Covered Entity Details

CH040130 HEALTH SERVICES, INC. (Active) - information as of 4/29/2025 4:36:11 AM

Main Details

Name

HEALTH SERVICES, INC.

Subdivision Name

River Region

Type

HRSA-Funded Health Center

Site ID

BPS-H80-009267

340B ID

CH040130

Grant Number

H80CS00795

Additional Details

Current Program Status

Active

Registration Date

12/1/1992

Participating Start Date

12/1/1992

Participating Approval Date

5/13/2004

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Health Services, Inc.
Gilbert F. Darrington, CEO
(334) 420-5001 Ext: 114

Primary Contact

Health Services Inc.
Allen McDaniel, PHARMACY DIRECTOR
(334) 420-5034

Addresses

Street Address

1845 CHERRY STREET
MONTGOMERY, AL 36107

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
CORRECTED ENTITY NAME	05/13/2004

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
AL	100001919	1053433797

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ADAMS DRUGS	8193 VAUGHN RD		MONTGOMERY	AL	36116	01/11/2023	04/01/2023		04/01/2023
Contract Detail	ADAMS DRUGS CHANTILLY	9168 EASTCHASE PKWY		MONTGOMERY	AL	36117-6883	01/11/2023	04/01/2023		04/01/2023
Contract Detail	ADAMS DRUGS EAST	35 MITCHELL DR		MONTGOMERY	AL	36109	01/11/2023	04/01/2023		04/01/2023
Contract Detail	ADAMS DRUGS PERRY HILL PLACE	1633 PERRY HILL RD		MONTGOMERY	AL	36106-2729	01/11/2023	04/01/2023		04/01/2023
Contract Detail	ADAMS DRUGS-SOUTH	3016 MCGEHEE RD		MONTGOMERY	AL	36111-2203	01/11/2023	04/01/2023		04/01/2023
Contract Detail	ADAMS DRUGS-TAYLOR	7200 COPPERFIELD DR STE A		MONTGOMERY	AL	36117-7100	01/11/2023	04/01/2023		04/01/2023
Contract Detail	ADAMS STREET DRUG COMPANY	934 ADAMS AVENUE		MONTGOMERY	AL	36104	01/11/2023	04/01/2023		04/01/2023
Contract Detail	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/10/2016	01/01/2017		10/10/2016
Contract Detail	AIM 2016, INC.	DBA: IKARE PHARMACY	7212 HALCYON PARK DR	MONTGOMERY	AL	36117	10/09/2024	01/01/2025		01/01/2025
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03095	6891 VAUGHN ROAD	MONTGOMERY	AL	36116	01/15/2019	04/01/2019		04/01/2019
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04856	3190 ZELDA RD.	MONTGOMERY	AL	36106	01/15/2019	04/01/2019		04/01/2019
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04862	2815 LOWER WETUMPKA RD	MONTGOMERY	AL	36110	01/15/2019	04/01/2019		04/01/2019
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04865	763 WILSON ST.	WETUMPKA	AL	36092	01/15/2019	04/01/2019		04/01/2019
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04895	615 W FAIRVIEW AVE	MONTGOMERY	AL	36105	01/15/2019	04/01/2019		04/01/2019
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04943	10 GILMER AVE.	TALLASSEE	AL	36078	01/15/2019	04/01/2019		04/01/2019
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04947	4790 MOBILE HWY	MONTGOMERY	AL	36108	01/15/2019	04/01/2019		04/01/2019
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04953	879 FORT DALE RD.	GREENVILLE	AL	36037	01/15/2019	04/01/2019		04/01/2019
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04970	1525 FOREST AVENUE	MONTGOMERY	AL	36106	01/15/2019	04/01/2019	04/09/2024	05/06/2024
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00585	9505 VAUGHN ROAD	PIKE ROAD	AL	36064	04/20/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04838	708 E. MAIN ST.	PRATTVILLE	AL	36067	04/20/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04853	520 HIGHLAND AVENUE	SELMA	AL	36701	04/20/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04872	3302 15TH STREET	TUSCALOOSA	AL	35401	04/20/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04894	3465 ATLANTA HWY.	MONTGOMERY	AL	36109	04/20/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04909	3680 HWY 14	MILLBROOK	AL	36054	04/20/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04915	2 N. BROADWAY AVE.	SYLACAUGA	AL	35150	04/20/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04919	1270 WEST MAIN STREET	DOTHAN	AL	36301	04/20/2021	07/01/2021		07/01/2021
