Covered Entity Details

CH031060G NEIGHBORHOOD HEALTH (Active) - information as of 5/16/2025 11:34:22 PM

Main Details

Name

NEIGHBORHOOD HEALTH

Subdivision Name

6677 RICHMOND HIGHWAY

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013594

340B ID

CH031060G

Grant Number

H80CS02446

Additional Details

Current Program Status

Active

Registration Date

1/9/2014

Participating Start Date

4/1/2014

Participating Approval Date

3/14/2014

Last Recertification Date

2/16/2025

Contacts

Authorizing Official

Neighborhood Health
Basim Khan, Executive Director
(703) 535-5568 Ext: 4104

Primary Contact

NEIGHBORHOOD HEALTH
DANY HERNANDEZ, PHARMACY PROGRAM MANAGER
(703) 535-5568 Ext: 2814

Addresses

Street Address

6677 RICHMOND HIGHWAY
ALEXANDRIA, VA 22306

Billing Address

Neighborhood Health at Huntwood Plaza
6677 RICHMOND HIGHWAY
4TH FLOOR
Suite 405
ALEXANDRIA, VA 22306

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?
Yes

State	Medicaid Number	NPI Number
VA	30015174830041,30015174830040,3001517483	1902104532,1093138588,1740641091,1790001741,1669801403,1093136947,1669989208,1164620027,1215259775,1841744265,1710544283,1154988269,1003354416,1093486680,1588311492,1942914775,1922711159,1225899719,1740976588,1245086875,1851099964

