
Details	Is Authorizing Official EHB Data	Insert				4/15/2013 5:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2013 5:24 PM
Details	Medicare Provider Number	Insert				4/15/2013 5:24 PM
Details	Entity Name	Insert			COMMUNITY HEALTH CENTER OF LUBBOCK, INC., THE	4/15/2013 5:24 PM
Details	Program Code	Insert			CH	4/15/2013 5:24 PM
Details	Entity Subname	Insert			Community Health Center of Lubbock Dental Mobile Unit	4/15/2013 5:24 PM
Dates	Participating Approval Date	Insert				4/15/2013 5:24 PM
Details	State	Insert			Pending	4/15/2013 5:24 PM
Dates	Registration Date	Insert			4/15/2013 12:00:00 AM	4/15/2013 5:24 PM
Dates	Signed By Date	Insert			4/15/2013 12:00:00 AM	4/15/2013 5:24 PM
Dates	Start Date	Insert				4/15/2013 5:24 PM
Terminations	Termination Comments	Insert				4/15/2013 5:24 PM
Terminations	Termination Date	Insert				4/15/2013 5:24 PM
Terminations	Termination Effective Date	Insert				4/15/2013 5:24 PM
Terminations	Termination Reason	Insert				4/15/2013 5:24 PM

340B Drug Pricing Program Database