Covered Entity Details

CH05847N COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC. (Terminated) - information as of 4/25/2025 9:21:46 PM

Main Details

Name

COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.

Subdivision Name

CNHC Dublin

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014087

340B ID

CH05847N

Grant Number

H80CS00118

Additional Details

Current Program Status

Terminated

Registration Date

10/23/2017

Participating Start Date

10/23/2017

Participating Approval Date

10/23/2017

Last Recertification Date

1/30/2019

Termination Date
Termination Reason

1/1/2020
Site closure

Contacts

Authorizing Official

Columbus Neighborhood Health Center, Inc.
Charleta B. Tavares, CEO
(614) 859-1946

Primary Contact

Columbus Neighborhood Health Center, Inc.
Dewitt D Harrell, Chief Financial Officer
(614) 859-1902

Addresses

Street Address

299 CRAMER CREEK CT
DUBLIN, OH 43017-2586

Billing Address

Columbus Neighborhood Health Center, Inc.
2780 Airport Drive
Suite 100
Columbus, OH 43219

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
Participating effective starting date (01/01/2015), until terminated effective date (10/22/2017), reinstatement effective date (01/01/2018)	10/23/2017

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
OH	0121809
		1538569827

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
Contract Detail	KROGER PHARMACY #682	DBA CARDINAL HEALTH WELLNESS CTR	7200 CARDINAL PL W	DUBLIN	OH	43017	10/22/2014	01/01/2015		10/17/2017	10/17/2017