Shipping Addresses

Shipping Address 1

NEIGHBORHOOD HEALTH 6677 RICHMOND HIGHWAY PHARMACY
6677 RICHMOND HIGHWAY
ALEXANDRIA, VA 22306

Shipping Address 2

NEIGHBORHOOD HEALTH AT RICHMOND HIGHWAY
6677 RICHMOND HIGHWAY
ALEXANDRIA, VA 22306

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	Address Cont.	City	State
CH031006J	Active	BPS-H80-013829	NEIGHBORHOOD HEALTH	Neighborhood Health at the Gartlan Mental Health Center	8119 HOLLAND RD		ALEXANDRIA	VA
CH031060A	Active	BPS-H80-001589	NEIGHBORHOOD HEALTH	2 EAST GLEBE RD	2 E GLEBE RD		Alexandria	VA
CH031060C	Active	BPS-H80-017326	Neighborhood Health	Arlington County Behavioral Health Services Division	2120 WASHINGTON BOULEVARD	3RD FLOOR	ARLINGTON	VA
CH031060D	Active	BPS-H80-008867	NEIGHBORHOOD HEALTH	Alexandria Health Department Casey Health Center	1200 N HOWARD ST		ALEXANDRIA	VA
CH031060E	Active	BPS-H80-010199	NEIGHBORHOOD HEALTH	ALEXANDRIA CSB	720 N ASAPH ST	3RD FLOOR	ALEXANDRIA	VA
CH031060G	Active	BPS-H80-013594	NEIGHBORHOOD HEALTH	6677 RICHMOND HIGHWAY	6677 RICHMOND HIGHWAY		ALEXANDRIA	VA
CH031060H	Active	BPS-H80-013799	NEIGHBORHOOD HEALTH	Neighborhood Health at the WOW Bus	2 E GLEBE RD		ALEXANDRIA	VA
CH031060K	Active	BPS-H80-010066	NEIGHBORHOOD HEALTH	Neighborhood Health Arlington Dental	2100 WASHINGTON BOULEVARD		ARLINGTON	VA
CH031060L	Active	BPS-H80-007067	NEIGHBORHOOD HEALTH	Neighborhood Health King Street Dental	4480 KING ST		Alexandria	VA
CH031060M	Active	BPS-H80-019194	Neighborhood Health	Neighborhood Health at Merrifield Center	8221 Willow Oaks Corporate Dr		Fairfax	VA
CH031060N	Active	BPS-H80-018165	NEIGHBORHOOD HEALTH	Neighborhood Health at Annandale, Central Fairfax County	7501 LITTLE RIVER TURNPIKE SUITE G4		ANNANDALE	VA
CH031060P	Active	BPS-H80-021467	NEIGHBORHOOD HEALTH	Neighborhood Health at Sherwood Hall Lane	2616 SHERWOOD HALL LANE	SUITE 106	ALEXANDRIA	VA
CH031060Q	Active	BPS-H80-027764	Neighborhood Health	Neighborhood Health at South County Center	8350 RICHMOND HIGHWAY SUITE 301		ALEXANDRIA	VA
CH031060R	Active	BPS-H80-027728	Neighborhood Health	Neighborhood Health at Merrifield Center	8221 Willow Oaks Corporate Dr		Fairfax	VA
CH031060S	Active	BPS-H80-033017	Neighborhood Health	Neighborhood Health at Annandale Medical	6715 Little River Tpke Ste 201		Annandale	VA
CH031060T	Active	BPS-H80-034341	Neighborhood Health	Neighborhood Health at Martha Custis Drive	1225 Martha Custis Dr STE C1		Alexandria	VA
CH031060U	Active	BPS-H80-038121	NEIGHBORHOOD HEALTH	Neighborhood Health Arlington Pediatric Center	3401 Columbia Pike, Ste 200		Arlington	VA
CH031060V	Active	BPS-H80-036570	NEIGHBORHOOD HEALTH	Neighborhood Health Mark Center Drive	4850 Mark Center Drive STE 3113		Alexandria	VA
CH031060W	Active	BPS-H80-036123	NEIGHBORHOOD HEALTH	Neighborhood Health South County Dental	8350 Richmond Highway STE 233		Alexandria	VA
CH031060X	Active	BPS-H80-036124	NEIGHBORHOOD HEALTH	Neighborhood Health Joseph Willard Dental	3750 Old Lee HWY		Fairfax	VA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH031060A	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2023
CH031060H	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2023
CH031060A	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2023
CH031060A	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2023
CH031060A	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2023
CH031060A	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2023
CH031060A	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2023
CH031060A	ALEXANDRIA HEALTH DEPT PHARMACY	GENERAL MEDICAL CLINIC	1200 NORTH HOWARD STREET	ALEXANDRIA	VA	22304	01/01/2017	06/03/2024
CH031060D	ALEXANDRIA HEALTH DEPT PHARMACY	GENERAL MEDICAL CLINIC	1200 NORTH HOWARD STREET	ALEXANDRIA	VA	22304	04/01/2014	06/03/2024
CH031060A	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2021
CH031060A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	01/01/2024
CH031060A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/01/2024
CH031060A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2024
CH031060A	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2021
