340B Drug Pricing Program Database


CH09008R MARANA HEALTH CENTER, INC. (Active) - information as of 6/9/2025 10:59:22 PM

Main Details
MARANA HEALTH CENTER, INC.
MHC Counseling and Wellness Center
HRSA-Funded Health Center
BPS-H80-011160
CH09008R
H80CS00231


Additional Details
Active
10/1/2013
1/1/2014
12/11/2013
2/10/2025

Contacts

Marana Health Center
Heidi Kurgat, Director of Compliance and Risk
(573) 578-1344

MHC Health Care
Greg Redding, Pharmacy Director
(520) 682-4111

Addresses

13395 N. Marana Main Street Bldg B
Marana, AZ 85653

Marana Health Center, Inc.
PO Box 188
Marana, AZ 85653


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
AZ988881,2344561689864597,1245609197
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/13/202301/01/2024  01/01/2024
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02372 7114 NORTH ORACLE
TUCSONAZ8570410/13/202301/01/2024  01/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH090080ActiveBPS-H80-010850MARANA HEALTH CENTER, INC.Marana Health Center, Inc.13395 N. Marana Main Street MARANAAZ
CH09008AActiveBPS-H80-014118MARANA HEALTH CENTER, INC.SANTA CATALINA HEALTH CENTER16701 N ORACLE RD TUCSONAZ
CH09008AAActiveBPS-H80-027559Marana Health Center, Inc.MHC Integrated Care2325 N Wyatt Dr TucsonAZ
CH09008ABActiveBPS-H80-031802Marana Health Center, Inc.West Side Health Center1707 W Saint Marys Rd Ste 175 # 39S TucsonAZ
CH09008ACActiveBPS-H80-037989MARANA HEALTH CENTER, INCMHC Healthcare Ronald McDonald Mobile13395 North Marana Main Street MaranaAZ
CH09008ADActiveBPS-H80-038434MARANA HEALTH CENTER, INCIna Health Center2945 West Ina Road TucsonAZ
CH09008CTerminatedBPS-H80-007185MARANA HEALTH CENTER, INC.Keeling Health Center435 EAST GLENN STREET TUCSONAZ
CH09008HActiveBPS-H80-001123MARANA HEALTH CENTER, INC.Ortiz Community Health Center12635 W. RUDASILL ROAD TUCSONAZ
CH09008ITerminatedBPS-H80-002978MARANA HEALTH CENTER, INC.DBA FREEDOM PARK HEALTH CENTER5000 EAST 29TH STREET TUCSONAZ
CH09008JActiveBPS-H80-004395MARANA HEALTH CENTER, INC.MARANA HEALTH CENTER OBSTETRICS AND GYNECOLOGY2055 W Hospital Dr STE 115 TucsonAZ
CH09008NActiveBPS-H80-003690MARANA HEALTH CENTER, INC.CLINICA DEL ALMA3690 S Park Ave STE 805 TucsonAZ
CH09008PActiveBPS-H80-014818MARANA HEALTH CENTER, INC.Wilmot Community Health Center899 N. Wilmot RoadBuilding BTucsonAZ
CH09008QActiveBPS-H80-011480MARANA HEALTH CENTER, INC.MHC Primary Care Health Center2355 N Wyatt Dr STE 101 TucsonAZ
CH09008RActiveBPS-H80-011160MARANA HEALTH CENTER, INC.MHC Counseling and Wellness Center13395 N. Marana Main Street Bldg B MaranaAZ
CH09008STerminatedBPS-H80-007525MARANA HEALTH CENTER, INC.East Side Health Center8181 E Irvington Rd TucsonAZ
CH09008UTerminatedBPS-H80-001568MARANA HEALTH CENTER, INC.West Side Health Center2202 W. Anklam TucsonAZ
CH09008VActiveBPS-H80-000242MARANA HEALTH CENTER, INC.FLOWING WELLS FAMILY PRACTICE1323 W Prince Rd TucsonAZ
CH09008WTerminatedBPS-H80-014781MARANA HEALTH CENTER, INC.Ellie Towne Health Center1670 W Ruthrauff Rd TucsonAZ
CH09008XTerminatedBPS-H80-018227MARANA HEALTH CENTER, INC.Marana Cares Mobile11279 W. Grier Rd. MaranaAZ
CH09008YActiveBPS-H80-018514MARANA HEALTH CENTER, INC.Dove Mountain Health Center5224 W. Dove Centre Road MaranaAZ
CH09008ZActiveBPS-H80-024812Marana Health Center, Inc.Oro Valley Pediatrics1856 E Innovation Park Dr Oro ValleyAZ
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH090080ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2023  
CH090080ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/01/2023  
CH090080ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2023  
CH090080ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/01/2023  
CH090080ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/01/2023  
CH090080ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/01/2023  
CH090080ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/01/2023  
CH090080ADVANCED PHARMACY, LLCADVANCED PHARMACY 350 FEASTER ROAD
SUITE D 		GREENVILLESC29615-617610/01/2016 04/02/2018