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH058470	Active	BPS-H80-021012	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	CNHC dba PrimaryOne Health	2780 Airport Drive, Suite 100		Columbus	OH
CH05847AA	Active	BPS-H80-038098	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC	PrimaryOne Health Parsons Central	946 Parsons Ave		Columbus	OH
CH05847C	Active	BPS-H80-005634	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 3781 South High Street	3781 S High St		Columbus	OH
CH05847D	Active	BPS-H80-008673	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 2300 West Broad Street	2300 W Broad St		Columbus	OH
CH05847G	Active	BPS-H80-002767	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 1180 East Main Street	1180 E Main St		Columbus	OH
CH05847H	Active	BPS-H80-001399	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 1500 East 17th Avenue	1500 E 17th Ave		Columbus	OH
CH05847I	Active	BPS-H80-000718	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 3433 Agler Road	3433 AGLER RD STE 2800		COLUMBUS	OH
CH05847J	Active	BPS-H80-036711	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 1751 Alum Creek Drive	1751 Alum Creek Dr.		Columbus	OH
CH05847K	Active	BPS-H80-003262	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 240 Parsons Avenue, Suite 233	240 Parsons Ave		Columbus	OH
CH05847L	Active	BPS-H80-012684	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 1905 Parsons Avenue	1905 Parsons Ave		Columbus	OH
CH05847M	Active	BPS-H80-013253	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health Circleville	600 North Pickaway St	STE 300	Circleville	OH
CH05847N	Terminated	BPS-H80-014087	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	CNHC Dublin	299 CRAMER CREEK CT		DUBLIN	OH
CH05847P	Terminated	BPS-H80-017579	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	Recuperative Care at Van Buren Shelter	595 Van Buren Dr STE F		Columbus	OH
CH05847Q	Terminated	BPS-H80-024998	Columbus Neighborhood Health Center, Inc.	PrimaryOne Health 1289 East Livingston Avenue	1289 E Livingston Ave		Columbus	OH
CH05847R	Active	BPS-H80-029650	Columbus Neighborhood Health Center, Inc.	PrimaryOne Health 720 East Broad Street, Suite 100, Columbus OH 43215	720 E Broad St Ste 100		Columbus	OH
CH05847S	Active	BPS-H80-031203	Columbus Neighborhood Health Center, Inc.	PrimaryOne Health 4661 Sawmill Road	4661 Sawmill Rd Ste 101		Columbus	OH
CH05847T	Active	BPS-H80-033695	Columbus Neighborhood Health Center, Inc.	PrimaryOne Health Mobile Health Center South	1905 Parsons Avenue		Columbus	OH
CH05847U	Active	BPS-H80-033696	Columbus Neighborhood Health Center, Inc.	PrimaryOne Health Mobile Health Center NE	3433 Agler Rd		Columbus	OH
CH05847V	Active	BPS-H80-034132	Columbus Neighborhood Health Center, Inc.	PrimaryOne Health Mobile Health Center West	2300 West Broad Street.		Columbus	OH
CH05847W	Active	BPS-H80-035192	Columbus Neighborhood Health Center, Inc	PrimaryOne Health Mobile Health Center East	1180 E. Main Street E. Main Street		Columbus	OH
CH05847X	Active	BPS-H80-036712	Columbus Neighborhood Health Center	PrimaryOne Health SBHC 4400 Marketing Pl Suite D, Groveport, OH 43125	4400 Marketing Pl		Groveport	OH
CH05847Y	Terminated	BPS-H80-036711	COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	PrimaryOne Health 1751 Alum Creek Drive	1751 Alum Creek Drive		Columbus	OH
CH05847Z	Active	BPS-H80-038177	COLUMBUS NEIGHBORHOOD	PrimaryOne Health 3480 Refugee Road, Columbus, OH 43232	3480 Refugee Rd		Columbus	OH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH058470	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	01/01/2022	12/30/2023
CH058470	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	01/01/2022	12/30/2023
CH058470	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2020	02/19/2023
CH058470	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2020	02/19/2023
CH058470	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2020	02/19/2023
CH058470	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2024
CH058470	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2024
CH058470	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2024
CH058470	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2020	02/19/2023
CH058470	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2020	02/19/2023
CH058470	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2020	02/19/2023
CH058470	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2023	02/19/2023
CH058470	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2024	04/01/2024
