Covered Entity Details

CH02152L OPEN DOOR FAMILY MEDICAL CENTER, INC. (Active) - information as of 5/1/2025 11:52:10 PM

Main Details

Name

OPEN DOOR FAMILY MEDICAL CENTER, INC.

Subdivision Name

Open Door Family Medical Center School Based Mobile Dental Van

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014515

340B ID

CH02152L

Grant Number

H80CS00160

Additional Details

Current Program Status

Active

Registration Date

4/1/2015

Participating Start Date

7/1/2015

Participating Approval Date

4/16/2015

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

Open Door Family Medical, Inc.
Lindsay Farrell, President and CEO
(914) 502-1450

Primary Contact

Open Door Family Medical Center
MARIA MAZZOTTA, CFO
(914) 941-1263 Ext: 1470

Addresses

Street Address

165 Main Street
Ossining, NY 10562

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?
Yes

State	Medicaid Number	NPI Number
NY	04040268	1073919973

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	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	78 CROTON AVE.	OSSINING	NY	10562	04/08/2025	07/01/2025			04/08/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH021520	Active	BPS-H80-003376	OPEN DOOR FAMILY MEDICAL CENTER, INC.	OPEN DOOR FAMILY MEDICAL CENTER, INC.	165 Main St	Ossining	NY
CH02152A	Active	BPS-H80-021977	OPEN DOOR FAMILY MEDICAL CENTER, INC.	OPEN DOOR FAM MED--SLEEPY HOLLOW	300 North Broadway	Sleepy Hollow	NY
CH02152B	Active	BPS-H80-001720	OPEN DOOR FAMILY MEDICAL CENTER, INC.	OPEN DOOR FAMILY MEDICAL CENTER	5 Grace Church St	Port Chester	NY
CH02152D	Active	BPS-H80-002397	OPEN DOOR FAMILY MEDICAL CENTER, INC.	EDISON ELEMENTARY SCHOOL BASED	132 Rectory St	Port Chester	NY
CH02152E	Active	BPS-H80-003340	OPEN DOOR FAMILY MEDICAL CENTER, INC.	JOHN F. KENNEDY MAGNET SCHOOL	40 Olivia St	Port Chester	NY
CH02152F	Active	BPS-H80-001801	OPEN DOOR FAMILY MEDICAL CENTER, INC.	PORT CHESTER HIGH SCHOOL-SBHC	1 TAMARACK LN	PORT CHESTER	NY
CH02152G	Active	BPS-H80-003593	OPEN DOOR FAMILY MEDICAL CENTER, INC.	OPEN DOOR MT. KISCO CLINIC	30 W MAIN ST	MOUNT KISCO	NY
CH02152H	Terminated	BPS-H80-009221	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Open Door Family Medical Center - Mobile Dental	351 Main Street	Mount Kisco	NY
CH02152I	Active	BPS-H80-007569	OPEN DOOR FAMILY MEDICAL CENTER, INC.	PORT CHESTER MIDDLE SCHOOL - SBHC	113 Bowman Avenue	Port Chester	NY
CH02152J	Active	BPS-H80-009872	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Park Ave Elementary School - SBHC	75 Park Ave	Port Chester	NY
CH02152K	Active	BPS-H80-012421	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Open Door Family Medical Center @ Brewster	155 Main St	Brewster	NY
CH02152L	Active	BPS-H80-014515	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Open Door Family Medical Center School Based Mobile Dental Van	165 Main Street	Ossining	NY
CH02152M	Active	BPS-H80-014430	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Ossining High School - SBHC	29 S HIGHLAND AVE	OSSINING	NY
CH02152N	Active	BPS-H80-018361	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Open Door Mamaroneck	689 Mamaroneck Avenue	Mamaroneck	NY