CH090080AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271207/01/2016  
CH090080AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291104/01/2018  
CH09008AAMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291110/01/2024  
CH090080AMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700310/01/2024  
CH090080AMAZON PHARMACY #008408 TECHNOLOGY PARKWAY BUILDING B, STE 101
COLLEGE STATIONTX7784510/01/2024  
CH090080AMAZON PHARMACY #0097469 KINGSPOINTE PKWY STE 400
ORLANDOFL3281910/01/2024  
CH090080AMAZON PHARMACY #0101331 E 6TH ST
CORONACA9287910/01/2024  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09207 865 E. GRANT
TUCSONAZ8571901/01/2020 06/23/2022
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09232 4748 E. SUNRISE DRIVE
TUCSONAZ8571801/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09272 7499 E. BROADWAY
TUCSONAZ8571001/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09273 3785 WEST INA RD.
TUCSONAZ8574101/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09274 615 N. ALVERNON
TUCSONAZ8571101/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09277 6895 E. SUNRISE
TUCSONAZ8575001/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09302 8920 E TANQUE VERDE
TUCSONAZ8574901/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09336 7901 E. GOLF LINKS ROAD
TUCSONAZ8573001/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09211 6488 N. ORACLE ROAD
TUCSONAZ8570401/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09374 1900 W. VALENCIA RD.
TUCSONAZ8574601/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09254 240 W CONTINENTAL RD
GREEN VALLEYAZ8562210/01/2020  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 08828 2090 EAST FRY BLVD.
SIERRA VISTAAZ8563504/01/2022  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09293 325 W APACHE TRAIL
APACHE JUNCTIONAZ8512004/01/2022  
CH090080ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09347 1525 NORTH CENTRAL AVENUE
PHOENIXAZ8500404/01/2022  
CH09008AAARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09273 3785 WEST INA RD.
TUCSONAZ8574101/01/2024  
CH09008HARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09336 7901 E. GOLF LINKS ROAD
TUCSONAZ8573001/01/2024  
CH09008NARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09274 615 N. ALVERNON
TUCSONAZ8571101/01/2024  
CH090080AVELLA OF DEER VALLEY23620 N 20TH DR #12
PHOENIXAZ85085-062107/01/2016 10/07/2022
CH090080AVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508507/01/2018 10/07/2022
CH090080AVELLA OF DEER VALLEY, INC. #3824416 N. 19TH AVE
PHOENIXAZ85085-188710/01/2018 10/07/2022
CH090080AVELLA OF ORLANDO100 TECHNOLOGY PARK STE 155
LAKE MARYFL32746-620507/01/2016 10/01/2017
CH090080AVELLA OF TUCSON4512 E CAMP LOWELL DR
TUCSONAZ85712-128201/01/2018 04/02/2018
CH090080AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503404/01/2019  
CH09008AAZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503410/01/2024  
CH090080BASHAS' #52RALEY'S ARIZONA LLC 15310 N. ORACLE RD
TUCSONAZ8573907/01/2024  
CH090080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/01/2024  
CH090080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/01/2024  
CH090080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/01/2024  
CH09008WBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/01/2024 04/01/2025
CH09008YBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/01/2024  
CH09008ZBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/01/2024  
CH090080BIOPLUS SPECIALTY PHARMACY, INC3200 LAKE EMMA RD UNIT 1000
LAKE MARYFL3274604/01/2024  
CH090080CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2021  
CH09008VCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2024  
CH090080CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2021  
CH09008SCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2024 10/01/2024
CH090080CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2021  
CH09008RCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2024  