CH058470	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2024
CH058470	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2024
CH058470	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2024
CH058470	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2021
CH058470	BEX RX	1924 PARSONS AVE		COLUMBUS	OH	43207	06/01/2023	08/25/2023
CH058470	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	01/01/2023	01/15/2024
CH058470	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/01/2024
CH058470	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	04/01/2024
CH058470	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2021
CH058470	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2021
CH058470	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2021
CH058470	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2021
CH058470	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2021
CH058470	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2021
CH058470	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2021
CH058470	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2021
CH058470	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2021
CH058470	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2021
CH058470	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2024
CH058470	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2024
CH058470	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2021
CH058470	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2024
CH058470	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	07/01/2021
CH058470	EDWARD'S DRUGS	1083 MOUNT VERNON AVE		COLUMBUS	OH	43203	01/01/2019
CH058470	ENCORE PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/01/2023	08/24/2023
CH058470	ENCORE PHARMACY #83	11209 METRIC BLVD STE B4		AUSTIN	TX	78758	10/01/2022	06/30/2023
CH058470	FOUNDATION CARE LLC	111 CHESTERFIELD INDUSTRIAL BLVD STE 115		CHESTERFIELD	MO	63005	01/01/2022	12/30/2023
CH058470	GENOA HEALTHCARE LLC	701 BROOKSEDGE PLAZA DR STE C		WESTERVILLE	OH	43081	04/01/2024	01/15/2025
CH058470	GENOA HEALTHCARE LLC	2458 STETZER RD RM 193		BUCYRUS	OH	44820	04/01/2024	01/15/2025
CH058470	GENOA HEALTHCARE LLC	741 SCHOLL ROAD, STE P1		MANSFIELD	OH	44907	04/01/2024	01/15/2025
CH058470	GIANT EAGLE PHARMACY # 6519	4780 W. BROAD STREET		COLUMBUS	OH	43228	07/01/2020
CH058470	GIANT EAGLE PHARMACY #2465	1380 S 4TH ST		COLUMBUS	OH	43207	01/01/2019
CH058470	GIANT EAGLE PHARMACY #6504	4747 SAWMILL ROAD		COLUMBUS	OH	43220	07/01/2020
CH05847S	GIANT EAGLE PHARMACY #6504	4747 SAWMILL ROAD		COLUMBUS	OH	43220	01/01/2024
CH058470	GIANT EAGLE PHARMACY #6517	2900 STELZER ROAD		COLUMBUS	OH	43219	01/01/2019
CH05847H	GIANT EAGLE PHARMACY #6517	2900 STELZER ROAD		COLUMBUS	OH	43219	01/01/2024
CH058470	GIANT EAGLE PHARMACY #6537	3841 S. HAMILTON RD		GROVEPORT	OH	43125	01/01/2019
CH05847X	GIANT EAGLE PHARMACY #6537	3841 S. HAMILTON RD		GROVEPORT	OH	43125	01/01/2024
CH058470	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	07/01/2020
CH058470	HEPCARE PHARMACY	11209 METRIC BLVD STE B-4		AUSTIN	TX	78758-4182	07/01/2021	09/29/2022
CH058470	KROGER	3675 E BROAD STREET		WHITEHALL	OH	43213	07/01/2017
CH058470	KROGER	ATTENTION PHARMACY	1585 GEORGESVILLE SQUARE DRIVE	COLUMBUS	OH	43228	01/01/2019
CH058470	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	07/01/2016
CH058470	KROGER PHARMACY	1441 PARSONS AVE		COLUMBUS	OH	43207-1247	04/01/2014
CH058470	KROGER PHARMACY	6095 GENDER ROAD		CANAL WINCHESTER	OH	43110	07/01/2017
CH058470	KROGER PHARMACY	5800 W. BROAD STREET		GALLOWAY	OH	43119	07/01/2017
CH058470	KROGER PHARMACY	2161 EAKIN RD		COLUMBUS	OH	43223	07/01/2017
CH058470	KROGER PHARMACY	6011 GROVEPORT ROAD		GROVEPORT	OH	43125	07/01/2017
CH05847L	KROGER PHARMACY	1441 PARSONS AVE		COLUMBUS	OH	43207-1247	01/01/2024
CH05847J	KROGER PHARMACY	6011 GROVEPORT ROAD		GROVEPORT	OH	43125	10/01/2024
CH058470	KROGER PHARMACY #01600232	KROGER COMPANY N-216	6580 E MAIN ST	REYNOLDSBURG	OH	43068-2319	07/01/2020
CH058470	KROGER PHARMACY #016514	3588 GENDER RD		CANAL WINCHESTER	OH	43110	01/01/2019
CH058470	KROGER PHARMACY #522	300 S. HAMILTON RD.		GAHANNA	OH	43230	07/01/2017
CH058470	KROGER PHARMACY #569	150 WEST SYCAMORE ST.		COLUMBUS	OH	43215	07/01/2017
CH058470	KROGER PHARMACY #593	1745 MORSE ROAD		COLUMBUS	OH	43229	07/01/2017
CH05847I	KROGER PHARMACY #593	1745 MORSE ROAD		COLUMBUS	OH	43229	01/01/2024
CH05847N	KROGER PHARMACY #682	DBA CARDINAL HEALTH WELLNESS CTR	7200 CARDINAL PL W	DUBLIN	OH	43017	01/01/2015	10/17/2017