CH031060A	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2020
CH031060A	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2022
CH031060A	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2021
CH031060A	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2021
CH031060A	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2022
CH031060A	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2020
CH031060A	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2021
CH031060A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2021
CH031060A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CH031060A	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	01/01/2024
CH031060A	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	01/01/2024
CH031060A	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02057	100-02 QUEENS BOULEVARD	FOREST HILLS	NY	11375	07/01/2020
CH031060A	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2022
CH031060A	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2022
CH031060A	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07299	7202 SAN PEDRO	SAN ANTONIO	TX	78216	07/01/2020
CH031060A	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07403	103 S.W. MILITARY DR.	SAN ANTONIO	TX	78221	10/01/2021
CH031060A	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 07092	110 W. 20TH ST.	HOUSTON	TX	77008	10/01/2022
CH031060A	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CH031060A	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 01348	1100 4TH STREET SW	WASHINGTON	DC	20024	01/01/2020
CH031060A	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 01340	845 BLADENSBURG RD., N.E.	WASHINGTON	DC	20002	10/01/2020
CH031060A	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 02174	4555 WISCONSIN AVENUE, NW	WASHINGTON	DC	20016	10/01/2021
CH031060A	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	01/01/2024
CH031060A	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2023
CH031060A	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2023
CH031060A	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2023
CH031060A	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2023
CH031060A	GENOA HEALTHCARE LLC	8119 HOLLAND RD		ALEXANDRIA	VA	22306	10/01/2019
CH031060A	GENOA HEALTHCARE LLC	8350 RICHMOND HWY, STE 301		ALEXANDRIA	VA	22309	10/01/2019
CH031060A	GENOA HEALTHCARE LLC	8221 WILLOW OAKS CORP DR, STE 450		FAIRFAX	VA	22031	10/01/2019
CH031060A	GENOA HEALTHCARE LLC	2120 WASHINGTON BLVD RM 115		ARLINGTON	VA	22204	10/01/2021
CH031060R	GENOA HEALTHCARE LLC	8221 WILLOW OAKS CORP DR, STE 450		FAIRFAX	VA	22031	01/01/2023
CH031060Q	GENOA HEALTHCARE LLC	8350 RICHMOND HWY, STE 301		ALEXANDRIA	VA	22309	01/01/2023
CH031060C	GENOA HEALTHCARE LLC	2120 WASHINGTON BLVD RM 115		ARLINGTON	VA	22204	01/01/2023
CH031060M	GENOA HEALTHCARE LLC	8221 WILLOW OAKS CORPORATE DR.	SUITE # 410 EAST	FAIRFAX	VA	22031	04/01/2023
CH031060A	GENOA HEALTHCARE LLC	16240 BENNETT RD STE A		CULPEPER	VA	22701	04/01/2023
CH031060A	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03392	266 EAST CHURCH ST	JASPER	GA	30143	10/01/2021
CH031060A	GIANT PHARMACY	2901-11 SOUTH GLEBE ROAD		ARLINGTON	VA	22206	01/04/2007
CH031060A	GIANT PHARMACY #261	3131 DUKE STREET		ALEXANDRIA	VA	22314	10/01/2020
CH031060A	GIANT PHARMACY #2742	621 EAST GLEBE STREET		ALEXANDRIA	VA	22305	10/01/2020
CH031060A	GIANT PHARMACY #2747	6200 LITTLE RIVER TURNPIKE		ALEXANDRIA	VA	22312	10/01/2020
CH031060A	GIANT PHARMACY #749	7137 COLUMBIA PIKE		ANNANDALE	VA	22003	10/01/2020
CH031060A	GIANT PHARMACY #760	6800 RICHMOND HIGHWAY		ALEXANDRIA	VA	22306-1704	10/01/2020
CH031060A	GIANT PHARMACY #780	3480 S JEFFERSON STREET		FALLS CHURCH	VA	22041-3104	10/01/2020
CH031060A	GRUBBS CARE PHARMACY NW INC.	1517 17TH ST NW		WASHINGTON	DC	20036	10/01/2022
CH031060A	HARRIS TEETER #133	4641 DUKE ST		ALEXANDRIA	VA	22304	01/01/2020
CH031060A	HARRIS TEETER #83		900 ARMY NAVY DRIVE	ARLINGTON	VA	22202	01/01/2020
CH031060A	HARRIS TEETER PHARMACY	4250 CAMPBELL AVE		ARLINGTON	VA	22206	01/01/2020