CH090080CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2021  
CH09008QCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2024  
CH090080CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2021  
CH09008PCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2024  
CH090080CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2021  
CH09008NCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2024  
CH090080CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2021  
CH09008JCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2024  
CH090080CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/01/2021  
CH09008HCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/01/2024  
CH090080CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/01/2021  
CH090080CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/01/2021  
CH090080CENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506904/01/2023  
CH090080CENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282401/01/2024  
CH090080COMMUNITY MEDICAL CENTER PHARMACY610 GATEWAY CENTER WAY STE A - E
SAN DIEGOCA92102-454810/01/2016 04/20/2018
CH090080CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2021  
CH090080CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2021  
CH090080CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/01/2021  
CH090080CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2019  
CH090080DESERT LIFE PHARMACY63675 E SADDLEBROOKE BLVD
TUCSONAZ85739-129707/01/2023  
CH090080DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654101/01/2024  
CH090080ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/01/2023  
CH090080EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/01/2023  
CH090080EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/01/2023  
CH090080EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/01/2023  
CH090080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08896 33205 TEMECULA PARKWAY
TEMECULACA9259210/01/2020  
CH090080GENOA HEALTHCARE LLC1101 NORTH CENTRAL AVE STE 102
PHOENIXAZ8500401/01/2023  
CH090080GENOA HEALTHCARE LLC1075 E FORT LOWELL RD
TUCSONAZ8571904/01/2024  
CH090080GENOA HEALTHCARE LLC1210 E. PENNSYLVANIA ST.
TUCSONAZ8571407/01/2025  
CH090080GENOA HEALTHCARE LLC1501 W COMMERCE CT STE P
TUCSONAZ8574607/01/2025  
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00091 8705 E SPEEDWAY BLVD
TUCSONAZ8571001/01/2020 08/11/2022
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07841 4365 N ORACLE RD
TUCSONAZ8570501/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07855 2601 S. HOUGHTON RD.
TUCSONAZ8573001/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07859 6370 N. CAMPBELL AVE., #120
TUCSONAZ8571801/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07867 5100 E. GRANT RD.
TUCSONAZ8571201/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07876 3832 EAST SPEEDWAY
TUCSONAZ8571601/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 08420 7740 N CORTARO RD
TUCSONAZ8574301/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY # 10006 10650 NORTH ORACLE RD
ORO VALLEYAZ8573701/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY # 10184 825 EAST UNIVERSITY BLVD., SUITE 101
TUCSONAZ8571901/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.CVS/PHARMACY #10742 2385 N. SILVERBELL ROAD
TUCSONAZ8574501/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16295 3901 W INA RD
TUCSONAZ8574101/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16296 6500 E GRANT RD
TUCSONAZ8571501/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16772 3699 E BROADWAY BLVD
TUCSONAZ8571601/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16983 9615 E OLD SPANISH TRL
TUCSONAZ8574801/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17223 4040 N ORACLE RD
TUCSONAZ8570501/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY # 10307 6310 E. BROADWAY BLVD.
TUCSONAZ8571001/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16217 10555 N ORACLE RD