Contract Detail	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04973	7 CAMDEN BYPASS	CAMDEN	AL	36726	04/20/2021	07/01/2021		07/01/2021
Contract Detail	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	07/03/2019	10/01/2019		10/01/2019
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/15/2018	01/01/2019		01/01/2019
Contract Detail	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	01/07/2019	04/01/2019		04/01/2019
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/17/2018	10/01/2018		10/01/2018
Contract Detail	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	01/12/2018	04/01/2018		01/12/2018
Contract Detail	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	07/17/2018	10/01/2018		10/01/2018
Contract Detail	FOSTER DRUG CO INC	12 LAFAYETTE ST		HAYNEVILLE	AL	36040	04/15/2014	07/01/2014	06/27/2022	06/27/2022
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	04/20/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00633	3090 S MONROE ST	TALLAHASSEE	FL	32301	04/20/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01256	1300 APALACHEE PKWY	TALLAHASSEE	FL	32301	10/05/2023	01/01/2024		01/01/2024
Contract Detail	HOOK-SUPERX, L.L.C.	CVS/PHARMACY #11114	2800 ENTERPRISE ST STE 5	INDIANAPOLIS	IN	46219-1106	04/20/2021	07/01/2021	06/06/2023	02/01/2024
Contract Detail	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/12/2018	04/01/2018		01/12/2018
Contract Detail	MONTGOMERY DRUG CO INC DBA	ADAMS DRUG MEDICINE ON TIME	37 MITCHELL DR	MONTGOMERY	AL	36109-2923	01/11/2023	04/01/2023		04/01/2023
Contract Detail	OPTUM PHARMACY 800, INC.	3016 GUADALUPE ST STE A		AUSTIN	TX	78705-2861	10/15/2018	01/01/2019		01/01/2019
Contract Detail	PARKS PHARMACY		1323-A MULBERRY ST	MONTGOMERY	AL	36106	02/15/2013	04/01/2013		03/09/2015
Contract Detail	PARKS PHARMACY, INC		225 HAYNEVILLE PLAZA	HAYNEVILLE	AL	36040	02/15/2013	04/01/2013		03/09/2015
Contract Detail	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/12/2018	04/01/2018		01/12/2018
Contract Detail	PUBLIX ALABAMA LLC	PUBLIX PHARMACY #1026	7700 VAUGHN ROAD	MONTGOMERY	AL	36116-1337	10/05/2023	01/01/2024		01/01/2024
Contract Detail	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1025	4045 ATLANTA HIGHWAY	MONTGOMERY	AL	36109-2920	01/15/2019	04/01/2019		04/01/2019
Contract Detail	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1024	7076 ATLANTA HIGHWAY	MONTGOMERY	AL	36117-4242	10/05/2023	01/01/2024		01/01/2024
Contract Detail	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1027	3026 ZELDA ROAD	MONTGOMERY	AL	36106-2651	10/05/2023	01/01/2024		01/01/2024
Contract Detail	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1228	2451 COBBS FORD RD.	PRATTVILLE	AL	36066	10/05/2023	01/01/2024		01/01/2024
Contract Detail	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1525	1147 US HIGHWAY 231 SOUTH	TROY	AL	36081	10/05/2023	01/01/2024		01/01/2024
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	10/05/2023	01/01/2024		01/01/2024
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	10/05/2023	01/01/2024		01/01/2024
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/17/2018	10/01/2018		10/01/2018
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/17/2018	10/01/2018		10/01/2018
Contract Detail	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	10/28/2020	11/10/2020		11/10/2020