CH031060A	HARRIS TEETER PHARMACY	735 N SAINT ASAPH STREET		ALEXANDRIA	VA	22314	01/01/2020
CH031060A	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01170	3200 CATON FARM	JOLIET	IL	60431	10/01/2021
CH031060A	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05216	2702 S ORANGE AVE	ORLANDO	FL	32806	04/01/2022
CH031060A	IOWA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10480	14201 HICKMAN RD.	URBANDALE	IA	50323	10/01/2021
CH031060K	JOULE PHARMACY GROUP INC	1028 S WALTER REED DRIVE		ARLINGTON	VA	22204	01/01/2023
CH031060A	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	10/01/2021
CH031060A	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02239	8201 OXON HILL ROAD	FORT WASHINGTON	MD	20744	10/01/2021
CH031060A	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16430	11200 REISTERSTOWN RD	OWINGS MILLS	MD	21117	10/01/2021
CH031060A	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	10/01/2021
CH031060A	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02005	5870 SILVER HILL RD SILVER HILL PLAZA	DISTRICT HEIGHTS	MD	20747	10/01/2021
CH031060A	NORTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16917	8651 BRIER CREEK PKWY	RALEIGH	NC	27617	07/01/2020
CH031060A	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05594	2400 GUM BRANCH RD.	JACKSONVILLE	NC	28540	10/01/2021
CH031060A	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/01/2023
CH031060A	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	04/01/2023
CH031060A	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02408	802 N LANSDOWNE AVE	DREXEL HILL	PA	19026	07/01/2020
CH031060A	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	10/01/2021
CH031060A	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2020
CH031060A	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CH031060A	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CH031060A	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/01/2022
CH031060A	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY#2733	1601 17TH STREET NW	WASHINGTON	DC	20009	10/01/2022
CH031060A	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/01/2024
CH031060A	RITE AID OF VIRGINIA, INC.	RITE AID #3676	1671 CRYSTAL SQUARE ARCADE	ARLINGTON	VA	22202	07/01/2018	09/30/2019
CH031060A	RITE AID OF VIRGINIA, INC.	RITE AID #3734	5230 PORT ROYAL ROAD	SPRINGFIELD	VA	22151	07/01/2018	09/30/2019
CH031060A	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/01/2024
CH031060A	SAFEWAY PHARMACY	299 SOUTH VAN DORN STREET		ALEXANDRIA	VA	22304	01/01/2020
CH031060A	SAFEWAY PHARMACY #3250	3526 KING ST		ALEXANDRIA	VA	22302	01/01/2020
CH031060A	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	01/01/2024
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01384	259 SOUTH VAN DORN STREET	ALEXANDRIA	VA	22304	07/01/2019	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01840	8628 RICHMOND HWY, RTE 1 ENGLESIDE PLZ	ALEXANDRIA	VA	22309	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01385	1462 BEAUREGARD STREET	ALEXANDRIA	VA	22311	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01382	1521-1523 NORTH QUAKER LANE	ALEXANDRIA	VA	22302	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02142	3301 COLUMBIA PIKE	ARLINGTON	VA	22204	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01375	5017 COLUMBIA PIKE	ARLINGTON	VA	22204	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02343	5101 DUKE STREET	ALEXANDRIA	VA	22304	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16456	3101 RICHMOND HWY	ALEXANDRIA	VA	22305	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01384	259 SOUTH VAN DORN STREET	ALEXANDRIA	VA	22304	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01373	433 SOUTH WASHINGTON STREET	ALEXANDRIA	VA	22314	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01410	415 E MONROE AVE	ALEXANDRIA	VA	22301	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01408	4606 KENMORE AVENUE	ALEXANDRIA	VA	22304	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02004	3117 LOCKHEED BLVD	ALEXANDRIA	VA	22306	07/01/2019
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01409	401 ENTERPRISE ST.	STERLING	VA	20164	01/01/2020
