Covered Entity Details

CHC26571-00 DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC (Terminated) - information as of 4/29/2025 1:40:54 AM

Main Details

Name

DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC

Subdivision Name

Detroit Central City Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013387

340B ID

CHC26571-00

Grant Number

H80CS26571

Additional Details

Current Program Status

Terminated

Registration Date

4/7/2014

Participating Start Date

7/1/2014

Participating Approval Date

4/17/2014

Last Recertification Date

2/13/2017

Termination Date
Termination Reason

4/1/2018
Failure to recertify

Contacts

Authorizing Official

Ryan Lepper, President and CEO
(313) 831-3160

Primary Contact

Melissa DaSilva, CInO
(313) 833-6275

Addresses

Street Address

3427 Woodward Ave.
Detroit, MI 48201-2725

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

Shipping Address 1

Detroit Central City Community Mental Health dba Central City Integrated Health
10 Peterboro Street
Detroit, MI 48201

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
Contract Detail	PHARMOR PHARMACY-DOCTORS	3169 WOODWARD AVE		DETROIT	MI	48201-2723	07/07/2014	10/01/2014		04/01/2018	04/01/2018

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC26571-00	Terminated	BPS-H80-013387	DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC	Detroit Central City Health Center	3427 Woodward Ave.		Detroit	MI
CHC26571-01	Active	BPS-H80-014084	DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH, INCORPORATED	Detroit Central City Administrative Site	10 Peterboro St		Detroit	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Carve-In Effective Date	Termination Date
CHC26571-00	PHARMOR PHARMACY-DOCTORS	3169 WOODWARD AVE		DETROIT	MI	48201-2723	10/01/2014		04/01/2018
CHC26571-01	PHARMOR PHARMACY-DOCTORS	3169 WOODWARD AVE		DETROIT	MI	48201-2723	04/23/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 2:38 PM
Details	State	Update	Recertification	Active	To Be Terminated	3/8/2018 2:38 PM
Terminations	Termination Date	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 2:38 PM
Terminations	Termination Effective Date	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 2:38 PM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	3/8/2018 2:38 PM
Contacts	Primary Contact	Update		Warren, Henriette Vice President and COO 3138336277	DaSilva, Melissa CInO 3138336275	2/13/2017 11:52 AM
Addresses	Main Address	Insert			3427 Woodward Ave. Detroit, MI 48201-2725	2/13/2017 7:03 AM
Addresses	Shipping Address	Insert			Detroit Central City Community Mental Health dba Central City Integrated Health 10 Peterboro Street Detroit, MI 48201	2/13/2017 7:03 AM
Contacts	Signed By	Insert			Bermudez, Irva Faber President and CEO 3138336275	2/13/2017 7:03 AM
Contacts	Authorizing Official	Insert			Lepper, Ryan President and CEO 3138313160	2/13/2017 7:03 AM
Details	Last Recertification Date	Update		3/7/2016 12:00:00 AM	2/13/2017 12:00:00 AM	2/13/2017 7:03 AM
Contacts	Primary Contact	Insert			Warren, Henriette Vice President and COO 3138336277	3/7/2016 4:37 PM
Details	Last Recertification Date	Update		3/9/2015 12:00:00 AM	3/7/2016 12:00:00 AM	3/7/2016 4:37 PM
Details	Last Recertification Date	Update			3/9/2015 12:00:00 AM	3/9/2015 10:18 PM
Details	Is Authorizing Official EHB Data	Update			False	3/9/2015 10:18 PM
Details	340B ID	Update		ONLINE_REG	CHC26571-00	4/17/2014 4:46 PM
Dates	Participating Approval Date	Update			4/17/2014 12:00:00 AM	4/17/2014 4:46 PM
Details	State	Update		Pending	Active	4/17/2014 4:46 PM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	4/17/2014 4:46 PM
Details	Last Recertification Date	Insert				4/7/2014 7:44 AM
Details	Grant Number	Insert			H80CS26571	4/7/2014 7:44 AM
Details	340B ID	Insert			ONLINE_REG	4/7/2014 7:44 AM
Details	Is Authorizing Official EHB Data	Insert				4/7/2014 7:44 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/7/2014 7:44 AM
Details	Medicare Provider Number	Insert				4/7/2014 7:44 AM
Details	Entity Name	Insert			DETROIT CENTRAL CITY COMMUNITY MENTAL HEALTH INC	4/7/2014 7:44 AM
Details	Program Code	Insert			CH	4/7/2014 7:44 AM
Details	Entity Subname	Insert			Detroit Central City Health Center	4/7/2014 7:44 AM
Dates	Participating Approval Date	Insert				4/7/2014 7:44 AM
Details	State	Insert			Pending	4/7/2014 7:44 AM
Dates	Registration Date	Insert			4/7/2014 12:00:00 AM	4/7/2014 7:44 AM
Dates	Signed By Date	Insert			4/7/2014 12:00:00 AM	4/7/2014 7:44 AM
Dates	Start Date	Insert				4/7/2014 7:44 AM
Terminations	Termination Comments	Insert				4/7/2014 7:44 AM
Terminations	Termination Date	Insert				4/7/2014 7:44 AM
Terminations	Termination Effective Date	Insert				4/7/2014 7:44 AM
Terminations	Termination Reason	Insert				4/7/2014 7:44 AM

340B Drug Pricing Program Database