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/08/2020	04/01/2020		04/01/2020
Contract Detail	WAL-MART PHARMACY 10-0424	1415 7TH ST. SOUTH		CLANTON	AL	35045	01/09/2014	04/01/2014		03/09/2015
Contract Detail	WAL-MART PHARMACY 10-0483	1903 COBBS FORD RD		PRATTVILLE	AL	36066	01/09/2014	04/01/2014		03/09/2015
Contract Detail	WAL-MART PHARMACY 10-0700	1501 HWY 14 EAST		SELMA	AL	36703	01/09/2014	04/01/2014		03/09/2015
Contract Detail	WAL-MART PHARMACY 10-0930	3801 EASTERN BLVD.		MONTGOMERY	AL	36116	01/09/2014	04/01/2014		03/09/2015
Contract Detail	WAL-MART PHARMACY 10-0938	6495 ATLANTA HIGHWAY		MONTGOMERY (E)	AL	36117	01/09/2014	04/01/2014		03/09/2015
Contract Detail	WAL-MART PHARMACY 10-1462	501 WILLOW LN		GREENVILLE	AL	36037	01/09/2014	04/01/2014		03/09/2015
Contract Detail	WAL-MART PHARMACY 10-5348	851 ANN STREET		MONTGOMERY	AL	36107	01/09/2014	04/01/2014		03/09/2015
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/08/2020	04/01/2020		04/01/2020
Contract Detail	WALGREEN CO	DBA: WALGREENS #11098	100 ELBA HWY	TROY	AL	36079	04/12/2018	07/01/2018		04/12/2018
Contract Detail	WALGREEN CO	DBA: WALGREENS #11468	101 GREENVILLE BYP	GREENVILLE	AL	36037-3724	04/12/2018	07/01/2018		04/12/2018
Contract Detail	WALGREEN CO.	JIM MYERS A WALGREENS PHARMACY #15448	3325 UNIVERSITY BLVD EAST	TUSCALOOSA	AL	35404	01/11/2017	04/01/2017	05/20/2019	01/08/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06800	703 S MEMORIAL DRIVE	PRATTVILLE	AL	36067	01/11/2017	04/01/2017		01/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07746	6680 ATLANTA HWY	MONTGOMERY	AL	36117	01/11/2017	04/01/2017		01/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06843	2281 E SOUTH BLVD	MONTGOMERY	AL	36116-2488	01/11/2017	04/01/2017	03/27/2025	03/27/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02203	3892 ATLANTA HWY	MONTGOMERY	AL	36109-3626	01/11/2017	04/01/2017		01/11/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15258	1758 PARK PL SUITE 102	MONTGOMERY	AL	36106	01/11/2017	04/01/2017	08/19/2021	08/25/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15450	701 UNIVERSITY BLVD E M-04	TUSCALOOSA	AL	35401	01/11/2017	04/01/2017	09/27/2019	01/08/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09456	2920 CARTER HILL RD	MONTGOMERY	AL	36106-2531	04/12/2018	07/01/2018		04/12/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13158	3110 TAYLOR RD	MONTGOMERY	AL	36116	04/12/2018	07/01/2018		04/12/2018
Contract Detail	WALGREEN CO.	WALGREENS #19239	10 W FAIRVIEW AVE	MONTGOMERY	AL	36105-1655	04/02/2019	07/01/2019	02/22/2023	07/26/2023
Contract Detail	WALMART PHARMACY 10-4672	1600 FEDERAL DRIVE		MONTGOMERY	AL	36109	01/12/2023	04/01/2023		04/01/2023
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/12/2023	04/01/2023		04/01/2023
Contract Detail	WINN DIXIE	DBA WINN-DIXIE PHARMACY #446	4724 MOBILE HWY	MONTGOMERY	AL	36108	02/22/2013	04/01/2013		03/09/2015
Contract Detail	WINN DIXIE 411	640 OLLIE AVE		CLANTON	AL	35045	10/02/2013	01/01/2014		03/09/2015
Contract Detail	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 428	5326 HWY 231 SOUTH	WETUMPKA	AL	36092	01/19/2016	04/01/2016		01/19/2016
Contract Detail	WINN DIXIE PHARMACY #451	3625 HWY 14		MILLBROOK	AL	36054	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WINN DIXIE PHARMACY #521	3881 ATLANTA HWY		MONTGOMERY	AL	36109	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WINN-DIXIE #503		2055 COLISEUM BLVD	MONTGOMERY	AL	36110	02/22/2013	04/01/2013	01/13/2016	04/06/2016
Contract Detail	WINN-DIXIE PHARMACY	DBA WINN-DIXIE PHARMACY #463	2730 EAST BLVD	MONTGOMERY	AL	36117	02/22/2013	04/01/2013		03/09/2015

