Covered Entity Details

CH10817D Dirne Health Centers, Inc. (Active) - information as of 5/13/2025 10:48:30 PM

Main Details

Name

Dirne Health Centers, Inc.

Subdivision Name

Heritage Health Union Gospel Mission

Type

HRSA-Funded Health Center

Site ID

BPS-H80-012443

340B ID

CH10817D

Grant Number

H80CS02331

Additional Details

Current Program Status

Active

Registration Date

10/1/2013

Participating Start Date

1/1/2014

Participating Approval Date

10/29/2013

Last Recertification Date

3/4/2025

Contacts

Authorizing Official

Heritage Health
Michael Baker, CEO
(208) 292-0256

Primary Contact

Dirne Health Centers, Inc
Monica Graybeal, Director of Pharmacy
(208) 292-0662

Addresses

Street Address

196 W Haycraft Ave
Coeur D Alene, ID 83815-9317

Billing Address

Dirne Health Centers, Inc.
PO Box 1387
Hayden, ID 83835

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
CH108170	Active	BPS-H80-011077	Dirne Health Centers, Inc.	Heritage Health CDA	1090 W Park Pl	Coeur D Alene	ID
CH10817A	Active	BPS-H80-011471	Dirne Health Centers, Inc.	Heritage Health Mobile Unit	1090 W Park Pl	Coeur D Alene	ID
CH10817C	Terminated	BPS-H80-011937	DIRNE HEALTH CENTERS, INC.	Dirne CHC Homeless Walk In Clinic	201 East Harrison	Coeur d Alene	ID
CH10817D	Active	BPS-H80-012443	Dirne Health Centers, Inc.	Heritage Health Union Gospel Mission	196 W Haycraft Ave	Coeur D Alene	ID
CH10817E	Terminated	BPS-H80-012573	Dirne Health Centers, Inc.	Dirne Behavioral Health	2025 Park Place STE B and C	Coeur d Alene	ID
CH10817F	Terminated	BPS-H80-012194	DIRNE HEALTH CENTERS, INC.	Dirne CHC Rathdrum Clinic	14775 N. Kimo Ct STE B	Rathdrum	ID
CH10817G	Active	BPS-H80-012744	Dirne Health Centers, Inc.	Heritage Health SBHC Mobile Unit	1090 W Park Pl	Coeur D Alene	ID
CH10817H	Terminated	BPS-H80-013802	DIRNE HEALTH CENTERS, INC.	Heritage Health - Family Support Services	2201 IRONWOOD PL	COEUR D ALENE	ID
CH10817J	Terminated	BPS-H80-012743	DIRNE HEALTH CENTERS, INC.	Dirne CHC Physical Therapy	610 W Hubbard St	Coeur D Alene	ID
CH10817K	Active	BPS-H80-013070	Dirne Health Centers, Inc.	Heritage Health Kellogg	740 Mckinley Ave	Kellogg	ID
CH10817L	Terminated	BPS-H80-014840	DIRNE HEALTH CENTERS, INC.	Heritage Health Dental Clinic - Wallace	413 PINE ST	WALLACE	ID
CH10817M	Terminated	BPS-H80-014839	DIRNE HEALTH CENTERS, INC.	Heritage Health Mullan Clinic	117 Terrill Loop	Mullan	ID
CH10817N	Active	BPS-H80-014419	Dirne Health Centers, Inc.	Heritage Health Post Falls	925 E POLSTON AVE	POST FALLS	ID
CH10817P	Active	BPS-H80-015365	Dirne Health Centers, Inc.	Heritage Health Rathdrum	16760 N Highway 41	Rathdrum	ID
CH10817Q	Active	BPS-H80-017199	Dirne Health Centers, Inc.	Heritage Health Homeless Program	109 E Harrison	Coeur d Alene	ID
CH10817R	Active	BPS-H80-019169	Dirne Health Centers, Inc.	Heritage Health SMCO	2205 Ironwood Pl	Coeur D Alene	ID
CH10817S	Terminated	BPS-H80-032643	Dirne Health Centers, Inc.	Heritage Health - 1221 West Ironwood Suite 100	1221 W Ironwood Dr Ste 100	Coeur D Alene	ID
CH10817T	Active	BPS-H80-035137	Dirne Health Centers, Inc.	Heritage Health - 1038 NW Blvd	1038 Northwest Blvd	Coeur D Alene	ID
CH10817U	Terminated	BPS-H80-035409	Dirne Health Centers, Inc.	Heritage Health - 1809 E Sherman Ave	1809 E Sherman Ave	Coeur dAlene	ID
CH10817V	Terminated	BPS-H80-031295	DIRNE COMMUNITY HEALTH CENTER	Heritage Health Northwood	1270 N Northwood Center Ct	Coeur D Alene	ID
CH10817W	Terminated	BPS-H80-021783	DIRNE COMMUNITY HEALTH CENTER	Heritage Health Family Support Services North	6795 N Mineral Dr	Coeur D Alene	ID
CH10817X	Active	BPS-H80-035938	DIRNE COMMUNITY HEALTH CENTER	Heritage Health - Restored Paths - St. Maries	120 S. 13th St.	St Maries	ID
CH10817Y	Active	BPS-H80-039230	Dirne Health Centers, Inc.	Heritage Health Coeur d'Alene Center for Health Living	3700 W Seltice Way	Coeur D Alene	ID