CH02152P	Active	BPS-H80-021284	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Ossining AMD Middle School - SBHC	100 Van Cortlandt Ave	Ossining	NY
CH02152Q	Active	BPS-H80-024963	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Open Door Saugerties	16 W Bridge St	Saugerties	NY
CH02152R	Active	BPS-H80-021597	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Ossining Park Early Childhood Center - SBHC	22 Edward St	Ossining	NY
CH02152S	Active	BPS-H80-027345	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Ossining Brookside SBHC	30 Ryder Rd	Ossining	NY
CH02152T	Active	BPS-H80-034203	OPEN DOOR FAMILY MEDICAL CENTER, INC.	Webutuck SBHC	194 Haight Road	Amenia	NY
CH02152U	Terminated	BPS-H80-009181	OPEN DOOR FAMILY MEDICAL CENTER, INC	Open Door Administrative Offices	2 Church St	Ossining	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH02152K	BREWSTER PHARMACY INC	D/B/A TRUCARE PHARMACY	995 ROUTE 22	BREWSTER	NY	10509	10/27/2012	04/14/2017
CH02152B	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05350	182 SOUTH RIDGE ST	RYE BROOK	NY	10573	04/01/2020	10/12/2023
CH021520	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 7130	350 SOUTH BROADWAY	TARRYTOWN	NY	10591	04/01/2020	10/12/2023
CH021520	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05048	1827 MAIN ST.	PEEKSKILL	NY	10566	04/01/2020	10/12/2023
CH021520	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00366	51 NORTH BROADWAY	TARRYTOWN	NY	10591	04/01/2020	10/12/2023
CH02152A	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 7130	350 SOUTH BROADWAY	TARRYTOWN	NY	10591	04/01/2020	10/12/2023
CH02152G	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01997	10 S. BEDFORD RD.	MOUNT KISCO	NY	10549	04/01/2020	10/12/2023
CH02152K	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05054	100 EAST LAKE BLVD	MAHOPAC	NY	10541	04/01/2020	10/12/2023
CH02152A	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00366	51 NORTH BROADWAY	TARRYTOWN	NY	10591	04/01/2020	10/12/2023
CH021520	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02080	202 S. HIGHLAND AVE.	OSSINING	NY	10562	04/01/2020	10/12/2023
CH02152G	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00530	309 MAIN ST.	NEW ROCHELLE	NY	10801	04/01/2020	10/12/2023
CH02152N	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00616	805 MAMARONECK AVENUE	MAMARONECK	NY	10543	04/01/2020	10/12/2023
CH02152K	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 10038	1905 ROUTE 6	CARMEL	NY	10512	04/01/2020	10/12/2023
CH02152G	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01134	715 BEDFORD ROAD	BEDFORD HILLS	NY	10507	04/01/2020	10/12/2023
CH02152N	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02578	16 WEYMAN AVE.	NEW ROCHELLE	NY	10805	04/01/2020	10/12/2023
CH021520	HEALTHSMART	203 MAIN ST		OSSINING	NY	10562-4750	02/15/2004	04/30/2020
CH02152M	HEALTHSMART	203 MAIN ST		OSSINING	NY	10562-4750	07/01/2015	04/30/2020
CH021520	HUDSON PHARMACY & SURGICAL SUPPLIES INC	40 SPRING ST		OSSINING	NY	10562-4716	01/01/2012	04/30/2020
CH02152M	HUDSON PHARMACY & SURGICAL SUPPLIES INC	40 SPRING ST		OSSINING	NY	10562-4716	07/01/2015	04/30/2020
CH02152N	JMR PHARMACY INC	1215 MAMARONECK AVENUE		WHITE PLAINS	NY	10605	07/01/2017	08/31/2018