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH040130	Active	BPS-H80-009267	HEALTH SERVICES, INC.	River Region	1845 CHERRY STREET	MONTGOMERY	AL
CH04013A	Active	BPS-H80-005191	HEALTH SERVICES, (INC)	Ramer Family Health Center	5422 State Highway 94	Ramer	AL
CH04013B	Active	BPS-H80-001237	HEALTH SERVICES, (INC)	Montgomery Primary Healthcare Center	3058 MOBILE HWY	MONTGOMERY	AL
CH04013C	Active	BPS-H80-027794	HEALTH SERVICES, (INC)	Montgomery East Family Health Center	309 Saint Lukes Drive	Montgomery	AL
CH04013D	Active	BPS-H80-016863	HEALTH SERVICES, (INC)	Gateway Family Health Center	2905 East South Blvd.	Montgomery	AL
CH04013E	Active	BPS-H80-008668	HEALTH SERVICES, (INC)	Hayneville Family Health Center	511 E Tuskeena St	Hayneville	AL
CH04013F	Active	BPS-H80-008659	HEALTH SERVICES, (INC)	Eclectic Family Health Center	30 Main St	Eclectic	AL
CH04013G	Active	BPS-H80-011890	HEALTH SERVICES, (INC)	Clanton Family Health Center	107 Medical Center Dr	Clanton	AL
CH04013H	Active	BPS-H80-001084	HEALTH SERVICES, (INC)	Chisholm Family Health Center	100 E Vandiver Blvd	Montgomery	AL
CH04013J	Active	BPS-H80-006057	HEALTH SERVICES, (INC)	Autaugaville Family Health Center	203 N Taylor St	Autaugaville	AL
CH04013K	Active	BPS-H80-029951	HEALTH SERVICES, (INC)	Highland Gardens School Based Health Center	2801 Willena Ave	Montgomery	AL
CH04013L	Active	BPS-H80-029946	HEALTH SERVICES, (INC)	River Region Mobile Unit	1845 Cherry St	Montgomery	AL
CH04013M	Active	BPS-H80-029952	HEALTH SERVICES, (INC)	Bellingrath School Based Health Center	3550 S Court St	Montgomery	AL
CH04013N	Active	BPS-H80-029599	HEALTH SERVICES, (INC)	Montevallo Family Health Center	33 Salem Rd Ste 2	Montevallo	AL
CH04013P	Active	BPS-H80-032777	HEALTH SERVICES INC	Health Services, Inc. Community Outreach Unit	3058 Mobile Hwy	Montgomery	AL
CH04013Q	Active	BPS-H80-031210	HEALTH SERVICES INC	Health Services, Inc. Montgomery Community Response Unit	2905 E South Blvd	Montgomery	AL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH040130	ADAMS DRUGS	8193 VAUGHN RD		MONTGOMERY	AL	36116	04/01/2023
CH04013D	ADAMS DRUGS	8193 VAUGHN RD		MONTGOMERY	AL	36116	01/01/2024
CH040130	ADAMS DRUGS CHANTILLY	9168 EASTCHASE PKWY		MONTGOMERY	AL	36117-6883	04/01/2023
CH04013N	ADAMS DRUGS CHANTILLY	9168 EASTCHASE PKWY		MONTGOMERY	AL	36117-6883	01/01/2024
CH040130	ADAMS DRUGS EAST	35 MITCHELL DR		MONTGOMERY	AL	36109	04/01/2023
CH040130	ADAMS DRUGS PERRY HILL PLACE	1633 PERRY HILL RD		MONTGOMERY	AL	36106-2729	04/01/2023
CH040130	ADAMS DRUGS-SOUTH	3016 MCGEHEE RD		MONTGOMERY	AL	36111-2203	04/01/2023
CH04013B	ADAMS DRUGS-SOUTH	3016 MCGEHEE RD		MONTGOMERY	AL	36111-2203	01/01/2024
CH040130	ADAMS DRUGS-TAYLOR	7200 COPPERFIELD DR STE A		MONTGOMERY	AL	36117-7100	04/01/2023