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH108170	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2022	01/12/2024
CH108170	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2022	01/12/2024
CH108170	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2022
CH108170	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2022	01/12/2024
CH108170	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2022	01/12/2024
CH108170	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2022	01/12/2024
CH108170	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2022	01/12/2024
CH108170	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	04/01/2017	03/17/2021
CH108170	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2018	05/17/2024
CH108170	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/01/2018	12/15/2020
CH108170	AVELLA OF SACRAMENTO, INC.	2288 AUBURN BLVD #102		SACRAMENTO	CA	95821	10/01/2018	03/15/2021
CH108170	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	05/17/2024
CH108170	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
CH108170	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2025
CH108170	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2025
CH108170	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2024
CH108170	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2024
CH108170	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	04/01/2017	02/04/2021
CH108170	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2022
CH108170	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2022
CH108170	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2022
CH108170	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2022
CH108170	FRED MEYER	560 WEST KATHLEEN AVE		COEUR D ALENE	ID	83815-8392	01/01/2020
CH108170	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	01/01/2020
CH108170	JACKS PHARMACY INC	103 E COLLEGE AVE		ST MARIES	ID	83861	07/01/2024
CH108170	KOHAL PHARMACY 2	740 MCKINLEY AVENUE #B		KELLOGG	ID	83837-2693	10/01/2014	02/17/2025
CH10817K	KOHAL PHARMACY 2	740 MCKINLEY AVENUE #B		KELLOGG	ID	83837-2693	01/01/2015	02/08/2023
CH108170	KOHAL PHARMACY INC	KOHAL PHARMACY INC	800 BANK ST	WALLACE	ID	83873	07/01/2022	02/17/2025
CH108170	KOHAL PHARMACY, INC.	KOHAL PHARMACY INCORPORATED	504 N. DIVISION PO BOX 400	PINEHURST	ID	83850	10/01/2019	02/17/2025
CH108170	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2018	01/27/2023
CH108170	MEDICINE MAN ATHOL PHARMACY	30585 N ROBERTS RD		ATHOL	ID	83801	01/01/2019	12/28/2022
CH108170	MEDICINE MAN ATHOL PHARMACY	30585 N ROBERTS RD		ATHOL	ID	83801	12/28/2022
CH108170	MEDICINE MAN HAYDEN PHARMACY	240 W HAYDEN AVE		HAYDEN	ID	83835-8194	12/28/2022
CH108170	MEDICINE MAN NORTH PHARMACY	305 W KATHLEEN AVE		COEUR D ALENE	ID	83815	10/04/2004	12/28/2022
CH10817J	MEDICINE MAN NORTH PHARMACY	305 W KATHLEEN AVE		COEUR D ALENE	ID	83815	01/01/2015	01/01/2016