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02278	6400 LANDSDOWNE CENTER	ALEXANDRIA	VA	22315	07/01/2020
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01383	7205 LITTLE RIVER TURNPIKE	ANNANDALE	VA	22003	07/01/2020
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17013	5115 LEESBURG PIKE	FALLS CHURCH	VA	22041	07/01/2020	12/31/2022
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01411	8124 ARLINGTON BLVD YORKTOWN CTR	FALLS CHURCH	VA	22042	10/01/2020
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01832	4338 DALE BLVD.	DALE CITY	VA	22193	10/01/2020
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01417	13031 LEE-JACKSON HIGHWAY	FAIRFAX	VA	22033	07/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01416	5652 PICKWICK RD.	CENTREVILLE	VA	20120	07/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01405	8928 BURKE LAKE ROAD	SPRINGFIELD	VA	22151	07/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01399	3053 NUTLEY STREET	FAIRFAX	VA	22031	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01407	3133 LANGSTON BLVD LYON VILLAGE SHOPPING CENTER	ARLINGTON	VA	22201	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2750	1201 SOUTH HAYES ST.	ARLINGTON	VA	22202	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01378	5711 BURKE CENTER PARKWAY	BURKE	VA	22015	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01403	337 EAST MAPLE STREET	VIENNA	VA	22180	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10900	2441 EISENHOWER AVE.	ALEXANDRIA	VA	22314	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01391	2200 TACKETTS MILL	WOODBRIDGE	VA	22192	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02418	2121 15TH ST. N.	ARLINGTON	VA	22201	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16754	6600 SPRINGFIELD MALL	SPRINGFIELD	VA	22150	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01394	1636 BELLE VIEW BOULEVARD	ALEXANDRIA	VA	22307	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02149	501 KING STREET	ALEXANDRIA	VA	22314	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02007	3120 DUKE ST,	ALEXANDRIA	VA	22314	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01413	7859 HERITAGE DRIVE	ANNANDALE	VA	22003	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10320	3401 CHARLES STREET	FALLS CHURCH	VA	22041	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01398	6436 SPRINGFIELD PLAZA	SPRINGFIELD	VA	22150	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01388	6164 ARLINGTON BOULEVARD	FALLS CHURCH	VA	22044	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01386	3535 SOUTH JEFFERSON STREET	BAILEYS CROSSROADS	VA	22041	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02491	2400 RICHMOND HWY	ARLINGTON	VA	22202	10/01/2021
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16863	6600 RICHMOND HWY	ALEXANDRIA	VA	22306	04/01/2022
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17678	1500 WILSON BLVD	ROSSLYN	VA	22209	04/01/2022
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02374	6150 FRANCONIA ROAD	ALEXANDRIA	VA	22310	04/01/2022
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01380	4709-A LANGSTON BLVD	ARLINGTON	VA	22207	10/01/2022
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01884	256 NORTH GLEBE ROAD	ARLINGTON	VA	22203	10/01/2022
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06852	16712 RICHMOND HIGHWAY	DUMFRIES	VA	22026	10/01/2022
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	10/01/2022
CH031060A	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01404	13600 JEFFERSON DAVIS HIGHWAY	WOODBRIDGE	VA	22191	01/01/2023
CH031060L	VIRGINIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17013	5115 LEESBURG PIKE	FALLS CHURCH	VA	22041	01/01/2023
CH031060A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020
CH031060A	WAL-MART PHARMACY 10-2194	5885 KINGSTOWNE BLVD		ALEXANDRIA	VA	22315	07/01/2019
CH031060A	WAL-MART PHARMACY 10-2258	7910 RICHMOND HWY		ALEXANDRIA (EAST)	VA	22306	07/01/2019
CH031060A	WAL-MART PHARMACY 10-5753	6303 RICHMOND HIGHWAY		ALEXANDRIA	VA	22306	07/01/2019