CH04013C	ADAMS DRUGS-TAYLOR	7200 COPPERFIELD DR STE A		MONTGOMERY	AL	36117-7100	01/01/2024
CH040130	ADAMS STREET DRUG COMPANY	934 ADAMS AVENUE		MONTGOMERY	AL	36104	04/01/2023
CH04013K	ADAMS STREET DRUG COMPANY	934 ADAMS AVENUE		MONTGOMERY	AL	36104	01/01/2024
CH040130	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2017
CH040130	AIM 2016, INC.	DBA: IKARE PHARMACY	7212 HALCYON PARK DR	MONTGOMERY	AL	36117	01/01/2025
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03095	6891 VAUGHN ROAD	MONTGOMERY	AL	36116	04/01/2019
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04856	3190 ZELDA RD.	MONTGOMERY	AL	36106	04/01/2019
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04862	2815 LOWER WETUMPKA RD	MONTGOMERY	AL	36110	04/01/2019
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04865	763 WILSON ST.	WETUMPKA	AL	36092	04/01/2019
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04895	615 W FAIRVIEW AVE	MONTGOMERY	AL	36105	04/01/2019
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04943	10 GILMER AVE.	TALLASSEE	AL	36078	04/01/2019
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04947	4790 MOBILE HWY	MONTGOMERY	AL	36108	04/01/2019
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04953	879 FORT DALE RD.	GREENVILLE	AL	36037	04/01/2019
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04970	1525 FOREST AVENUE	MONTGOMERY	AL	36106	04/01/2019	04/09/2024
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00585	9505 VAUGHN ROAD	PIKE ROAD	AL	36064	07/01/2021
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04838	708 E. MAIN ST.	PRATTVILLE	AL	36067	07/01/2021
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04853	520 HIGHLAND AVENUE	SELMA	AL	36701	07/01/2021
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04872	3302 15TH STREET	TUSCALOOSA	AL	35401	07/01/2021
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04894	3465 ATLANTA HWY.	MONTGOMERY	AL	36109	07/01/2021
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04909	3680 HWY 14	MILLBROOK	AL	36054	07/01/2021
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04915	2 N. BROADWAY AVE.	SYLACAUGA	AL	35150	07/01/2021
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04919	1270 WEST MAIN STREET	DOTHAN	AL	36301	07/01/2021
CH040130	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04973	7 CAMDEN BYPASS	CAMDEN	AL	36726	07/01/2021
CH040130	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	10/01/2019
CH040130	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	01/01/2019
CH040130	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH040130	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/01/2018
CH040130	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	04/01/2018