CH058470	KROGER PHARMACY #N-971	3417 N HIGH STREET		COLUMBUS	OH	43214	04/01/2024
CH058470	KROGER PHARMACY N-299	4485 REFUGEE RD		COLUMBUS	OH	43232	01/01/2017	05/19/2022
CH058470	KROGER PHARMACY N-348	887 N BRIDGE STREET		CHILLICOTHE	OH	45601	07/01/2017
CH058470	KROGER PHARMACY N-587	1350 NORTH HIGH ST		COLUMBUS	OH	43201	07/01/2013
CH05847R	KROGER PHARMACY N-587	1350 NORTH HIGH ST		COLUMBUS	OH	43201	01/01/2024
CH058470	KROGER PHARMACY N-598	3600 SOLDANO BLVD		COLUMBUS	OH	43228	07/01/2013
CH05847D	KROGER PHARMACY N-598	3600 SOLDANO BLVD		COLUMBUS	OH	43228	01/01/2024
CH058470	KROGER PHARMACY N-844	175 LANCASTER PIKE		CIRCLEVILLE	OH	43113	07/01/2014
CH05847M	KROGER PHARMACY N-844	175 LANCASTER PIKE		CIRCLEVILLE	OH	43113	01/01/2024
CH058470	KROGER SAV-ON #941	3353 CLEVELAND AVENUE		COLUMBUS	OH	43224	07/01/2013	01/25/2018
CH05847I	KROGER SAV-ON #941	3353 CLEVELAND AVENUE		COLUMBUS	OH	43224	10/05/2006	01/25/2018
CH058470	KROGER SAV-ON PHARMACY	299 W BRIDGE ST		DUBLIN	OH	43017	01/01/2015
CH058470	KROGER SAV-ON PHARMACY	850 S. HAMILTON ROAD		WHITEHALL	OH	43213	07/01/2017
CH058470	KROGER SAV-ON PHARMACY	2525 HILLIARD-ROME ROAD		HILLIARD	OH	43026	07/01/2020
CH058470	KROGER SAV-ON PHARMACY N-815	3637 S HIGH STREET		COLUMBUS	OH	43207	10/09/2019
CH05847C	KROGER SAV-ON PHARMACY N-815	3637 S HIGH STREET		COLUMBUS	OH	43207	01/01/2024
CH058470	KROGER SAV-ON PHARMACY N-853	7000 EAST BROAD STREET		COLUMBUS	OH	43213	07/01/2017
CH058470	LOWER LIGHTS PHARMACY	1160 W BROAD ST		COLUMBUS	OH	43222	04/01/2024
CH058470	MVP PHARMACY	1924 PARSONS AVE		COLUMBUS	OH	43207	01/01/2018
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03193	1400 PARSONS AVE.	COLUMBUS	OH	43206	04/01/2017	10/10/2023
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03238	1500 LOCKBOURNE RD	COLUMBUS	OH	43206	04/01/2017	01/24/2024
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03484	591 E. LIVINGSTON AVE.	COLUMBUS	OH	43215	04/01/2017
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04223	3100 CLEVELAND AVE.	COLUMBUS	OH	43224	04/01/2017
CH058470	OHIO CVS STORES, L.L.C.	DBA CVS/PHARMACY # 5060	3424 S. HIGH STREET	COLUMBUS	OH	43207	04/01/2017
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05715	3355 EAST LIVINGSTON AVE	COLUMBUS	OH	43227	04/01/2017	03/15/2023
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06195	205 EAST MAIN ST	CIRCLEVILLE	OH	43113	04/01/2017
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06159	1515 W. BROAD ST.	COLUMBUS	OH	43222	04/01/2018	11/01/2022
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03405	109 S. HIGH ST.	COLUMBUS	OH	43215	04/01/2018	04/14/2022
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06182	3499 CLIME RD	COLUMBUS	OH	43223	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06192	2120 STRINGTOWN RD.	GROVE CITY	OH	43123	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06158	1211 MORSE RD.	COLUMBUS	OH	43229	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 17085	4211 TRUEMAN BLVD	HILLIARD	OH	43026	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04621	1001 NORTON RD.	GALLOWAY	OH	43119	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03412	3307 E BROAD ST	COLUMBUS	OH	43213	07/01/2019	08/15/2022
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03410	60 N. STYGLER RD.	COLUMBUS	OH	43230	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06188	111 SOUTH MEMORIAL DRIVE	LANCASTER	OH	43130	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06198	2020 EAKIN RD.	COLUMBUS	OH	43223	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09898	2929 STELZER RD.	COLUMBUS	OH	43219	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 02518	2160 N. HIGH ST.	COLUMBUS	OH	43201	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05717	3506 GENDER RD.	CANAL WINCHESTER	OH	43110	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 01223	3575 BROADWAY	GROVE CITY	OH	43123	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06949	4801 W. BROAD ST.	COLUMBUS	OH	43228	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06946	4548 E. MAIN ST.	WHITEHALL	OH	43213	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 17088	3955 E BROAD ST	WHITEHALL	OH	43213	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05436	2100 EAST DUBLIN-GRANVILLE ROAD	COLUMBUS	OH	43229	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03413	4400 CLEVELAND AVE	COLUMBUS	OH	43224	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06950	2680 N. HIGH ST.	COLUMBUS	OH	43202	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06153	2532 E. MAIN ST.	COLUMBUS	OH	43209	07/01/2019