CH021520	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152A	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152B	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152E	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152D	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152G	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152F	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152I	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152J	MAXOR SPECIALTY PHARMACY	216 S POLK ST		AMARILLO	TX	79101-1407	10/27/2012	09/15/2022
CH02152G	ROSHAN PHARM & SURGICALS	NWPC	19 E MAIN ST	MOUNT KISCO	NY	10549-2218	08/11/2006	09/15/2022
CH02152H	ROSHAN PHARM & SURGICALS	NWPC	19 E MAIN ST	MOUNT KISCO	NY	10549-2218	10/27/2012	04/01/2020
CH02152A	SLEEPY HOLLOW PHARMACY INC.	95 BEEKMAN AVE # 4		SLEEPY HOLLOW	NY	10591-2549	11/17/2005	04/30/2020
CH021520	THE STOP & SUPERMARKET CO	DBA STOP & SHOP PHARMACY #502	25 WATERFRONT PLACE	PORT CHESTER	NY	10573	05/01/2010
CH02152B	THE STOP & SUPERMARKET CO	DBA STOP & SHOP PHARMACY #502	25 WATERFRONT PLACE	PORT CHESTER	NY	10573	05/01/2010
CH02152E	THE STOP & SUPERMARKET CO	DBA STOP & SHOP PHARMACY #502	25 WATERFRONT PLACE	PORT CHESTER	NY	10573	05/01/2010
CH02152D	THE STOP & SUPERMARKET CO	DBA STOP & SHOP PHARMACY #502	25 WATERFRONT PLACE	PORT CHESTER	NY	10573	05/01/2010
CH02152F	THE STOP & SUPERMARKET CO	DBA STOP & SHOP PHARMACY #502	25 WATERFRONT PLACE	PORT CHESTER	NY	10573	04/16/2010
CH02152I	THE STOP & SUPERMARKET CO	DBA STOP & SHOP PHARMACY #502	25 WATERFRONT PLACE	PORT CHESTER	NY	10573	10/27/2012
CH02152J	THE STOP & SUPERMARKET CO	DBA STOP & SHOP PHARMACY #502	25 WATERFRONT PLACE	PORT CHESTER	NY	10573	10/27/2012
CH02152K	TRUECARE APOTHECARY INC	DBA TRUECARE PHARMACY	995 ROUTE 22	BREWSTER	NY	10509	07/01/2017	09/15/2022
CH021520	WALGREEN EASTERN CO INC	DBA: WALGREENS #09866	370 WHITE PLAINS RD.	EASTCHESTER	NY	10709-2804	07/01/2017
CH02152J	WALGREEN EASTERN CO INC	DBA: WALGREENS #09866	370 WHITE PLAINS RD.	EASTCHESTER	NY	10709-2804	07/01/2025
CH021520	WALGREEN EASTERN CO INC.	DBA WALGREENS	1333 BOSTON POST ROAD	LARCHMONT	NY	10538	07/01/2017
CH02152I	WALGREEN EASTERN CO INC.	DBA WALGREENS	1333 BOSTON POST ROAD	LARCHMONT	NY	10538	07/01/2025
CH021520	WALGREEN EASTERN CO. INC.	DBA WALGREENS	411 KING ST.	CHAPPAQUA	NY	10514	01/01/2016
CH02152G	WALGREEN EASTERN CO. INC.	DBA WALGREENS	411 KING ST.	CHAPPAQUA	NY	10514	07/01/2025
CH021520	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02758	162 WILDEY ST	TARRYTOWN	NY	10591-2902	01/01/2016
CH021520	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03523	75 MAIN ST # 83	DANBURY	CT	06810	01/01/2016
CH021520	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #07485	107 N. MAIN ST.	PORT CHESTER	NY	10573-4210	01/01/2016
CH021520	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	35 KENSICO RD.	THORNWOOD	NY	10594	01/01/2016
CH021520	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1201 MAIN ST.	PEEKSKILL	NY	10566	01/01/2016
CH021520	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	78 CROTON AVE.	OSSINING	NY	10562	01/01/2016
CH021520	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #15313	19 BRADHURST AVENUE SUITE L1	HAWTHORNE	NY	10532	01/01/2016