CH040130	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	10/01/2018
CH040130	FOSTER DRUG CO INC	12 LAFAYETTE ST		HAYNEVILLE	AL	36040	07/01/2014	06/27/2022
CH040130	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	07/01/2021
CH040130	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00633	3090 S MONROE ST	TALLAHASSEE	FL	32301	07/01/2021
CH040130	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01256	1300 APALACHEE PKWY	TALLAHASSEE	FL	32301	01/01/2024
CH040130	HOOK-SUPERX, L.L.C.	CVS/PHARMACY #11114	2800 ENTERPRISE ST STE 5	INDIANAPOLIS	IN	46219-1106	07/01/2021	06/06/2023
CH040130	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2018
CH040130	MONTGOMERY DRUG CO INC DBA	ADAMS DRUG MEDICINE ON TIME	37 MITCHELL DR	MONTGOMERY	AL	36109-2923	04/01/2023
CH04013F	MONTGOMERY DRUG CO INC DBA	ADAMS DRUG MEDICINE ON TIME	37 MITCHELL DR	MONTGOMERY	AL	36109-2923	01/01/2024
CH040130	OPTUM PHARMACY 800, INC.	3016 GUADALUPE ST STE A		AUSTIN	TX	78705-2861	01/01/2019
CH040130	PARKS PHARMACY		1323-A MULBERRY ST	MONTGOMERY	AL	36106	04/01/2013
CH040130	PARKS PHARMACY, INC		225 HAYNEVILLE PLAZA	HAYNEVILLE	AL	36040	04/01/2013
CH040130	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018
CH040130	PUBLIX ALABAMA LLC	PUBLIX PHARMACY #1026	7700 VAUGHN ROAD	MONTGOMERY	AL	36116-1337	01/01/2024
CH04013E	PUBLIX ALABAMA LLC	PUBLIX PHARMACY #1026	7700 VAUGHN ROAD	MONTGOMERY	AL	36116-1337	01/01/2024
CH040130	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1025	4045 ATLANTA HIGHWAY	MONTGOMERY	AL	36109-2920	04/01/2019
CH040130	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1024	7076 ATLANTA HIGHWAY	MONTGOMERY	AL	36117-4242	01/01/2024
CH040130	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1027	3026 ZELDA ROAD	MONTGOMERY	AL	36106-2651	01/01/2024
CH040130	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1228	2451 COBBS FORD RD.	PRATTVILLE	AL	36066	01/01/2024
CH040130	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1525	1147 US HIGHWAY 231 SOUTH	TROY	AL	36081	01/01/2024
CH04013J	PUBLIX ALABAMA, LLC	PUBLIX PHARMACY #1228	2451 COBBS FORD RD.	PRATTVILLE	AL	36066	01/01/2024
CH040130	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	01/01/2024
CH040130	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	01/01/2024
CH040130	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/01/2018
CH040130	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/01/2018
CH040130	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	11/10/2020
CH040130	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
CH040130	WAL-MART PHARMACY 10-0424	1415 7TH ST. SOUTH		CLANTON	AL	35045	04/01/2014
CH04013G	WAL-MART PHARMACY 10-0424	1415 7TH ST. SOUTH		CLANTON	AL	35045	01/01/2024