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 07247	900 N. HAMILTON RD.	GAHANNA	OH	43230	01/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06189	11 CENTENNIAL BLVD.	CHILLICOTHE	OH	45601	01/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06161	7470 SAWMILL RD.	DUBLIN	OH	43016	01/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06190	1021 NORTH BRIDGE ST.	CHILLICOTHE	OH	45601	01/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05425	8910 E. BROAD ST.	PATASKALA	OH	43062	01/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03408	1795 COLUMBUS AVENUE	WASHINGTONCOURTHSE	OH	43160	01/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03407	918 HIGH ST.	WORTHINGTON	OH	43085	01/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06149	1885 WEST HENDERSON ROAD	UPPER ARLINGTON	OH	43220	04/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06163	711 PARK RD.	WORTHINGTON	OH	43085	04/01/2020	12/03/2024
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03992	620 S. CLEVELAND AVE.	WESTERVILLE	OH	43081	04/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05949	775 NEIL AVE	COLUMBUS	OH	43215	04/01/2020
CH058470	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16384	1300 RIVER VALLEY BLVD	LANCASTER	OH	43130	07/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06411	3282 TREMONT RD	UPPER ARLINGTON	OH	43221	07/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06953	6659 E. MAIN ST.	REYNOLDSBURG	OH	43068	07/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04483	4777 SAWMILL RD GALLERIA TOWN CENTRE	COLUMBUS	OH	43220	07/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05918	933 BETHEL ROAD	COLUMBUS	OH	43214	10/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 02540	4961 ROBERTS ROAD	HILLIARD	OH	43026	10/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05434	1950 HARD ROAD	COLUMBUS	OH	43235	10/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 01756	8467 E. MAIN ST.	REYNOLDSBURG	OH	43068	10/01/2020
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05654	797 W. COSHOCTON ST.	JOHNSTOWN	OH	43031	01/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06185	1100 HILL RD. N	PICKERINGTON	OH	43147	01/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 02381	9151 S OLD STATE RD	LEWIS CENTER	OH	43035-9496	01/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 02677	175 W MAIN ST	NEW ALBANY	OH	43054	01/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06147	1495 WEST 5TH AVE.	COLUMBUS	OH	43212	01/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03174	1370 WEST MAIN STREET	NEWARK	OH	43055	01/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 02735	4280 MORSE RD	COLUMBUS	OH	43230	01/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03094	379 E. MAIN ST	NEWARK	OH	43055	04/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03613	5445 N. HIGH ST.	COLUMBUS	OH	43214	04/01/2021	11/15/2023
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06148	190 S. SANDUSKY ST.	DELAWARE	OH	43015	04/01/2021
CH058470	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16590	1485 POLARIS PKWY	COLUMBUS	OH	43240	04/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06186	2565 EAST MAIN ST.	SPRINGFIELD	OH	45503	04/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06194	4610 CEMETERY RD	HILLIARD	OH	43026	10/01/2021	07/12/2022
CH058470	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16193	6000 SAWMILL RD	DUBLIN	OH	43017	10/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06155	145 S. STATE ST.	WESTERVILLE	OH	43081	10/01/2021
CH058470	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05458	2565 LONDON GROVEPORT RD.	GROVE CITY	OH	43123	04/01/2022
CH058470	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16453	4199 MORSE XING	COLUMBUS	OH	43219	04/01/2022
CH058470	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 17422	1970 HILLIARD ROME RD	HILLIARD	OH	43026	04/01/2022
CH058470	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	07/01/2021
CH058470	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	07/01/2021
CH058470	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	07/01/2021
CH058470	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	07/01/2021
CH058470	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/24/2022
CH058470	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025	01/01/2025
CH058470	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2021
CH058470	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	07/01/2021
