Covered Entity Details

CH04327AK EAU CLAIRE COOPERATIVE HEALTH CENTER (Terminated) - information as of 4/25/2025 12:00:22 AM

Main Details

Name

EAU CLAIRE COOPERATIVE HEALTH CENTER

Subdivision Name

Saint Lawrence Place

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014486

340B ID

CH04327AK

Grant Number

H80CS00730

Additional Details

Current Program Status

Terminated

Registration Date

4/9/2015

Participating Start Date

7/1/2015

Participating Approval Date

5/11/2015

Last Recertification Date

2/16/2017

Termination Date
Termination Reason

4/1/2017
Site closure

Contacts

Authorizing Official

Eau Calire Cooperative Health Center, Inc
DELGADO CANTAVE, CEO
(803) 733-5969 Ext: 4146

Primary Contact

Eau Claire Cooperative Health Center, Inc
GRETCHEN BECKHAM, DIRECTOR OF PHARMACY
(803) 603-5737

Addresses

Street Address

2400 WAITES RD
COLUMBIA, SC 29204-1325

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
SC	FQC031,763323,714345
		1780788430,1417385899,1760871115

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH043270	Active	BPS-H80-039956	EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.	EAU CLAIRE COOPERATIVE HEALTH CENTER ADMINISTRATIVE OFFICES	221 Dawson Road		COLUMBIA	SC
CH04327A	Terminated	BPS-H80-000930	EAU CLAIRE COOPERATIVE HEALTH CENTER	WAVERLY FAMILY PRACTICE	2117 Gervais St		Columbia	SC
CH04327AA	Terminated	BPS-H80-012485	EAU CLAIRE COOPERATIVE HEALTH CENTER	Innovations Health - Greenview	6904 N Main St		Columbia	SC
CH04327AB	Terminated	BPS-H80-012337	EAU CLAIRE COOPERATIVE HEALTH CENTER	Innovation Health - Eau Claire	4206 N Main St		Columbia	SC
CH04327AC	Active	BPS-H80-012699	EAU CLAIRE COOPERATIVE HEALTH CENTER	Eau Claire - Walk-In	4605 Monticello Rd BLDG B STE #2		Columbia	SC
CH04327AD	Terminated	BPS-H80-013771	EAU CLAIRE COOPERATIVE HEALTH CENTER	Lake Monticello Family Practice @ McCrorey-Liston	1978 STATE HIGHWAY 215 S		BLAIR	SC
CH04327AE	Terminated	BPS-H80-004129	EAU CLAIRE COOPERATIVE HEALTH CENTER	Innovations Health - Ridgewood	4801 Monticello Rd		Columbia	SC
CH04327AF	Terminated	BPS-H80-003534	EAU CLAIRE COOPERATIVE HEALTH CENTER	EAU CLAIRE COOPERATIVE HEALTH CENTERS	1228 Harden St		Columbia	SC
CH04327AG	Terminated	BPS-H80-014778	EAU CLAIRE COOPERATIVE HEALTH CENTER	Eau Claire Cooperative Health Centers, Inc. - Administrative Offices	1800 St. Julian Place, Suite 206		Columbia	SC
CH04327AH	Active	BPS-H80-014487	EAU CLAIRE COOPERATIVE HEALTH CENTER	Transitions Center	2025 MAIN ST		COLUMBIA	SC
CH04327AJ	Terminated	BPS-H80-013767	EAU CLAIRE COOPERATIVE HEALTH CENTER	Eau Claire Developmental Clinic	4605 MONTICELLO RD BUILDING C		COLUMBIA	SC
CH04327AK	Terminated	BPS-H80-014486	EAU CLAIRE COOPERATIVE HEALTH CENTER	Saint Lawrence Place	2400 WAITES RD		COLUMBIA	SC
CH04327AL	Terminated	BPS-H80-014476	EAU CLAIRE COOPERATIVE HEALTH CENTER	Cooperative Ministry	3821 W BELTLINE BLVD		COLUMBIA	SC
CH04327AM	Terminated	BPS-H80-014389	EAU CLAIRE COOPERATIVE HEALTH CENTER	Eau Claire Family Dentistry	3800 North Main Street Suite C		Columbia	SC
CH04327AN	Active	BPS-H80-013768	EAU CLAIRE COOPERATIVE HEALTH CENTER	Eau Claire Podiatry	3800 North Main Street Suite B		Columbia	SC
CH04327AP	Terminated	BPS-H80-014706	EAU CLAIRE COOPERATIVE HEALTH CENTER	Five Points Walk-in Center	1228 Harden St Suite A		Columbia	SC
CH04327AQ	Active	BPS-H80-015200	EAU CLAIRE COOPERATIVE HEALTH CENTER	Waverly Family Practice	1228 Harden St, Suite C		Columbia	SC
CH04327AR	Active	BPS-H80-017093	Eau Claire Cooperative Health Center	Cayce/West Columbia Primary Care Center	407 North Brown Street		West Columbia	SC
CH04327AS	Active	BPS-H80-028162	Eau Claire Cooperative Health Center	Little Mountain Pediatric and Family Practice	99 N Mill St		Little Mountain	SC