CH040130	WAL-MART PHARMACY 10-0483	1903 COBBS FORD RD		PRATTVILLE	AL	36066	04/01/2014
CH040130	WAL-MART PHARMACY 10-0700	1501 HWY 14 EAST		SELMA	AL	36703	04/01/2014
CH040130	WAL-MART PHARMACY 10-0930	3801 EASTERN BLVD.		MONTGOMERY	AL	36116	04/01/2014
CH040130	WAL-MART PHARMACY 10-0938	6495 ATLANTA HIGHWAY		MONTGOMERY (E)	AL	36117	04/01/2014
CH040130	WAL-MART PHARMACY 10-1462	501 WILLOW LN		GREENVILLE	AL	36037	04/01/2014
CH040130	WAL-MART PHARMACY 10-5348	851 ANN STREET		MONTGOMERY	AL	36107	04/01/2014
CH040130	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
CH040130	WALGREEN CO	DBA: WALGREENS #11098	100 ELBA HWY	TROY	AL	36079	07/01/2018
CH040130	WALGREEN CO	DBA: WALGREENS #11468	101 GREENVILLE BYP	GREENVILLE	AL	36037-3724	07/01/2018
CH040130	WALGREEN CO.	JIM MYERS A WALGREENS PHARMACY #15448	3325 UNIVERSITY BLVD EAST	TUSCALOOSA	AL	35404	04/01/2017	05/20/2019
CH040130	WALGREEN CO.	DBA: WALGREENS # 06800	703 S MEMORIAL DRIVE	PRATTVILLE	AL	36067	04/01/2017
CH040130	WALGREEN CO.	DBA: WALGREENS # 07746	6680 ATLANTA HWY	MONTGOMERY	AL	36117	04/01/2017
CH040130	WALGREEN CO.	DBA: WALGREENS # 06843	2281 E SOUTH BLVD	MONTGOMERY	AL	36116-2488	04/01/2017	03/27/2025
CH040130	WALGREEN CO.	DBA: WALGREENS # 02203	3892 ATLANTA HWY	MONTGOMERY	AL	36109-3626	04/01/2017
CH040130	WALGREEN CO.	DBA: WALGREENS #15258	1758 PARK PL SUITE 102	MONTGOMERY	AL	36106	04/01/2017	08/19/2021
CH040130	WALGREEN CO.	DBA: WALGREENS #15450	701 UNIVERSITY BLVD E M-04	TUSCALOOSA	AL	35401	04/01/2017	09/27/2019
CH040130	WALGREEN CO.	DBA: WALGREENS # 09456	2920 CARTER HILL RD	MONTGOMERY	AL	36106-2531	07/01/2018
CH040130	WALGREEN CO.	DBA: WALGREENS #13158	3110 TAYLOR RD	MONTGOMERY	AL	36116	07/01/2018
CH040130	WALGREEN CO.	WALGREENS #19239	10 W FAIRVIEW AVE	MONTGOMERY	AL	36105-1655	07/01/2019	02/22/2023
CH040130	WALMART PHARMACY 10-4672	1600 FEDERAL DRIVE		MONTGOMERY	AL	36109	04/01/2023
CH04013A	WALMART PHARMACY 10-4672	1600 FEDERAL DRIVE		MONTGOMERY	AL	36109	01/01/2024
CH04013H	WALMART PHARMACY 10-4672	1600 FEDERAL DRIVE		MONTGOMERY	AL	36109	01/01/2024
CH040130	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH040130	WINN DIXIE	DBA WINN-DIXIE PHARMACY #446	4724 MOBILE HWY	MONTGOMERY	AL	36108	04/01/2013
CH040130	WINN DIXIE 411	640 OLLIE AVE		CLANTON	AL	35045	01/01/2014
CH040130	WINN DIXIE MONTGOMERY, LLC.	WINN DIXIE PHARMACY # 428	5326 HWY 231 SOUTH	WETUMPKA	AL	36092	04/01/2016
CH040130	WINN DIXIE PHARMACY #451	3625 HWY 14		MILLBROOK	AL	36054	04/01/2018
CH040130	WINN DIXIE PHARMACY #521	3881 ATLANTA HWY		MONTGOMERY	AL	36109	04/01/2018
CH040130	WINN-DIXIE #503		2055 COLISEUM BLVD	MONTGOMERY	AL	36110	04/01/2013	01/13/2016
CH040130	WINN-DIXIE PHARMACY	DBA WINN-DIXIE PHARMACY #463	2730 EAST BLVD	MONTGOMERY	AL	36117	04/01/2013