CH02152G	WALGREEN EASTERN CO., INC.	RITE AID #03432	55 S MOGER AVE #59	MOUNT KISCO	NY	10549	07/01/2019	12/31/2023
CH021520	WALGREEN EASTERN CO., INC.	RITE AID #03432	55 S MOGER AVE #59	MOUNT KISCO	NY	10549	07/01/2019	12/31/2023
CH02152N	WALGREEN EASTERN CO., INC.	DBA: COMMUNITY, A WALGREENS PHARMACY #2	66 E. POST RD 1ST FLOOR	WHITE PLAINS	NY	10601	07/01/2020
CH021520	WALGREEN EASTERN CO., INC.	DBA: COMMUNITY, A WALGREENS PHARMACY #2	66 E. POST RD 1ST FLOOR	WHITE PLAINS	NY	10601	07/01/2020
CH02152T	WALGREEN EASTERN CO., INC.	WALGREENS #17219	76 MAIN ST.	CANAAN	CT	06018	10/01/2023
CH02152T	WALGREEN EASTERN CO., INC.	WALGREENS #19134	331 WEST ST.	LITCHFIELD	CT	06759	10/01/2023
CH02152T	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	827 DUTCHESS TURNPIKE	POUGHKEEPSIE	NY	12603-2059	10/01/2023
CH02152T	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	704 FREEDOM PLAINS RD. SUITE A1	POUGHKEEPSIE	NY	12603	10/01/2023
CH02152R	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	35 KENSICO RD.	THORNWOOD	NY	10594	07/01/2025
CH02152P	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1201 MAIN ST.	PEEKSKILL	NY	10566	07/01/2025
CH021520	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	827 DUTCHESS TURNPIKE	POUGHKEEPSIE	NY	12603-2059	07/01/2025
CH021520	WALGREEN EASTERN CO., INC.	WALGREENS #19134	331 WEST ST.	LITCHFIELD	CT	06759	07/01/2025
CH02152K	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03523	75 MAIN ST # 83	DANBURY	CT	06810	07/01/2025
CH02152N	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #07485	107 N. MAIN ST.	PORT CHESTER	NY	10573-4210	07/01/2025
CH02152A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02758	162 WILDEY ST	TARRYTOWN	NY	10591-2902	07/01/2025
CH021520	WALGREEN EASTERN CO., INC.	WALGREENS #17219	76 MAIN ST.	CANAAN	CT	06018	07/01/2025
CH02152L	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	78 CROTON AVE.	OSSINING	NY	10562	07/01/2025
CH021520	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	704 FREEDOM PLAINS RD. SUITE A1	POUGHKEEPSIE	NY	12603	07/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 4:41:29 PM	2/13/2025 6:12:50 PM	2/13/2025 6:12 PM
Details	Last Recertification Date	Update	Recertification	2/1/2023 5:48:35 PM	1/29/2024 4:41:29 PM	1/29/2024 4:41 PM
Details	Last Recertification Date	Update	Recertification	1/31/2022 1:35:09 PM	2/1/2023 5:48:35 PM	2/1/2023 5:48 PM
Contacts	Authorizing Official	Update	New Registration	Farrell, Lindsay President and CEO Open Door Family Medical, Inc. 9145021450	Farrell, Lindsay President and CEO Open Door Family Medical, Inc. 9145021450	1/31/2022 2:45 PM
Details	Last Recertification Date	Update	Recertification	2/3/2021 5:47:08 PM	1/31/2022 1:35:09 PM	1/31/2022 1:35 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	2/3/2021 5:47 PM
Details	Last Recertification Date	Update	Recertification	2/5/2020 2:15:27 PM	2/3/2021 5:47:08 PM	2/3/2021 5:47 PM
Details	Last Recertification Date	Update	Recertification	1/31/2019 9:32:47 AM	2/5/2020 2:15:27 PM	2/5/2020 2:15 PM
Details	Last Recertification Date	Update	Recertification	2/15/2018 3:37:09 PM	1/31/2019 9:32:47 AM	1/31/2019 9:32 AM