ORO VALLEYAZ8573701/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16659 1225 W IRVINGTON RD
TUCSONAZ8571401/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00086 1686 E FLORENCE BLVD
CASA GRANDEAZ8512210/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY # 2412 60 E DEUCE OF CLUBS DR.
SHOW LOWAZ8590110/01/2020  
CH090080GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 09205 802 S. MILL AVE.
TEMPEAZ8528107/01/2021  
CH090080GERMAN DOBSON CVS, L.L.C.CVS/PHARMACY # 10859 286 E 7TH ST
DOUGLASAZ8560704/01/2022  
CH09008AGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 08420 7740 N CORTARO RD
TUCSONAZ8574301/01/2024  
CH09008ABGERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY # 10006 10650 NORTH ORACLE RD
ORO VALLEYAZ8573701/01/2024  
CH09008CGERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07867 5100 E. GRANT RD.
TUCSONAZ8571201/01/2024 10/01/2024
CH09008JGERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17223 4040 N ORACLE RD
TUCSONAZ8570501/01/2024  
CH090080IC PHARMACY LLCAMAZON PHARMACY #004 34 35TH STREET
STE 4BSW, UNIT 28 		BROOKLYNNY1123210/01/2024  
CH090080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09893 2539 N 11TH AVE
HANFORDCA9323007/01/2021  
CH090080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09979 3375 PLACER ST
REDDINGCA9600107/01/2021  
CH090080M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312604/01/2018  
CH09008AM.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312610/01/2024  
CH090080OPTUM INFUSION SERVICES 308, LLC485 N JUNIPER DR STE 2
CHANDLERAZ8522604/01/2024  
CH090080OPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705810/01/2021 10/07/2022
CH090080OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276510/01/2021 10/07/2022
CH090080OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276501/01/2023  
CH090080OPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705801/01/2023  
CH090080OPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502910/01/2021  
CH090080OPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302510/01/2021 10/07/2022
CH090080OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850707/01/2022  
CH090080OPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302501/01/2023  
CH090080OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520404/01/2024  
CH090080OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713010/01/2021  
CH090080OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824910/01/2021  
CH090080OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/01/2024  
CH090080OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140110/01/2021  
CH090080OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508510/01/2021  
CH090080OPTUM PHARMACY 805, INC1101 N CENTRAL AVE, STE 102
PHOENIXAZ85004-182910/01/2021 10/07/2022
CH090080OPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660810/01/2021 10/13/2022
CH090080OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/01/2021  
CH090080OVERLAKE PHARMACY, LLC4124 148TH AVE NE STE JA
REDMONDWA9805204/01/2020 01/08/2024
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SUITES A--E 		SAN DIEGOCA9210204/20/2018 01/08/2024
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/31/2024 9:07:42 AM2/10/2025 9:45:28 AM2/10/2025 9:45 AM
ContactsAuthorizing OfficialUpdateAO Change RequestOlson, Tamie Chief Financial Officer Marana Health Center, Inc. 5206824111-6221Kurgat, Heidi Director of Compliance and Risk Marana Health Center 57357813444/12/2024 2:52 PM
AddressesMain AddressUpdateRecertification 13395 B N. Marana Main Street Marana, AZ 85653 13395 N. Marana Main Street Bldg B Marana, AZ 856531/31/2024 9:07 AM
DetailsLast Recertification DateUpdateRecertification1/31/2023 4:17:33 PM1/31/2024 9:07:42 AM1/31/2024 9:07 AM
DetailsLast Recertification DateUpdateRecertification1/31/2022 9:16:37 AM1/31/2023 4:17:33 PM1/31/2023 4:17 PM
DetailsLast Recertification DateUpdateRecertification2/8/2021 10:47:12 AM1/31/2022 9:16:37 AM1/31/2022 9:16 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/8/2021 10:47 AM