CH058470	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	07/01/2021
CH058470	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/01/2021
CH058470	OPTUM PHARMACY 705, LLC	11142 RENNER BLVD		LENEXA	KS	66219	07/01/2021	07/15/2021
CH058470	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	07/01/2021
CH058470	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	07/01/2021
CH058470	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/01/2021
CH058470	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/01/2021
CH058470	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	07/01/2021	07/22/2021
CH058470	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2021	01/01/2025
CH058470	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	07/01/2021	05/27/2022
CH058470	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2021
CH058470	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2021
CH058470	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2021
CH058470	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2021
CH058470	REFILL RX LLC	3433 AGLER RD.	STE. 1150	COLUMBUS	OH	43219-3387	01/01/2018	12/18/2018
CH058470	ROYAL PHARMACY	2575 S. HAMILTON RD		COLUMBUS	OH	43232-4964	01/01/2019
CH05847Y	ROYAL PHARMACY	2575 S. HAMILTON RD		COLUMBUS	OH	43232-4964	01/01/2024	01/01/2025
CH05847J	ROYAL PHARMACY	2575 S. HAMILTON RD		COLUMBUS	OH	43232-4964	04/01/2024	07/01/2024
CH058470	SCHIEBER FAMILY PHARMACY	212 LANCASTER PIKE		CIRCLEVILLE	OH	43113	01/01/2018
CH058470	THE KROGER CO	2000 E MAIN STREET N315		COLUMBUS	OH	43205	07/01/2013
CH05847G	THE KROGER CO	2000 E MAIN STREET N315		COLUMBUS	OH	43205	01/01/2024
CH058470	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017
CH058470	WAL-MART PHARMACY 10-1427	1470 SO. COURT ST.		CIRCLEVILLE	OH	43113	10/01/2016
CH058470	WAL-MART PHARMACY 10-2098	3900 MORSE RD		COLUMBUS	OH	43219	07/01/2015	03/31/2021
CH058470	WAL-MART PHARMACY 10-2666	3579 SO. HIGH ST (US23)		COLUMBUS (SOUTH)	OH	43207	07/01/2015	03/04/2023
CH058470	WAL-MART PHARMACY 10-3447	3657 EAST MAIN		WHITEHALL	OH	43213	07/01/2015
CH058470	WAL-MART PHARMACY 10-5185	1221 GEORGESVILLE RD		COLUMBUS(WSW)	OH	43228	07/01/2015
CH058470	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017
CH058470	WALGREEN CO.	DBA: WALGREENS # 01317	3445 S HIGH ST	COLUMBUS	OH	43207	10/01/2015
CH058470	WALGREEN CO.	DBA: WALGREENS # 06118	3583 E BROAD ST	COLUMBUS	OH	43213	10/01/2015	04/21/2023
CH058470	WALGREEN CO.	DBA: WALGREENS # 06273	3015 E LIVINGSTON AVE	COLUMBUS	OH	43209-3047	10/01/2015
CH058470	WALGREEN CO.	DBA: WALGREENS # 06378	2770 W BROAD ST	COLUMBUS	OH	43204	10/01/2015
CH058470	WALGREEN CO.	DBA: WALGREENS # 06981	1280 DEMOREST ROAD	COLUMBUS	OH	43204	10/01/2015
CH058470	WALGREEN CO.	DBA: WALGREENS # 07113	3093 CLEVELAND AVE	COLUMBUS	OH	43224	10/01/2015	03/26/2025
CH058470	WALGREEN CO.	DBA: WALGREENS # 07525	2150 E DUBLIN GRANVILLE ROAD	COLUMBUS	OH	43229-3513	10/01/2015
CH058470	WALGREEN CO.	DBA: WALGREENS # 07523	5690 W BROAD STREET	GALLOWAY	OH	43119	10/01/2015
CH058470	WALGREEN CO.	DBA: WALGREENS # 07942	4617 E MAIN ST	WHITEHALL	OH	43213-3219	10/01/2015
CH058470	WALGREEN CO.	DBA: WALGREENS # 09138	1162 HARRISBURG PIKE	COLUMBUS	OH	43223-2847	10/01/2015	02/28/2023
CH058470	WALGREEN CO.	DBA: WALGREENS # 09193	2615 BRICE ROAD	REYNOLDSBURG	OH	43068	10/01/2015
CH058470	WALGREEN CO.	DBA: WALGREENS # 07524	6266 GENDER ROAD	CANAL WINCHESTER	OH	43110-2042	01/01/2017
CH058470	WALGREEN CO.	DBA: WALGREENS #21338	6300 E MAIN ST	REYNOLDSBURG	OH	43068	01/01/2017
CH058470	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #16422	114 W 3RD AVE STE 114	COLUMBUS	OH	43201	10/01/2018
CH058470	WALGREEN CO.	DBA: WALGREENS # 09286	2300 BALTIMORE REYNOLDSBURG RD	REYNOLDSBURG	OH	43068-8030	10/01/2018	11/12/2019
CH058470	WALGREEN CO.	WALGREENS #09904	5383 CEMETERY RD.	HILLIARD	OH	43026-1502	10/01/2018
CH058470	WALGREEN CO.	DBA: WALGREENS # 02117	181 TAYLOR AVENUE UNIVERSITY HOSPITALS EAST	COLUMBUS	OH	43203	10/01/2018	07/17/2019
CH058470	WALGREEN CO.	DBA: WALGREENS # 07973	2110 STRINGTOWN RD	GROVE CITY	OH	43123-2931	10/01/2018
CH058470	WALGREEN CO.	DBA: WALGREENS # 09540	4530 KENNY RD	COLUMBUS	OH	43220-3509	10/01/2018
CH058470	WALGREEN CO.	DBA: WALGREENS # 06119	7900 E BROAD STREET	BLACKLICK	OH	43004	10/01/2018
CH058470	WALGREEN CO.	DBA: WALGREENS # 07368	4890 N HIGH ST	COLUMBUS	OH	43214-1552	10/01/2018
CH058470	WALGREEN CO.	DBA: WALGREENS # 07799	850 NORTH BRIDGE STREET	CHILLICOTHE	OH	45601	10/01/2018
CH058470	WALGREEN CO.	DBA: WALGREENS # 09093	5195 N HAMILTON RD	COLUMBUS	OH	43230-1313	01/01/2020