CH10817H	MEDICINE MAN NORTH PHARMACY	305 W KATHLEEN AVE		COEUR D ALENE	ID	83815	01/01/2015	12/28/2022
CH108170	MEDICINE MAN NORTH PHARMACY	MEDICINE MAN NORTH PHARMACY	305 W KATHLEEN AVE	COEUR D ALENE	ID	83815	12/28/2022
CH108170	MEDICINE MAN NORTH PHCY INC	DBA MEDICINE MAN HAYDEN PHCY	240 W HAYDEN AVE PO BOX 1706	HAYDEN	ID	83835	01/01/2016	12/28/2022
CH108170	MEDICINE MAN PRAIRIE PHARMACY	8093 N CORNERSTONE DR	MEDICINE MAN PRAIRIE PHARMACY	HAYDEN	ID	83835	01/01/2025
CH108170	MEDICINE MAN RATHDRUM	15837 N WESTWOOD DR		RATHDRUM	ID	83858-6432	01/01/2014	08/19/2024
CH10817J	MEDICINE MAN RATHDRUM	15837 N WESTWOOD DR		RATHDRUM	ID	83858-6432	01/01/2015	01/01/2016
CH108170	MEDICINE MAN SOUTHWEST	805 E POLSTON AVE		POST FALLS	ID	83854	01/01/2014	08/19/2024
CH108170	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	01/30/2023
CH108170	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/14/2020	03/15/2021
CH108170	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	10/14/2020	03/15/2021
CH108170	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/30/2023
CH108170	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	04/01/2020	05/12/2023
CH108170	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018	01/27/2023
CH108170	SAFEWAY INC	SAFEWAY PHARMACY #1470	121 W NEIDER AVENUE	COEUR D ALENE	ID	83815	07/01/2015
CH108170	SAFEWAY INC	SAFEWAY PHARMACY #3295	1001 N FOURTH STREET	COEUR D ALENE	ID	83814-3113	07/01/2015
CH108170	SHOPKO PHARMACY #2069	217 WEST IRONWOOD DRIVE		COEUR D'ALENE	ID	83814	01/01/2018	12/06/2019
CH108170	THRIFTY PAYLESS, INC.	RITE AID #5420	208 WEST IRONWOOD DRIVE	COEUR D'ALENE	ID	83814	07/01/2013
CH10817J	THRIFTY PAYLESS, INC.	RITE AID #5420	208 WEST IRONWOOD DRIVE	COEUR D'ALENE	ID	83814	01/01/2015	01/01/2016
CH108170	THRIFTY PAYLESS, INC.	RITE AID #6200	43 WEST PRAIRIE SHOPPING CTR	HAYDEN	ID	83835	07/01/2019
CH108170	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	04/01/2020	05/12/2023
CH108170	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CH108170	WAL-MART PHARMACY 10-2485	476999 HWY 95 NORTH		PONDERAY	ID	83852	01/01/2020	04/17/2024
CH108170	WAL-MART PHARMACY 10-3472	3050 EAST MULLAN AVENUE		POST FALLS	ID	83854	04/01/2014
CH10817J	WAL-MART PHARMACY 10-3472	3050 EAST MULLAN AVENUE		POST FALLS	ID	83854	01/01/2015	01/01/2016
CH108170	WAL-MART PHARMACY 10-3511	550 W. HONEYSUCKLE AVE.		HAYDEN	ID	83835	04/01/2014
CH10817J	WAL-MART PHARMACY 10-3511	550 W. HONEYSUCKLE AVE.		HAYDEN	ID	83835	01/01/2015	01/01/2016
CH108170	WAL-MART PHARMACY 10-4249	583 COMMERCE DRIVE		SMELTERVILLE	ID	83868	10/01/2018
CH108170	WAL-MART PHARMACY 10-4395	6405 W POINTE PARKWAY		POST FALLS	ID	83854	10/01/2018
CH108170	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CH108170	WALGREEN CO.	DBA: WALGREENS # 06863	335 W APPLEWAY AVE	COEUR D ALENE	ID	83814	02/14/2012
CH108170	WALGREEN CO.	DBA: WALGREENS # 07949	706 E SELTICE WAY	POST FALLS	ID	83854	02/14/2012