CH04327AT	Active	BPS-H80-028163	Eau Claire Cooperative Health Center	Cooperative Health Mobile Unit	4605 Monticello Road		Columbia	SC
CH04327AU	Active	BPS-H80-029783	Eau Claire Cooperative Health Center	Eau Claire Family Dentistry at Monticello Road	4605 Monticello Rd Bldg C		Columbia	SC
CH04327AV	Active	BPS-H80-031747	Eau Claire Cooperative Health Center	Toby's Place (Oliver Gospel Mission)	Domestic Violence Setting - Address Undisclosed		Undisclosed	SC
CH04327AW	Terminated	BPS-H80-031863	Eau Claire Cooperative Health Center	Columbia Community Family Practice	4808 Colonial Dr		Columbia	SC
CH04327AX	Active	BPS-H80-033591	Eau Claire Cooperative Health Center	Cooperative Community CareMobile	4605 Monticello Rd		Columbia	SC
CH04327AY	Terminated	BPS-H80-034887	Eau Claire Cooperative Health Center	Advantage Eye Care	115 Atrium Way STE 120		Columbia	SC
CH04327AZ	Active	BPS-H80-036018	EAU CLAIRE COOPERATIVE HEALTH CENTER	Waverly Women's Health	2117 Gervais St		Columbia	SC
CH04327BA	Terminated	BPS-H80-035860	EAU CLAIRE COOPERATIVE HEALTH CENTER	Cooperative Health @ CAMH	2715 Colonial Dr		Columbia	SC
CH04327BB	Active	BPS-H80-027189	EAU CLAIRE COOPERATIVE HEALTH CENTER	Five Points Pediatrics Behavioral Health @ Hand Middle School	2600 Wheat St		Columbia	SC
CH04327C	Active	BPS-H80-011147	EAU CLAIRE COOPERATIVE HEALTH CENTER	EAU CLAIRE INTERNAL MEDICINE	4605 Monticello Rd		Columbia	SC
CH04327D	Active	BPS-H80-001508	EAU CLAIRE COOPERATIVE HEALTH CENTER	BROOKLAND-CAYCE MEDICAL PRACTICE	1115 State St		Cayce	SC
CH04327F	Active	BPS-H80-001268	EAU CLAIRE COOPERATIVE HEALTH CENTER	PEDIATRICS OF BATESBURG-LEESVILLE	120 WEST CHURCH STREET		LEESVILLE	SC
CH04327G	Active	BPS-H80-014747	EAU CLAIRE COOPERATIVE HEALTH CENTER	Sterling Sharpe Pediatric Center	4605 Monticello Rd, BUILDING A, SUITE 1		Columbia	SC
CH04327I	Active	BPS-H80-002540	EAU CLAIRE COOPERATIVE HEALTH CENTER	BROOKLAND COMMUNITY PEDIATRICS	500 N 12th St		West Columbia	SC
CH04327K	Active	BPS-H80-002994	EAU CLAIRE COOPERATIVE HEALTH CENTER	FIVE POINTS PEDIATRICS	1228 Harden St	SUITE B	Columbia	SC
CH04327N	Active	BPS-H80-003306	EAU CLAIRE COOPERATIVE HEALTH CENTER	RIDGEWAY PEDIATRICS, FAMILY & DENTAL PRACTICE	755 US HIGHWAY 21 S		RIDGEWAY	SC
CH04327P	Active	BPS-H80-011150	EAU CLAIRE COOPERATIVE HEALTH CENTER	Pelion Pediatrics, Family & Dental Practice	8063 Edmund Hwy		Pelion	SC
CH04327Q	Active	BPS-H80-011279	EAU CLAIRE COOPERATIVE HEALTH CENTER	Winnsboro Pediatric and Family Practice	1136 Kincaid Bridge Rd	Ste A	Winnsboro	SC
CH04327R	Active	BPS-H80-013620	EAU CLAIRE COOPERATIVE HEALTH CENTER	Lake Monticello Family Practice	9017 HWY 215 S		Jenkinsville	SC
CH04327S	Active	BPS-H80-011152	EAU CLAIRE COOPERATIVE HEALTH CENTER	Pediatrics of Newberry	2525 Kinard St		Newberry	SC
CH04327T	Active	BPS-H80-007534	EAU CLAIRE COOPERATIVE HEALTH CENTER	Waverly Women's Healthcare and Internal Medicine of Batesburg/Leesville	338 East Columbia Avenue		Batesburg/Leesville	SC
CH04327U	Terminated	BPS-H80-011277	EAU CLAIRE COOPERATIVE HEALTH CENTER	Laurel Medical Practice	1520 Laurel St		Columbia	SC
CH04327W	Active	BPS-H80-024916	EAU CLAIRE COOPERATIVE HEALTH CENTER	Eastover Family Practice	3041 Old Eastover Road		Eastover	SC
CH04327X	Active	BPS-H80-014706	EAU CLAIRE COOPERATIVE HEALTH CENTER	Five Points Walk-in Center	1228 Harden St	SUITE A	Columbia	SC
CH04327Y	Active	BPS-H80-013621	EAU CLAIRE COOPERATIVE HEALTH CENTER	Hopkins Pediatrics and Family Practice	9023 Garners Ferry Rd		Hopkins	SC
CH04327Z	Active	BPS-H80-014748	EAU CLAIRE COOPERATIVE HEALTH CENTER	Eau Claire Behavioral Medicine	4605 Monticello Rd, BUILDING B, SUITE 1		Columbia	SC