Medicaid BillingMedicaid: NumberInsertRecertification 9888812/8/2021 10:47 AM
Medicaid BillingMedicaid: StateInsertRecertification AZ2/8/2021 10:47 AM
Medicaid BillingNPI: NumberDeleteRecertification1689864597 ( ) 2/8/2021 10:47 AM
Medicaid BillingNPI: NumberInsertRecertification 16898645972/8/2021 10:47 AM
Medicaid BillingNPI: StateInsertRecertification AZ2/8/2021 10:47 AM
Medicaid BillingNPI: NumberInsertRecertification 12456091972/8/2021 10:47 AM
Medicaid BillingNPI: StateInsertRecertification AZ2/8/2021 10:47 AM
DetailsLast Recertification DateUpdateRecertification1/28/2020 10:02:51 AM2/8/2021 10:47:12 AM2/8/2021 10:47 AM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 2/8/2021 10:47 AM
DetailsLast Recertification DateUpdateRecertification2/15/2019 12:22:57 PM1/28/2020 10:02:51 AM1/28/2020 10:02 AM
DetailsLast Recertification DateUpdateRecertification2/21/2018 1:48:27 PM2/15/2019 12:22:57 PM2/15/2019 12:22 PM
DetailsLast Recertification DateUpdateRecertification2/1/2017 12:00:00 AM2/21/2018 1:48:27 PM2/21/2018 1:48 PM
ContactsAuthorizing OfficialUpdateAO Change RequestArnoldi, Jania Chief Financial Officer 5206824111-6221Olson, Tamie Chief Financial Officer Marana Health Center, Inc. 5206824111-62212/21/2018 1:12 PM
ContactsPrimary ContactUpdate Redding, Greg Pharmacy Director 5206824111Redding, Greg Pharmacy Director MHC Health Care 52068241119/27/2017 12:11 PM
ContactsPrimary ContactInsert  Redding, Greg Pharmacy Director 52068241112/1/2017 8:52 AM
ContactsAuthorizing OfficialInsert  Arnoldi, Jania Chief Financial Officer 5206824111-62212/1/2017 8:52 AM
ContactsSigned ByInsert  Redding, Greg Director of Pharmacy 52068241112/1/2017 8:52 AM
AddressesMain AddressInsert   13395 B N. Marana Main Street Marana, AZ 856532/1/2017 8:52 AM
DetailsLast Recertification DateUpdate 3/2/2016 12:00:00 AM2/1/2017 12:00:00 AM2/1/2017 8:52 AM
DetailsLast Recertification DateUpdate 3/10/2015 12:00:00 AM3/2/2016 12:00:00 AM3/2/2016 10:45 AM
DetailsLast Recertification DateUpdate 3/5/2014 12:00:00 AM3/10/2015 12:00:00 AM3/10/2015 10:52 AM
AddressesBilling AddressInsert  Marana Health Center, Inc. PO Box 188 Marana, AZ 8565312/10/2014 12:58 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False12/10/2014 12:57 PM
Medicaid BillingMedicaid: NumberInsert  23445612/10/2014 12:57 PM
Medicaid BillingMedicaid: StateInsert  AZ12/10/2014 12:57 PM
Medicaid BillingNPI: NumberInsert  168986459712/10/2014 12:57 PM
DetailsIs Authorizing Official EHB DataUpdate  False12/10/2014 12:57 PM
DetailsLast Recertification DateUpdate  3/5/2014 12:00:00 AM3/5/2014 4:34 PM
DatesParticipating Approval DateUpdate  12/11/2013 12:00:00 AM12/11/2013 2:10 PM
DetailsStateUpdate PendingActive12/11/2013 2:10 PM
DatesStart DateUpdate  1/1/2014 12:00:00 AM12/11/2013 2:10 PM
Details340B IDUpdate ONLINE_REGCH09008R11/8/2013 4:17 PM
DetailsLast Recertification DateInsert   10/1/2013 3:15 PM
DetailsGrant NumberInsert  H80CS0023110/1/2013 3:15 PM
Details340B IDInsert  ONLINE_REG10/1/2013 3:15 PM
DetailsIs Authorizing Official EHB DataInsert   10/1/2013 3:15 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/1/2013 3:15 PM
DetailsMedicare Provider NumberInsert   10/1/2013 3:15 PM
DetailsEntity NameInsert  MARANA HEALTH CENTER, INC.10/1/2013 3:15 PM
DetailsProgram CodeInsert  CH10/1/2013 3:15 PM
DetailsEntity SubnameInsert  MHC Counseling and Wellness Center10/1/2013 3:15 PM
DatesParticipating Approval DateInsert   10/1/2013 3:15 PM
DetailsStateInsert  Pending10/1/2013 3:15 PM
DatesRegistration DateInsert  10/1/2013 12:00:00 AM10/1/2013 3:15 PM
DatesSigned By DateInsert  10/1/2013 12:00:00 AM10/1/2013 3:15 PM
DatesStart DateInsert   10/1/2013 3:15 PM
TerminationsTermination CommentsInsert   10/1/2013 3:15 PM
TerminationsTermination DateInsert   10/1/2013 3:15 PM
TerminationsTermination Effective DateInsert   10/1/2013 3:15 PM
TerminationsTermination ReasonInsert   10/1/2013 3:15 PM