CH108170	WALGREEN CO.	DBA: WALGREENS #10314	260 W HONEYSUCKLE AVE	HAYDEN	ID	83835-9270	02/14/2012
CH10817H	WALGREEN CO.	DBA: WALGREENS # 06863	335 W APPLEWAY AVE	COEUR D ALENE	ID	83814	01/01/2015	02/08/2023
CH108170	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #21243	327 W 3RD AVE STE A	SPOKANE	WA	99201	10/14/2020
CH108170	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH108170	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH108170	WESTERN PHARMACY GROUP LLC	DBA COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY SUITES A--E	SAN DIEGO	CA	92102	10/01/2018	04/14/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/21/2024 2:05:10 PM	3/4/2025 2:01:37 PM	3/4/2025 2:01 PM
Details	Entity Subname	Update	Recertification	Dirne CHC - UGM Clinic	Heritage Health Union Gospel Mission	3/4/2025 2:01 PM
Contacts	Primary Contact	Update	Profile Change Request	Graybeal, Monica Director of Pharmacy Dirne (dba Heritage Health) 2082920303	Graybeal, Monica Director of Pharmacy Dirne Health Centers, Inc 2082920662	3/4/2025 12:57 PM
Details	Last Recertification Date	Update	Recertification	2/22/2023 1:05:52 PM	2/21/2024 2:05:10 PM	2/21/2024 2:05 PM
Details	Entity Name	Update	Recertification	DIRNE HEALTH CENTERS, INC.	Dirne Health Centers, Inc.	2/21/2024 2:05 PM
Addresses	Billing Address	Update	Recertification	Dirne Health Centers, Inc PO Box 3648 Coeur d ALene, ID 83816	Dirne Health Centers, Inc. PO Box 1387 Hayden, ID 83835	2/22/2023 1:05 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 1:30:11 PM	2/22/2023 1:05:52 PM	2/22/2023 1:05 PM
Contacts	Primary Contact	Update	PC Change Request	Hampe, Mark Chief Financial Officer Dirne Health Centers, Inc DBA Heritage Health 2082920134	Graybeal, Monica Director of Pharmacy Dirne (dba Heritage Health) 2082920303	8/12/2022 10:32 AM
Details	Last Recertification Date	Update	Recertification	2/3/2021 3:14:32 AM	2/1/2022 1:30:11 PM	2/1/2022 1:30 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 2:55:52 PM	2/3/2021 3:14:32 AM	2/3/2021 3:14 AM
Details	Last Recertification Date	Update	Recertification	2/20/2019 3:03:23 PM	1/27/2020 2:55:52 PM	1/27/2020 2:55 PM
Contacts	Primary Contact	Update	Recertification	Hampe, Mark CFO Dirne Health Centers Inc DBA Heritage Health 2082620252	Hampe, Mark Chief Financial Officer Dirne Health Centers, Inc DBA Heritage Health 2082920134	2/20/2019 3:03 PM
Details	Last Recertification Date	Update	Recertification	2/22/2018 12:57:53 PM	2/20/2019 3:03:23 PM	2/20/2019 3:03 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/20/2019 3:03 PM
Contacts	Authorizing Official	Update	AO Change Request	Potter, Benjamin CFO Heritage Health 2086205255	Baker, Michael CEO Heritage Health 2082920256	2/20/2019 2:50 PM
Contacts	Primary Contact	Update	Change Request	Potter, Ben CFO Dirne Health Centers Inc DBA Heritage Health 2082620252	Hampe, Mark CFO Dirne Health Centers Inc DBA Heritage Health 2082620252	2/11/2019 3:36 PM