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH043270	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2024
CH043270	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2024
CH043270	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2024
CH043270	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2024
CH043270	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2024
CH043270	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2024
CH043270	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2024
CH043270	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2024
CH043270	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2024
CH043270	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2024
CH043270	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2024
CH043270	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2024
CH043270	ECKERD CORPORATION	RITE AID #11581	702 MAIN STREET	WEST COLUMBIA	SC	29170	10/01/2013	01/23/2018
CH043270	ECKERD CORPORATION	RITE AID #11588	7900 GARNERS FERRY ROAD	COLUMBIA	SC	29209	04/01/2016	01/23/2018
CH043270	EDC DRUG STORES, INC.	RITE AID #11582	5900 NORTH MAIN STREET	COLUMBIA	SC	29203	10/01/2013	01/23/2018
CH043270	EDC DRUG STORES, INC.	RITE AID #11584	2708 ROSEWOOD DRIVE	COLUMBIA	SC	29205	04/01/2016	01/23/2018
CH043270	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2024
CH043270	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2024
CH043270	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2024
CH043270	RITE AID PHARMACY #11583		818 HARDEN STREET	COLUMBIA	SC	29205	10/01/2013	07/27/2015
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03850	7749 GARNERS FERRY ROAD	COLUMBIA	SC	29209	01/01/2016
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05596	4627 NORTH MAIN STREET	COLUMBIA	SC	29203	01/01/2016
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03578	120 WEST COLUMBIA AVENUE	BATESBURG	SC	29006	10/01/2020
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04114	3700 TWO NOTCH ROAD	COLUMBIA	SC	29204	10/01/2020
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07516	3595 HARDEN ST	COLUMBIA	SC	29203	10/01/2020
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05474	27 US HIGHWAY 321 BYP S	WINNSBORO	SC	29180	07/01/2021
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03849	3055 BROAD RIVER ROAD	COLUMBIA	SC	29210	10/01/2024
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17041	6090A GARNERS FERRY RD	COLUMBIA	SC	29209	10/01/2024
CH043270	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03542	1210 WILSON ROAD	NEWBERRY	SC	29108	10/01/2024
CH04327Y	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03850	7749 GARNERS FERRY ROAD	COLUMBIA	SC	29209	01/01/2025
CH04327C	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05596	4627 NORTH MAIN STREET	COLUMBIA	SC	29203	01/01/2025
CH04327AS	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03849	3055 BROAD RIVER ROAD	COLUMBIA	SC	29210	01/01/2025
CH04327AQ	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04114	3700 TWO NOTCH ROAD	COLUMBIA	SC	29204	01/01/2025
CH04327X	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17041	6090A GARNERS FERRY RD	COLUMBIA	SC	29209	01/01/2025
CH04327T	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03578	120 WEST COLUMBIA AVENUE	BATESBURG	SC	29006	01/01/2025