CH031060A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020
CH031060A	WALGREEN CO.	DBA: WALGREENS #10616	6717 RICHMOND HWY.	ALEXANDRIA	VA	22306-6704	10/01/2017
CH031060A	WALGREEN CO.	DBA: WALGREENS #10617	615 KING ST.	ALEXANDRIA	VA	22314-3105	10/01/2017	07/01/2020
CH031060A	WALGREEN CO.	DBA: WALGREENS #10233	7629 RICHMOND HWY.	ALEXANDRIA	VA	22306-2802	10/01/2017
CH031060A	WALGREEN CO.	DBA: WALGREENS #12800	8414 OLD KEENE MILL RD. UNIT A	SPRINGFIELD	VA	22152	10/01/2017
CH031060A	WALGREEN CO.	DBA: WALGREENS #12359	1517 MOUNT VERNON AVE	ALEXANDRIA	VA	22301	10/01/2017
CH031060A	WALGREEN CO.	DBA: WALGREENS #11297	3050A NUTLEY ST.	FAIRFAX	VA	22031	10/01/2017
CH031060A	WALGREEN CO.	DBA: WALGREENS #15444	6715A ARLINGTON BLVD	FALLS CHURCH	VA	22042	10/01/2017
CH031060A	WALGREEN CO.	WALGREENS #17684	6100 ROSE HILL DR	ALEXANDRIA	VA	22310-1901	04/01/2018
CH031060A	WALGREEN CO.	4515 DUKE ST		ALEXANDRIA	VA	22304-2591	04/01/2018
CH031060A	WALGREEN CO.	WALGREENS #19650	2820 COLUMBIA PIKE	ARLINGTON	VA	22204-4412	04/01/2018
CH031060A	WALGREEN CO.	WALGREENS #18162	6053 LEESBURG PIKE	FALLS CHURCH	VA	22041-2205	04/01/2018
CH031060A	WALGREEN CO.	WALGREENS #18330	3614 KING ST	ALEXANDRIA	VA	22302-1908	04/01/2018
CH031060A	WALGREEN CO.	RITE AID #04623	6711 RICHMOND HIGHWAY	ALEXANDRIA	VA	22306	04/01/2018	06/06/2018
CH031060A	WALGREEN CO.	RITE AID #03660	8244 RICHMOND HIGHWAY	ALEXANDRIA	VA	22309	04/01/2018	02/12/2019
CH031060A	WALGREEN CO.	WALGREENS #17217	7100 SILVER LAKE BLVD	ALEXANDRIA	VA	22315-3200	04/01/2018
CH031060A	WALGREEN CO.	WALGREENS #18419	1301 S JOYCE ST	ARLINGTON	VA	22202-2079	04/01/2018
CH031060A	WALGREEN CO.	WALGREENS #19265	5841 WASHINGTON BLVD	ARLINGTON	VA	22205	07/01/2018
CH031060A	WALGREEN CO.	WALGREENS #17573	6224 OLD DOMINION DR	MC LEAN	VA	22101-4217	07/01/2018
CH031060A	WALGREEN CO.	WALGREENS #19791	9579 BRADDOCK RD	FAIRFAX	VA	22032-2539	07/01/2018
CH031060A	WALGREEN CO.	RITE AID #11225	1003 WEST BROAD STREET	FALLS CHURCH	VA	22046	07/01/2018	06/04/2019
CH031060A	WALGREEN CO.	WALGREENS #19419	4720B LANGSTON BLVD	ARLINGTON	VA	22207	07/01/2018
CH031060A	WALGREEN CO.	WALGREENS #19804	7968 FORT HUNT RD	ALEXANDRIA	VA	22308-1249	07/01/2018
CH031060A	WALGREEN CO.	RITE AID #03686	10521 FAIRFAX BLVD	FAIRFAX	VA	22030	07/01/2018	10/08/2018
CH031060A	WALGREEN CO.	RITE AID #11222	8416 LEE HIGHWAY	FAIRFAX	VA	22031	07/01/2018	06/05/2019
CH031060A	WALGREEN CO.	WALGREENS # 17465	5230 PORT ROYAL RD	SPRINGFIELD	VA	22151-2102	10/01/2019
CH031060A	WALGREEN CO.	RITE AID #03676	1671 CRYSTAL SQUARE ARCADE	ARLINGTON	VA	22202	10/01/2019	02/17/2020
CH031060A	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	10/01/2023
CH031060A	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2017	01/01/2018
CH031060A	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018
CH031060A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2024
CH031060A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2024
CH031060A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2024
CH031060A	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CH031060A	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/16/2025 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		30015174830041	2/16/2025 12:05 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	2/16/2025 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/16/2025 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		30015174830040	2/16/2025 12:05 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	2/16/2025 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/16/2025 12:05 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3001517483	2/16/2025 12:05 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	2/16/2025 12:05 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1730551193 (VA)		2/16/2025 12:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1225899719	2/16/2025 12:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/16/2025 12:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740976588	2/16/2025 12:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/16/2025 12:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1245086875	2/16/2025 12:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/16/2025 12:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1851099964	2/16/2025 12:05 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/16/2025 12:05 PM
