Covered Entity Details

FQHCLA334AG NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (Terminated) - information as of 6/7/2025 6:08:36 AM

Main Details

Name

NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

Subdivision Name

Judson Health Center

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-014609

340B ID

FQHCLA334AG

Grant Number

LALCS00169

Additional Details

Current Program Status

Terminated

Registration Date

4/15/2015

Participating Start Date

7/1/2015

Participating Approval Date

4/22/2015

Last Recertification Date

2/21/2018

Termination Date
Termination Reason

4/1/2019
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

New York City Health and Hospitals
Paul Albertson, Vice President
(212) 748-2256

Primary Contact

New York City Health + Hospitals
Danielle Sestito, Senior Director, 340B Operations
(212) 442-3892

Addresses

Street Address

34 Spring St
New York, NY 10012-4107

Billing Address

Gouverneur Healthcare Services
227 Madison Street
New York, NY 10002

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	0343288
		1548208127

Shipping Addresses

Shipping Address 1

Gouverneur Healthcare Services
227 Madison Street
New York, NY 10002

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	City	State
FQHCLA334	Terminated	BPS-LAL-014629	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Washington Heights	600 W 168th St	New York	NY
FQHCLA334A	Terminated	BPS-LAL-014628	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Sydenham Health Center	264 W 118th St	New York	NY
FQHCLA334AA	Terminated	BPS-LAL-014599	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Eleanor Roosevelt Houses Child Health Clinic	388 Pulaski St	Brooklyn	NY
FQHCLA334AB	Terminated	BPS-LAL-014595	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Cumberland Diagnostic and Treatment Center	100 N Portland Ave	Brooklyn	NY
FQHCLA334AC	Terminated	BPS-LAL-014614	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Melrose Houses	348 E 156th St	Bronx	NY
FQHCLA334AD	Terminated	BPS-LAL-014623	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Segundo Ruiz Belvis Diagnostic and Treatment Center	545 E 142nd St	Bronx	NY
FQHCLA334AE	Terminated	BPS-LAL-014624	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Smith Communicare Health Center	60 Madison St	New York	NY
FQHCLA334AF	Terminated	BPS-LAL-014622	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Roberto Clemente/Sylvia Del Villard Health Center	540 E 13th St	New York	NY
FQHCLA334AG	Terminated	BPS-LAL-014609	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Judson Health Center	34 Spring St	New York	NY
FQHCLA334AH	Terminated	BPS-LAL-014601	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Gouverneur Healthcare Services	227 Madison St	New York	NY
FQHCLA334AJ	Terminated	BPS-LAL-014608	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Jordan L Mott JHS 22	270 E 167th St	Bronx	NY
FQHCLA334AK	Terminated	BPS-LAL-014610	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Junior High School 117	1865 Morris Ave	Bronx	NY
FQHCLA334AL	Terminated	BPS-LAL-014593	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	CES 73	1020 Anderson Ave	Bronx	NY
FQHCLA334AM	Terminated	BPS-LAL-014596	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Daniel Webster	401 E 168th St	Bronx	NY
FQHCLA334AN	Terminated	BPS-LAL-014615	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Morrisania D&TC	1225 Gerard Ave	Bronx	NY
FQHCLA334B	Terminated	BPS-LAL-014625	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	St Nicholas Houses	281 W 127th St	New York	NY
FQHCLA334C	Terminated	BPS-LAL-014621	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	PS 46 Tappan	2987 Eighth Avenue	New York	NY
FQHCLA334D	Terminated	BPS-LAL-014620	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	PS 30/31	144 E 128th St	New York	NY
FQHCLA334E	Terminated	BPS-LAL-014619	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	PS 200	2589 7th Avenue	New York	NY
FQHCLA334F	Terminated	BPS-LAL-014618	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	PS 194	244 W 144th St	New York	NY
FQHCLA334G	Terminated	BPS-LAL-014617	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	PS 161	499 W 133rd St	New York	NY