CH04327AC	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07516	3595 HARDEN ST	COLUMBIA	SC	29203	01/01/2025
CH04327S	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03542	1210 WILSON ROAD	NEWBERRY	SC	29108	01/01/2025
CH043270	THE MEDICINE MART	1300 SUNSET BLVD		WEST COLUMBIA	SC	29169-5914	04/01/2013	05/01/2020
CH043270	WALGREEN CO	DBA: WALGREENS #10230	1537 CHARLESTON HIGHWAY	WEST COLUMBIA	SC	29169-5047	03/07/2012
CH04327I	WALGREEN CO	DBA: WALGREENS #10230	1537 CHARLESTON HIGHWAY	WEST COLUMBIA	SC	29169-5047	01/01/2025
CH043270	WALGREEN CO.	DBA: WALGREENS # 06137	2224 AUGUSTA ROAD	WEST COLUMBIA	SC	29169-4524	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS # 06136	4467 DEVINE STREET	COLUMBIA	SC	29205	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS # 06262	3501 FOREST DRIVE	COLUMBIA	SC	29204-4003	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS # 09487	1223 ST ANDREWS RD	COLUMBIA	SC	29210-5821	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS #11362	1903 S. LAKE DR.	LEXINGTON	SC	29073-7760	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS #12478	9001 TWO NOTCH RD.	COLUMBIA	SC	29223-5834	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS #11379	7801 GARNERS FERRY RD.	COLUMBIA	SC	29209	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS # 01073	1010 OLD BARNWELL ROAD	WEST COLUMBIA	SC	29170-3406	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS # 07399	423 W MAIN ST	LEXINGTON	SC	29072-2637	03/07/2012
CH043270	WALGREEN CO.	DBA: WALGREENS #12163	127 W. COLUMBIA AVE.	BATESBURG	SC	29006	10/01/2013
CH043270	WALGREEN CO.	DBA: WALGREENS #11433	1941 BLOSSOM ST.	COLUMBIA	SC	29205	01/01/2014
CH043270	WALGREEN CO.	RITE AID #11588	7900 GARNERS FERRY RD	COLUMBIA	SC	29209	07/01/2018	05/08/2018
CH043270	WALGREEN CO.	DBA: WALGREENS #17168	1233 WILSON RD	NEWBERRY	SC	29108-4000	07/01/2018	11/08/2023
CH043270	WALGREEN CO.	WALGREENS #17412	5900 N MAIN ST	COLUMBIA	SC	29203	07/01/2018	06/12/2020
CH043270	WALGREEN CO.	WALGREENS #17059	2300 DECKER BLVD	COLUMBIA	SC	29206	07/01/2018	01/16/2023
CH04327W	WALGREEN CO.	DBA: WALGREENS #11379	7801 GARNERS FERRY RD.	COLUMBIA	SC	29209	01/01/2025
CH04327G	WALGREEN CO.	DBA: WALGREENS # 09487	1223 ST ANDREWS RD	COLUMBIA	SC	29210-5821	01/01/2025
CH04327F	WALGREEN CO.	DBA: WALGREENS #12163	127 W. COLUMBIA AVE.	BATESBURG	SC	29006	01/01/2025
CH04327D	WALGREEN CO.	DBA: WALGREENS # 07399	423 W MAIN ST	LEXINGTON	SC	29072-2637	01/01/2025
CH04327AH	WALGREEN CO.	DBA: WALGREENS # 06262	3501 FOREST DRIVE	COLUMBIA	SC	29204-4003	01/01/2025
CH04327AZ	WALGREEN CO.	DBA: WALGREENS #11433	1941 BLOSSOM ST.	COLUMBIA	SC	29205	01/01/2025
CH04327P	WALGREEN CO.	DBA: WALGREENS #11362	1903 S. LAKE DR.	LEXINGTON	SC	29073-7760	01/01/2025
CH04327K	WALGREEN CO.	DBA: WALGREENS # 06136	4467 DEVINE STREET	COLUMBIA	SC	29205	01/01/2025
CH04327N	WALGREEN CO.	DBA: WALGREENS #12478	9001 TWO NOTCH RD.	COLUMBIA	SC	29223-5834	01/01/2025
CH04327AN	WALGREEN CO.	DBA: WALGREENS # 01073	1010 OLD BARNWELL ROAD	WEST COLUMBIA	SC	29170-3406	01/01/2025
CH04327AR	WALGREEN CO.	DBA: WALGREENS # 06137	2224 AUGUSTA ROAD	WEST COLUMBIA	SC	29169-4524	01/01/2025
CH043270	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	07/07/2015