Details	Last Recertification Date	Update	Recertification	2/21/2024 2:28:30 PM	2/16/2025 12:05:12 PM	2/16/2025 12:05 PM
Addresses	Billing Address	Update	Change Request	Neighborhood Health at Huntwood Plaza 5845 Richmond Highway Suite 405 Alexandria, VA 22303	Neighborhood Health at Huntwood Plaza 6677 RICHMOND HIGHWAY 4TH FLOOR Suite 405 ALEXANDRIA, VA 22306	8/12/2024 12:39 PM
Addresses	Shipping Address	Insert	Change Request		NEIGHBORHOOD HEALTH 6677 RICHMOND HIGHWAY PHARMACY 6677 RICHMOND HIGHWAY ALEXANDRIA, VA 22306	8/12/2024 12:39 PM
Addresses	Shipping Address	Insert	Change Request		NEIGHBORHOOD HEALTH AT RICHMOND HIGHWAY 6677 RICHMOND HIGHWAY ALEXANDRIA, VA 22306	8/12/2024 12:39 PM
Details	Last Recertification Date	Update	Recertification	2/13/2023 12:26:19 PM	2/21/2024 2:28:30 PM	2/21/2024 2:28 PM
Addresses	Billing Address	Insert	Group Change Request		Neighborhood Health at Huntwood Plaza 5845 Richmond Highway Suite 405 Alexandria, VA 22303	10/16/2023 5:44 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1003354416	10/16/2023 5:44 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	10/16/2023 5:44 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1093486680	10/16/2023 5:44 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	10/16/2023 5:44 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1588311492	10/16/2023 5:44 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	10/16/2023 5:44 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1942914775	10/16/2023 5:44 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	10/16/2023 5:44 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1922711159	10/16/2023 5:44 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		VA	10/16/2023 5:44 PM
Details	Last Recertification Date	Update	Recertification	2/17/2022 9:37:28 AM	2/13/2023 12:26:19 PM	2/13/2023 12:26 PM
Details	Last Recertification Date	Update	Recertification	2/27/2021 1:13:48 PM	2/17/2022 9:37:28 AM	2/17/2022 9:37 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1902104532	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1093138588	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740641091	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1790001741	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669801403	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1093136947	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669989208	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1164620027	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1215259775	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1841744265	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1710544283	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1154988269	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730551193	2/27/2021 1:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1730551193 ( )		2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1093138588 ( )		2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1164620027 ( )		2/27/2021 1:13 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1215259775 ( )		2/27/2021 1:13 PM
Details	Last Recertification Date	Update	Recertification	2/18/2020 7:41:56 AM	2/27/2021 1:13:48 PM	2/27/2021 1:13 PM
Contacts	Primary Contact	Update	Profile Change Request	Hernandez, Dany Pharmacy Program Manager NEIGHBORHOOD HEALTH 7035355568-2813	HERNANDEZ, DANY PHARMACY PROGRAM MANAGER NEIGHBORHOOD HEALTH 7035355568-2814	2/24/2021 6:08 AM
Details	Last Recertification Date	Update	Recertification	2/7/2019 12:05:52 AM	2/18/2020 7:41:56 AM	2/18/2020 7:41 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1164620027	2/7/2019 12:05 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215259775	2/7/2019 12:05 AM