FQHCLA334H	Terminated	BPS-LAL-014616	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	PS 197	2230 5th Ave	New York	NY
FQHCLA334J	Terminated	BPS-LAL-014611	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	La Clinica de Las Americas	175 Nagle Ave	New York	NY
FQHCLA334K	Terminated	BPS-LAL-014605	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	IS 286/172	509 W 129th St	New York	NY
FQHCLA334L	Terminated	BPS-LAL-014603	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	IS 10 Frederick Douglas Academy	2581 7th Avenue	New York	NY
FQHCLA334M	Terminated	BPS-LAL-014602	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Grant Houses	3170 Broadway	New York	NY
FQHCLA334N	Terminated	BPS-LAL-014597	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Drew Hamilton	2698 Eighth Avenue	New York	NY
FQHCLA334P	Terminated	BPS-LAL-014627	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Sutter Avenue CHC	1091 Sutter Ave	Brooklyn	NY
FQHCLA334Q	Terminated	BPS-LAL-014606	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	IS 302	350 Linwood St	Brooklyn	NY
FQHCLA334R	Terminated	BPS-LAL-014604	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	IS 166 - Gershwin	800 Van Siclen Ave	Brooklyn	NY
FQHCLA334S	Terminated	BPS-LAL-014594	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Crown Heights	1218 Prospect Pl	Brooklyn	NY
FQHCLA334T	Terminated	BPS-LAL-014592	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Brownsville CHC	259 Bristol St.	Brooklyn	NY
FQHCLA334U	Terminated	BPS-LAL-014598	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	East New York Diagnostic and Treatment Center	2094 Pitkin Ave	Brooklyn	NY
FQHCLA334V	Terminated	BPS-LAL-014630	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Williamsburg Community Health Center	279 Graham Ave	Brooklyn	NY
FQHCLA334W	Terminated	BPS-LAL-014626	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Sumner Avenue Houses Child Health Clinic	47 Marcus Garvey Avenue	Brooklyn	NY
FQHCLA334X	Terminated	BPS-LAL-014612	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Lafayette Houses Child Health Clinic	434 Dekalb Ave	Brooklyn	NY
FQHCLA334Y	Terminated	BPS-LAL-014607	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Jonathan Williams Child Health Clinic	333 Roebling St	Brooklyn	NY
FQHCLA334Z	Terminated	BPS-LAL-014600	NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	Fort Greene Child Health Clinic	295 Flatbush Avenue	Brooklyn	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA334	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	10/01/2016	04/01/2018
FQHCLA334AH	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	01/01/2018	04/01/2019
FQHCLA334U	31ST & 3RD PHARMACY INC	D/B/A AVITA PHARMACY 1063	1860 WALT WHITMAN RD STE 700	MELVILLE	NY	11747	04/01/2018	04/01/2019
FQHCLA334	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/01/2017	04/01/2018
FQHCLA334	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	01/01/2017	07/19/2017
FQHCLA334	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2017	04/01/2018
FQHCLA334AH	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/01/2018	04/01/2019
FQHCLA334AH	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2018	04/01/2019
FQHCLA334U	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2018	04/01/2019
FQHCLA334A	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2018	04/01/2019
FQHCLA334AD	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2018	04/01/2019
FQHCLA334	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/01/2017	04/01/2018
FQHCLA334	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/01/2017	04/01/2018
FQHCLA334	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2017	04/01/2018
FQHCLA334AH	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/01/2018	04/01/2019
FQHCLA334AH	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2018	04/01/2019
FQHCLA334AH	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/01/2018	04/01/2019
FQHCLA334AD	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2018	07/10/2018
FQHCLA334A	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2018	04/01/2019
FQHCLA334U	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2018	04/01/2019
FQHCLA334AD	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2018	04/01/2019