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	CANTAVE, DELGADO CEO 8037335969-4146	CANTAVE, DELGADO CEO Eau Calire Cooperative Health Center, Inc 8037335969-4146	12/7/2017 10:18 AM
Contacts	Primary Contact	Update	BECKHAM, GRETCHEN DIRECTOR OF PHARMACY 8036035737	BECKHAM, GRETCHEN DIRECTOR OF PHARMACY Eau Claire Cooperative Health Center, Inc 8036035737	10/12/2017 9:40 AM
Contacts	Signed By	Insert		HAMILTON, STUART A. CEO 8037335969-4125	6/22/2017 2:21 PM
Addresses	Main Address	Insert		2400 WAITES RD COLUMBIA, SC 29204-1325	2/16/2017 11:14 AM
Contacts	Primary Contact	Insert		BECKHAM, GRETCHEN DIRECTOR OF PHARMACY 8036035737	2/16/2017 11:14 AM
Contacts	Authorizing Official	Insert		CANTAVE, DELGADO CEO 8037335969-4146	2/16/2017 11:14 AM
Details	Last Recertification Date	Update	3/1/2016 12:00:00 AM	2/16/2017 12:00:00 AM	2/16/2017 11:14 AM
Dates	Last Date That 340B Drugs Purchased	Update		1/1/2016 12:00:00 AM	2/16/2017 11:14 AM
Details	State	Update	Active	Terminated	2/16/2017 11:14 AM
Terminations	Termination Comments	Update		Due to low volume at this location, ECCHC decided to close this site. However, we will continue to provide health care and case management to our homeless population at other eligible locations.	2/16/2017 11:14 AM
Terminations	Termination Date	Update		4/1/2017 12:00:00 AM	2/16/2017 11:14 AM
Terminations	Termination Effective Date	Update		8/25/2016 12:00:00 AM	2/16/2017 11:14 AM
Terminations	Termination Reason	Update		Site closure	2/16/2017 11:14 AM
Medicaid Billing	NPI: Number	Insert		1760871115	3/30/2016 11:13 AM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	3/1/2016 2:30 PM
Dates	Participating Approval Date	Update		5/11/2015 12:00:00 AM	5/11/2015 3:56 PM
Details	State	Update	Pending	Active	5/11/2015 3:56 PM
Dates	Start Date	Update		7/1/2015 12:00:00 AM	5/11/2015 3:56 PM
Details	340B ID	Update	ONLINE_REG_50944	CH04327AK	4/10/2015 11:20 AM
Details	340B ID	Update	ONLINE_REG	ONLINE_REG_50944	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert		False	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: Number	Insert		FQC031	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: State	Insert		SC	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert		False	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: Number	Insert		763323	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: State	Insert		SC	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert		False	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: Number	Insert		714345	4/9/2015 11:45 AM
Medicaid Billing	Medicaid: State	Insert		SC	4/9/2015 11:45 AM
Medicaid Billing	NPI: Number	Insert		1780788430	4/9/2015 11:45 AM
Medicaid Billing	NPI: Number	Insert		1417385899	4/9/2015 11:45 AM
Details	Last Recertification Date	Insert			4/9/2015 11:45 AM
Details	Grant Number	Insert		H80CS00730	4/9/2015 11:45 AM
Details	340B ID	Insert		ONLINE_REG	4/9/2015 11:45 AM
Details	Is Authorizing Official EHB Data	Insert		False	4/9/2015 11:45 AM
Dates	Last Date That 340B Drugs Purchased	Insert			4/9/2015 11:45 AM
Details	Medicare Provider Number	Insert			4/9/2015 11:45 AM
Details	Entity Name	Insert		EAU CLAIRE COOPERATIVE HEALTH CENTER	4/9/2015 11:45 AM
Details	Program Code	Insert		CH	4/9/2015 11:45 AM
Details	Entity Subname	Insert		Saint Lawrence Place	4/9/2015 11:45 AM
Dates	Participating Approval Date	Insert			4/9/2015 11:45 AM
Details	State	Insert		Pending	4/9/2015 11:45 AM
Dates	Registration Date	Insert		4/9/2015 12:00:00 AM	4/9/2015 11:45 AM
Dates	Signed By Date	Insert		4/9/2015 12:00:00 AM	4/9/2015 11:45 AM
Dates	Start Date	Insert			4/9/2015 11:45 AM
Terminations	Termination Comments	Insert			4/9/2015 11:45 AM
Terminations	Termination Date	Insert			4/9/2015 11:45 AM
Terminations	Termination Effective Date	Insert			4/9/2015 11:45 AM
Terminations	Termination Reason	Insert			4/9/2015 11:45 AM

340B Drug Pricing Program Database