Details	Last Recertification Date	Update	Recertification	2/8/2018 3:28:35 PM	2/7/2019 12:05:52 AM	2/7/2019 12:05 AM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/8/2018 3:28:35 PM	2/8/2018 3:28 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/8/2018 3:28 PM
Contacts	Primary Contact	Update	Profile Change Request	Hernandez, Dany Hernandez Pharmacy Program Manager NEIGHBORHOOD HEALTH 7035355568-2813	Hernandez, Dany Pharmacy Program Manager NEIGHBORHOOD HEALTH 7035355568-2813	2/8/2018 1:50 PM
Contacts	Authorizing Official	Update	Profile Change Request	KHAN, BASIM MEDICAL DIRECTOR/INTERIM CEO Neighborhood Health 7035355568-4104	Khan, Basim Executive Director Neighborhood Health 7035355568-4104	10/16/2017 5:34 PM
Contacts	Authorizing Official	Update		KHAN, BASIM MEDICAL DIRECTOR/INTERIM CEO 7035355568-4104	KHAN, BASIM MEDICAL DIRECTOR/INTERIM CEO Neighborhood Health 7035355568-4104	10/5/2017 6:44 PM
Contacts	Primary Contact	Update		Hernandez, Dany Pharmacy Program Manager 7035355568-2813	Hernandez, Dany Hernandez Pharmacy Program Manager NEIGHBORHOOD HEALTH 7035355568-2813	10/5/2017 6:14 PM
Contacts	Authorizing Official	Insert			KHAN, BASIM MEDICAL DIRECTOR/INTERIM CEO 7035355568-4104	7/12/2017 10:19 AM
Contacts	Primary Contact	Update		Hernandez, Dany Pharmacy Program Director 7035355568-2813	Hernandez, Dany Pharmacy Program Manager 7035355568-2813	7/3/2017 4:05 PM
Addresses	Main Address	Insert			6677 Richmond Highway Alexandria, VA 22306	2/13/2017 8:05 AM
Contacts	Signed By	Insert			Wooten, Martha Executive Director 7035355568-1010	2/13/2017 8:05 AM
Medicaid Billing	NPI: Number	Insert			1730551193	2/13/2017 8:05 AM
Medicaid Billing	NPI: Number	Insert			1093138588	2/13/2017 8:05 AM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	2/13/2017 12:00:00 AM	2/13/2017 8:05 AM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 9:34 AM
Details	Last Recertification Date	Update			3/4/2015 12:00:00 AM	3/4/2015 8:22 AM
Addresses	Billing Address	Insert			NEIGHBORHOOD HEALTH PO BOX 2518 ALEXANDRIA, VA 22301	1/27/2015 2:42 PM
Details	Entity Name	Update		ALEXANDRIA NEIGHBORHOOD HEALTH SERVICE INC	NEIGHBORHOOD HEALTH	1/20/2015 8:46 AM
Details	Entity Subname	Update		Alexandria Neighborhood Health Services, Inc. Family Practice Site	6677 RICHMOND HIGHWAY	1/20/2015 8:46 AM
Contacts	Primary Contact	Insert			Hernandez, Dany Pharmacy Program Director 7035355568-2813	12/30/2014 12:08 PM
Details	Is Authorizing Official EHB Data	Update			False	12/30/2014 11:54 AM
Details	340B ID	Update		REINSTATEMENT ANHSI	CH031060G	3/14/2014 10:42 AM
Dates	Participating Approval Date	Update			3/14/2014 12:00:00 AM	3/14/2014 10:42 AM
Details	State	Update		Pending	Active	3/14/2014 10:42 AM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	3/14/2014 10:42 AM
Details	340B ID	Update		ONLINE_REG	REINSTATEMENT ANHSI	1/15/2014 6:11 PM
Details	Last Recertification Date	Insert				1/9/2014 1:46 PM
Details	Grant Number	Insert			H80CS02446	1/9/2014 1:46 PM
Details	340B ID	Insert			ONLINE_REG	1/9/2014 1:46 PM
Details	Is Authorizing Official EHB Data	Insert				1/9/2014 1:46 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/9/2014 1:46 PM
Details	Medicare Provider Number	Insert				1/9/2014 1:46 PM
Details	Entity Name	Insert			ALEXANDRIA NEIGHBORHOOD HEALTH SERVICE INC	1/9/2014 1:46 PM
Details	Program Code	Insert			CH	1/9/2014 1:46 PM
Details	Entity Subname	Insert			Alexandria Neighborhood Health Services, Inc. Family Practice Site	1/9/2014 1:46 PM
Dates	Participating Approval Date	Insert				1/9/2014 1:46 PM
Details	State	Insert			Pending	1/9/2014 1:46 PM
Dates	Registration Date	Insert			1/9/2014 12:00:00 AM	1/9/2014 1:46 PM
Dates	Signed By Date	Insert			1/9/2014 12:00:00 AM	1/9/2014 1:46 PM
Dates	Start Date	Insert				1/9/2014 1:46 PM
Terminations	Termination Comments	Insert				1/9/2014 1:46 PM
Terminations	Termination Date	Insert				1/9/2014 1:46 PM
Terminations	Termination Effective Date	Insert				1/9/2014 1:46 PM
Terminations	Termination Reason	Insert				1/9/2014 1:46 PM

340B Drug Pricing Program Database