CH058470	WALGREEN CO.	DBA: WALGREENS #12008	1101 HILL ROAD NORTH	PICKERINGTON	OH	43147-8887	01/01/2022
CH058470	WALGREEN CO.	DBA: WALGREENS #10050	6201 E. BROAD STREET	COLUMBUS	OH	43213-5500	01/01/2022
CH058470	WALGREEN CO.	DBA: WALGREENS # 07798	911 N MEMORIAL DRIVE	LANCASTER	OH	43130-1745	01/01/2022
CH058470	WALGREEN CO.	DBA: WALGREENS #13007	1040 POLARIS PARKWAY	COLUMBUS	OH	43240-2005	04/01/2022
CH058470	WALGREEN CO.	DBA: WALGREENS #12083	1444 W. 5TH AVE.	COLUMBUS	OH	43212	04/01/2022
CH058470	WALGREEN CO.	DBA: WALGREENS #11294	1070 WESTERN AVE.	CHILLICOTHE	OH	45601-1174	04/01/2022
CH058470	WALGREEN CO.	DBA: WALGREENS # 06115	6805 HOSPITAL DRIVE	DUBLIN	OH	43016-8556	04/01/2022
CH058470	WALGREEN CO.	DBA: WALGREENS #11145	9669 SAWMILL PARKWAY	POWELL	OH	43065-6612	04/01/2022
CH058470	WALGREEN CO.	WALGREENS # 09541	5555 NEW ALBANY RD	NEW ALBANY	OH	43054-8825	04/01/2022
CH058470	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CH058470	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2024
CH058470	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2024
CH058470	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2024
CH058470	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH058470	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Details	State	Update	Termination Request	Active	To Be Terminated	10/16/2019 11:14 AM
Terminations	Termination Date	Update	Termination Request		1/1/2020 12:00:00 AM	10/16/2019 11:14 AM
Terminations	Termination Effective Date	Update	Termination Request		8/31/2019 12:00:00 AM	10/16/2019 11:14 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	10/16/2019 11:14 AM
Details	Last Recertification Date	Update	Recertification	2/8/2018 2:34:40 PM	1/30/2019 4:08:29 PM	1/30/2019 4:08 PM
Terminations	Termination Reason	Update		Other		7/21/2018 12:21 PM
Contacts	Authorizing Official	Update	Profile Change Request	Tavares, Charleta B. CEO Columbus Neighborhood Health Center, Inc. 6148591903-2003	Tavares, Charleta B. CEO Columbus Neighborhood Health Center, Inc. 6148591946	7/12/2018 2:28 PM
Contacts	Signed By	Update	Profile Change Request	Tavares, Charleta B. CEO Columbus Neighborhood Health Center, Inc. 6148591903-2003	Tavares, Charleta B. CEO Columbus Neighborhood Health Center, Inc. 6148591946	7/12/2018 2:28 PM
Contacts	Primary Contact	Update		Harrell, Dewitt Chief Financial Officer Columbus Neighborhood Health Center, Inc. 6148591902	Harrell, Dewitt D Chief Financial Officer Columbus Neighborhood Health Center, Inc. 6148591902	7/12/2018 9:48 AM
Contacts	Primary Contact	Update	Change Request	Mohammed, Buhari Director , Regional Operations Columbus Neighborhood Health Center Inc. 6146455500-2018	Harrell, Dewitt Chief Financial Officer Columbus Neighborhood Health Center, Inc. 6148591902	4/27/2018 10:09 AM
Details	Last Recertification Date	Update	Recertification	1/30/2017 12:00:00 AM	2/8/2018 2:34:40 PM	2/8/2018 2:34 PM
Details	State	Update	OPA Edit	Approved	Active	10/24/2017 9:44 AM
Dates	Start Date	Update	OPA Edit	1/1/2018 12:00:00 AM	10/23/2017 12:00:00 AM	10/24/2017 9:44 AM
Addresses	Billing Address	Insert	Reinstatement		Columbus Neighborhood Health Center, Inc. 2780 Airport Drive Suite 100 Columbus, OH 43219	10/23/2017 3:30 PM
Contacts	Signed By	Update	Reinstatement	Horan, Thomas CEO 6146455500-2011	Tavares, Charleta B. CEO Columbus Neighborhood Health Center, Inc. 6148591903-2003	10/23/2017 3:30 PM
Details	Is Authorizing Official EHB Data	Update	Reinstatement	False		10/23/2017 3:30 PM
Dates	Participating Approval Date	Update	Reinstatement		10/23/2017 3:30:23 PM	10/23/2017 3:30 PM
Details	State	Update	Reinstatement	Pending	Approved	10/23/2017 3:30 PM
Dates	Signed By Date	Update	Reinstatement	10/13/2014 12:00:00 AM	10/23/2017 3:07:31 PM	10/23/2017 3:30 PM
Dates	Start Date	Update	Reinstatement		1/1/2018 12:00:00 AM	10/23/2017 3:30 PM
Terminations	Termination Reason	Update	Reinstatement		Other	10/23/2017 3:30 PM
Details	Comments Public	Insert	Reinstatement		Participating effective starting date (01/01/2015), until terminated effective date (10/22/2017), reinstatement effective date (01/01/2018)	10/23/2017 3:17 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	10/22/2014 12:00:00 AM		10/23/2017 3:07 PM
Dates	Participating Approval Date	Update	Reinstatement	10/22/2014 12:00:00 AM		10/23/2017 3:07 PM
Details	State	Update	Reinstatement	Terminated	Pending	10/23/2017 3:07 PM
Dates	Registration Date	Update	Reinstatement	10/13/2014 12:00:00 AM	10/23/2017 3:07:29 PM	10/23/2017 3:07 PM