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 11:56:07 AM	2/10/2025 11:00:52 AM	2/10/2025 11:00 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 3:07:15 PM	2/1/2024 11:56:07 AM	2/1/2024 11:56 AM
Details	Last Recertification Date	Update	Recertification	1/31/2022 9:52:57 AM	1/31/2023 3:07:15 PM	1/31/2023 3:07 PM
Details	Last Recertification Date	Update	Recertification	2/9/2021 9:07:37 AM	1/31/2022 9:52:57 AM	1/31/2022 9:52 AM
Medicaid Billing	NPI: State	Update	Recertification		AL	2/9/2021 9:07 AM
Details	Last Recertification Date	Update	Recertification	1/28/2020 1:50:57 PM	2/9/2021 9:07:37 AM	2/9/2021 9:07 AM
Contacts	Authorizing Official	Update	New Registration	Darrington, Gilbert F. CEO Health Services, Inc. 3344205001	Darrington, Gilbert F. CEO Health Services, Inc. 3344205001-114	10/1/2020 12:23 PM
Details	Last Recertification Date	Update	Recertification	1/29/2019 1:00:40 AM	1/28/2020 1:50:57 PM	1/28/2020 1:50 PM
Details	Last Recertification Date	Update	Recertification	2/8/2018 11:25:41 AM	1/29/2019 1:00:40 AM	1/29/2019 1:00 AM
Details	Last Recertification Date	Update	Recertification	1/27/2017 12:00:00 AM	2/8/2018 11:25:41 AM	2/8/2018 11:25 AM
Contacts	Primary Contact	Update		McDaniel, Allen PHARMACY DIRECTOR 3344205034	McDaniel, Allen PHARMACY DIRECTOR Health Services Inc. 3344205034	11/3/2017 5:35 PM
Contacts	Authorizing Official	Update		Darrington, Gilbert CEO 3344205001	Darrington, Gilbert F. CEO Health Services, Inc. 3344205001	9/18/2017 4:31 PM
Addresses	Main Address	Insert			1845 CHERRY STREET MONTGOMERY, AL 36107	1/27/2017 12:41 PM
Contacts	Authorizing Official	Insert			Darrington, Gilbert CEO 3344205001	1/27/2017 12:41 PM
Contacts	Primary Contact	Insert			McDaniel, Allen PHARMACY DIRECTOR 3344205034	1/27/2017 12:41 PM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	1/27/2017 12:00:00 AM	1/27/2017 12:41 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/12/2016 12:42 PM
Details	Last Recertification Date	Update		3/9/2015 12:00:00 AM	2/12/2016 12:00:00 AM	2/12/2016 12:42 PM
Details	Last Recertification Date	Update		3/12/2014 12:00:00 AM	3/9/2015 12:00:00 AM	3/9/2015 10:11 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/12/2014 12:00:00 AM	3/12/2014 11:34 AM
Medicaid Billing	NPI: Number	Insert			1053433797	2/14/2013 12:31 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/14/2013 12:31 PM
Details	Entity Subname	Update		LISTER HILL HEALTH CENTER	River Region	12/6/2012 3:07 PM
Dates	Participating Approval Date	Update		5/13/2004 10:04:23 AM	5/13/2004 12:00:00 AM	11/5/2012 12:01 PM
Details	Last Recertification Date	Insert				5/13/2004 10:04 AM
Details	Grant Number	Insert			H80CS00795	5/13/2004 10:04 AM
Details	340B ID	Insert			CH040130	5/13/2004 10:04 AM
Details	Is Authorizing Official EHB Data	Insert				5/13/2004 10:04 AM
Dates	Last Date That 340B Drugs Purchased	Insert				5/13/2004 10:04 AM
Details	Medicare Provider Number	Insert				5/13/2004 10:04 AM
Details	Entity Name	Insert			HEALTH SERVICES, INC.	5/13/2004 10:04 AM
Details	Program Code	Insert			CH	5/13/2004 10:04 AM
Details	Entity Subname	Insert			LISTER HILL HEALTH CENTER	5/13/2004 10:04 AM
Dates	Participating Approval Date	Insert			5/13/2004 10:04:23 AM	5/13/2004 10:04 AM
Details	State	Insert			Active	5/13/2004 10:04 AM
Dates	Registration Date	Insert			12/1/1992 12:00:00 AM	5/13/2004 10:04 AM
Dates	Signed By Date	Insert				5/13/2004 10:04 AM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	5/13/2004 10:04 AM
Terminations	Termination Comments	Insert				5/13/2004 10:04 AM
Terminations	Termination Date	Insert				5/13/2004 10:04 AM
Terminations	Termination Effective Date	Insert				5/13/2004 10:04 AM
Terminations	Termination Reason	Insert				5/13/2004 10:04 AM
Details	Comments Public	Insert			CORRECTED ENTITY NAME	5/13/2004 10:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	12/1/1992 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			100001919	12/1/1992 12:00 AM
Medicaid Billing	Medicaid: State	Insert			AL	12/1/1992 12:00 AM

340B Drug Pricing Program Database