Contacts	Primary Contact	Update	Recertification	Graffitti, Linda Controller Open Door Family Medical, Inc. 9145021327	MAZZOTTA, MARIA CFO Open Door Family Medical Center 9149411263-1470	2/15/2018 3:37 PM
Details	Last Recertification Date	Update	Recertification	2/6/2017 12:00:00 AM	2/15/2018 3:37:09 PM	2/15/2018 3:37 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/15/2018 11:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		04040268	1/15/2018 11:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	1/15/2018 11:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1073919973	1/15/2018 11:03 AM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		1/15/2018 11:03 AM
Contacts	Authorizing Official	Update		Farrell, Lindsay President and CEO 9145021450	Farrell, Lindsay President and CEO Open Door Family Medical, Inc. 9145021450	10/16/2017 9:17 AM
Contacts	Primary Contact	Update		Graffitti, Linda Controller 9145021327	Graffitti, Linda Controller Open Door Family Medical, Inc. 9145021327	10/13/2017 3:11 PM
Contacts	Authorizing Official	Insert			Farrell, Lindsay President and CEO 9145021450	5/24/2017 2:34 PM
Contacts	Primary Contact	Update		MAZZOTTA, MARIA CFO 9149411263-1470	Graffitti, Linda Controller 9145021327	2/13/2017 10:51 AM
Contacts	Signed By	Insert			Wilenkin, Anita Chief Operating Officer 9145021452	2/6/2017 1:07 PM
Addresses	Main Address	Insert			165 Main Street Ossining, NY 10562	2/6/2017 1:07 PM
Details	Last Recertification Date	Update		2/16/2016 12:00:00 AM	2/6/2017 12:00:00 AM	2/6/2017 1:07 PM
Contacts	Primary Contact	Insert			MAZZOTTA, MARIA CFO 9149411263-1470	2/17/2016 3:04 PM
Details	Last Recertification Date	Update			2/16/2016 12:00:00 AM	2/17/2016 3:04 PM
Dates	Participating Approval Date	Update			4/16/2015 12:00:00 AM	4/16/2015 2:47 PM
Details	State	Update		Pending	Active	4/16/2015 2:47 PM
Dates	Start Date	Update			7/1/2015 12:00:00 AM	4/16/2015 2:47 PM
Details	340B ID	Update		ONLINE_REG_50189	CH02152L	4/1/2015 2:23 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_50189	4/1/2015 9:50 AM
Details	Last Recertification Date	Insert				4/1/2015 9:50 AM
Details	Grant Number	Insert			H80CS00160	4/1/2015 9:50 AM
Details	340B ID	Insert			ONLINE_REG	4/1/2015 9:50 AM
Details	Is Authorizing Official EHB Data	Insert			False	4/1/2015 9:50 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/1/2015 9:50 AM
Details	Medicare Provider Number	Insert				4/1/2015 9:50 AM
Details	Entity Name	Insert			OPEN DOOR FAMILY MEDICAL CENTER, INC.	4/1/2015 9:50 AM
Details	Program Code	Insert			CH	4/1/2015 9:50 AM
Details	Entity Subname	Insert			Open Door Family Medical Center School Based Mobile Dental Van	4/1/2015 9:50 AM
Dates	Participating Approval Date	Insert				4/1/2015 9:50 AM
Details	State	Insert			Pending	4/1/2015 9:50 AM
Dates	Registration Date	Insert			4/1/2015 12:00:00 AM	4/1/2015 9:50 AM
Dates	Signed By Date	Insert			4/1/2015 12:00:00 AM	4/1/2015 9:50 AM
Dates	Start Date	Insert				4/1/2015 9:50 AM
Terminations	Termination Comments	Insert				4/1/2015 9:50 AM
Terminations	Termination Date	Insert				4/1/2015 9:50 AM
Terminations	Termination Effective Date	Insert				4/1/2015 9:50 AM
Terminations	Termination Reason	Insert				4/1/2015 9:50 AM

340B Drug Pricing Program Database