Dates	Start Date	Update	Reinstatement	1/1/2015 12:00:00 AM		10/23/2017 3:07 PM
Terminations	Termination Comments	Update	Reinstatement	Registered in error.		10/23/2017 3:07 PM
Terminations	Termination Date	Update	Reinstatement	10/22/2017 12:00:00 AM		10/23/2017 3:07 PM
Terminations	Termination Effective Date	Update	Reinstatement	10/17/2017 12:00:00 AM		10/23/2017 3:07 PM
Terminations	Termination Reason	Update	Reinstatement	Other		10/23/2017 3:07 PM
Details	State	Update	OPA Edit Termination Info	To Be Terminated	Terminated	10/23/2017 1:54 PM
Terminations	Termination Date	Update	OPA Edit Termination Info	1/1/2018 12:00:00 AM	10/22/2017 12:00:00 AM	10/23/2017 1:54 PM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/22/2014 12:00:00 AM	10/17/2017 2:08 PM
Details	State	Update	Termination Request	Active	To Be Terminated	10/17/2017 2:08 PM
Terminations	Termination Comments	Update	Termination Request		Registered in error.	10/17/2017 2:08 PM
Terminations	Termination Date	Update	Termination Request		1/1/2018 12:00:00 AM	10/17/2017 2:08 PM
Terminations	Termination Effective Date	Update	Termination Request		10/17/2017 12:00:00 AM	10/17/2017 2:08 PM
Terminations	Termination Reason	Update	Termination Request		Other	10/17/2017 2:08 PM
Contacts	Authorizing Official	Update		Tavares, Charleta B. CEO 6148591903-2003	Tavares, Charleta B. CEO Columbus Neighborhood Health Center, Inc. 6148591903-2003	10/16/2017 3:54 PM
Contacts	Primary Contact	Update		Mohammed, Buhari Director , Regional Operations 6146455500-2018	Mohammed, Buhari Director , Regional Operations Columbus Neighborhood Health Center Inc. 6146455500-2018	9/22/2017 2:39 PM
Contacts	Authorizing Official	Insert			Tavares, Charleta B. CEO 6148591903-2003	4/18/2017 1:41 PM
Addresses	Main Address	Insert			299 CRAMER CREEK CT DUBLIN, OH 43017-2586	1/30/2017 2:43 PM
Addresses	Billing Address	Insert			Columbus Neighborhood Health Center, Inc. 1800 Watermark Drive Suite 420 Columbus, OH 43215	1/30/2017 2:43 PM
Contacts	Signed By	Insert			Horan, Thomas CEO 6146455500-2011	1/30/2017 2:43 PM
Contacts	Primary Contact	Insert			Mohammed, Buhari Director , Regional Operations 6146455500-2018	1/30/2017 2:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/30/2017 2:43 PM
Medicaid Billing	Medicaid: Number	Insert			0121809	1/30/2017 2:43 PM
Medicaid Billing	Medicaid: State	Insert			OH	1/30/2017 2:43 PM
Medicaid Billing	NPI: Number	Insert			1538569827	1/30/2017 2:43 PM
Details	Last Recertification Date	Update		2/16/2016 12:00:00 AM	1/30/2017 12:00:00 AM	1/30/2017 2:43 PM
Details	Last Recertification Date	Update		2/11/2015 12:00:00 AM	2/16/2016 12:00:00 AM	2/16/2016 12:23 PM
Details	Last Recertification Date	Update			2/11/2015 12:00:00 AM	2/11/2015 10:21 AM
Dates	Participating Approval Date	Update			10/22/2014 12:00:00 AM	10/22/2014 11:41 AM
Details	State	Update		Pending	Active	10/22/2014 11:41 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	10/22/2014 11:41 AM
Details	340B ID	Update		ONLINE_REG_47088	CH05847N	10/21/2014 10:40 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_47088	10/13/2014 10:54 AM
Details	Last Recertification Date	Insert				10/13/2014 10:54 AM
Details	Grant Number	Insert			H80CS00118	10/13/2014 10:54 AM
Details	340B ID	Insert			ONLINE_REG	10/13/2014 10:54 AM
Details	Is Authorizing Official EHB Data	Insert			False	10/13/2014 10:54 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/13/2014 10:54 AM
Details	Medicare Provider Number	Insert				10/13/2014 10:54 AM
Details	Entity Name	Insert			COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.	10/13/2014 10:54 AM
Details	Program Code	Insert			CH	10/13/2014 10:54 AM
Details	Entity Subname	Insert			CNHC Dublin	10/13/2014 10:54 AM
Dates	Participating Approval Date	Insert				10/13/2014 10:54 AM
Details	State	Insert			Pending	10/13/2014 10:54 AM
Dates	Registration Date	Insert			10/13/2014 12:00:00 AM	10/13/2014 10:54 AM
Dates	Signed By Date	Insert			10/13/2014 12:00:00 AM	10/13/2014 10:54 AM
Dates	Start Date	Insert				10/13/2014 10:54 AM
Terminations	Termination Comments	Insert				10/13/2014 10:54 AM
Terminations	Termination Date	Insert				10/13/2014 10:54 AM
Terminations	Termination Effective Date	Insert				10/13/2014 10:54 AM
Terminations	Termination Reason	Insert				10/13/2014 10:54 AM

340B Drug Pricing Program Database

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Medicaid Billing

Shipping Addresses

Contract Pharmacies

Grantee Sites

Grantee Sites Contract Pharmacies

History