Details	Last Recertification Date	Update	Recertification	2/8/2017 12:00:00 AM	2/22/2018 12:57:53 PM	2/22/2018 12:57 PM
Contacts	Primary Contact	Update	Recertification	Gaby, Ben CFO 2082920240	Potter, Ben CFO Dirne Health Centers Inc DBA Heritage Health 2082620252	2/13/2018 1:04 AM
Contacts	Authorizing Official	Update	AO Change Request	Baker, Michael CEO 2082920256	Potter, Benjamin CFO Heritage Health 2086205255	10/4/2017 1:46 PM
Contacts	Signed By	Update	New Registration	Baker, Michael CEO 2082920256	Baker, Michael CEO Heritage Health 2082920256	10/4/2017 12:41 PM
Addresses	Main Address	Insert			196 W Haycraft Ave Coeur D Alene, ID 83815-9317	2/8/2017 12:20 PM
Contacts	Authorizing Official	Insert			Baker, Michael CEO 2082920256	2/8/2017 12:20 PM
Contacts	Signed By	Insert			Baker, Michael CEO 2082920256	2/8/2017 12:20 PM
Contacts	Primary Contact	Insert			Gaby, Ben CFO 2082920240	2/8/2017 12:20 PM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	2/8/2017 12:00:00 AM	2/8/2017 12:20 PM
Details	Last Recertification Date	Update		2/12/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 7:56 AM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	2/12/2015 12:00:00 AM	2/12/2015 2:14 PM
Details	Is Authorizing Official EHB Data	Update			False	2/12/2015 2:14 PM
Details	Last Recertification Date	Update			2/10/2014 12:00:00 AM	2/10/2014 11:50 AM
Addresses	Billing Address	Insert			Dirne Health Centers, Inc PO Box 3648 Coeur d ALene, ID 83816	10/29/2013 12:54 PM
Details	340B ID	Update		ONLINE_REG	CH10817D	10/29/2013 12:54 PM
Dates	Participating Approval Date	Update			10/29/2013 12:00:00 AM	10/29/2013 12:54 PM
Details	State	Update		Pending	Active	10/29/2013 12:54 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	10/29/2013 12:54 PM
Details	Last Recertification Date	Insert				10/1/2013 3:07 PM
Details	Grant Number	Insert			H80CS02331	10/1/2013 3:07 PM
Details	340B ID	Insert			ONLINE_REG	10/1/2013 3:07 PM
Details	Is Authorizing Official EHB Data	Insert				10/1/2013 3:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/1/2013 3:07 PM
Details	Medicare Provider Number	Insert				10/1/2013 3:07 PM
Details	Entity Name	Insert			DIRNE HEALTH CENTERS, INC.	10/1/2013 3:07 PM
Details	Program Code	Insert			CH	10/1/2013 3:07 PM
Details	Entity Subname	Insert			Dirne CHC - UGM Clinic	10/1/2013 3:07 PM
Dates	Participating Approval Date	Insert				10/1/2013 3:07 PM
Details	State	Insert			Pending	10/1/2013 3:07 PM
Dates	Registration Date	Insert			10/1/2013 12:00:00 AM	10/1/2013 3:07 PM
Dates	Signed By Date	Insert			10/1/2013 12:00:00 AM	10/1/2013 3:07 PM
Dates	Start Date	Insert				10/1/2013 3:07 PM
Terminations	Termination Comments	Insert				10/1/2013 3:07 PM
Terminations	Termination Date	Insert				10/1/2013 3:07 PM
Terminations	Termination Effective Date	Insert				10/1/2013 3:07 PM
Terminations	Termination Reason	Insert				10/1/2013 3:07 PM

340B Drug Pricing Program Database