FQHCLA334AH	BELLEVUE HOSPITAL CENTER	462 1ST AVE		NEW YORK	NY	10016-9196	10/01/2018	04/01/2019
FQHCLA334	BRIGHT PHARMA INC	142 E 170TH ST		BRONX	NY	10452-7021	10/01/2016	04/01/2018
FQHCLA334AD	BRIGHT PHARMA INC	142 E 170TH ST		BRONX	NY	10452-7021	01/01/2018	03/30/2018
FQHCLA334AN	BRIGHT PHARMA INC	142 E 170TH ST		BRONX	NY	10452-7021	04/01/2018	03/30/2018
FQHCLA334	BRONX PRESCRIPTION CENTER SOUTH INC	DBA-LEFF PRESCRIPTION CENTER	70 EAST 161ST STREET	BRONX	NY	10451	07/01/2017	04/01/2018
FQHCLA334AD	BRONX PRESCRIPTION CENTER SOUTH INC	DBA-LEFF PRESCRIPTION CENTER	70 EAST 161ST STREET	BRONX	NY	10451	01/01/2018	04/01/2019
FQHCLA334AN	BRONX PRESCRIPTION CENTER SOUTH INC	DBA-LEFF PRESCRIPTION CENTER	70 EAST 161ST STREET	BRONX	NY	10451	04/01/2018	04/01/2019
FQHCLA334	BROOKDALE PHARMA INC	D/B/A BROOKDALE PHARMACY	2568 LINDEN BLVD	BROOKLYN	NY	11208-4904	07/01/2017	04/01/2018
FQHCLA334U	BROOKDALE PHARMA INC	D/B/A BROOKDALE PHARMACY	2568 LINDEN BLVD	BROOKLYN	NY	11208-4904	01/01/2018	04/01/2019
FQHCLA334AH	BROOKDALE PHARMA INC	D/B/A BROOKDALE PHARMACY	2568 LINDEN BLVD	BROOKLYN	NY	11208-4904	04/01/2018	04/01/2019
FQHCLA334	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2017	09/27/2017
FQHCLA334	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2017	09/27/2017
FQHCLA334	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2017	09/27/2017
FQHCLA334	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2017	09/27/2017
FQHCLA334	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2017	09/27/2017
FQHCLA334	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2017	09/27/2017
FQHCLA334	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2017	09/27/2017
FQHCLA334	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2017	09/27/2017
FQHCLA334	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2017	09/27/2017
FQHCLA334	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	11 H COMMERCE WAY	TOTOWA	NJ	07512	10/01/2017	04/01/2018
FQHCLA334AH	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	11 H COMMERCE WAY	TOTOWA	NJ	07512	01/01/2018	04/01/2019
FQHCLA334	CORAM HEALTHCARE CORPORATION OF GREATER	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	48-23 55TH AVENUE	MASPETH	NY	11378	10/01/2017	04/01/2018
FQHCLA334AH	CORAM HEALTHCARE CORPORATION OF GREATER	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	48-23 55TH AVENUE	MASPETH	NY	11378	01/01/2018	04/01/2019
FQHCLA334	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02939	500 GRAND ST.	NEW YORK	NY	10002	10/01/2017	04/01/2018
FQHCLA334AH	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02939	500 GRAND ST.	NEW YORK	NY	10002	01/01/2018	04/01/2019
FQHCLA334AN	DUANE READE	941 SOUTHERN BLVD #943		BRONX	NY	10459	10/01/2016	04/01/2019
FQHCLA334AN	DUANE READE	617 WEST 181ST STREET		NEW YORK	NY	10033-4913	10/01/2016	08/16/2018
FQHCLA334AN	DUANE READE	1-13 EAST KINGSBRIDGE RD		BRONX	NY	10468	10/01/2016	04/01/2019
FQHCLA334AN	DUANE READE	320 W 145TH STREET		NEW YORK	NY	10039	10/01/2016	04/01/2019
FQHCLA334AN	DUANE READE	300 WEST 135TH ST.		NEW YORK	NY	10030	10/01/2016	04/01/2019
FQHCLA334AN	DUANE READE	58 E. FORDHAM ROAD		BRONX	NY	10468	10/01/2016	04/01/2019
FQHCLA334AN	DUANE READE		3225 THIRD AVE	BRONX	NY	10451	10/01/2016	01/03/2018
FQHCLA334AN	DUANE READE	DBA: DUANE READE	3387 BROADWAY	NEW YORK	NY	10031	10/01/2016	04/01/2019
FQHCLA334AN	DUANE READE	DBA: MELROSE PHARMACY	666 COURTLANDT AVE.	BRONX	NY	10451	10/01/2016	04/01/2019
FQHCLA334AN	DUANE READE	133-141 DYCKMAN STREET		NEW YORK	NY	10040	10/01/2016	04/01/2019
FQHCLA334AH	DUANE READE	95 WALL ST		NEW YORK	NY	10005	10/01/2016	04/01/2019
FQHCLA334AH	DUANE READE	1 WHITEHALL ST		NEW YORK	NY	10004	10/01/2016	04/01/2019
FQHCLA334AH	DUANE READE	100 DELANCEY STREET		NEW YORK	NY	10002-3202	10/01/2016	04/01/2019
FQHCLA334AH	DUANE READE		17 BATTERY PL SOUTH	NEW YORK	NY	10004-1102	10/01/2016	01/03/2018
FQHCLA334AH	DUANE READE	352 GREENWICH ST		NEW YORK	NY	10013	10/01/2016	04/01/2019
FQHCLA334AH	DUANE READE	60 SPRING STREET		NEW YORK	NY	10012	10/01/2016	04/01/2019
FQHCLA334AD	DUANE READE	941 SOUTHERN BLVD #943		BRONX	NY	10459	10/01/2016	04/01/2019
FQHCLA334AD	DUANE READE		3225 THIRD AVE	BRONX	NY	10451	10/01/2016	01/03/2018
FQHCLA334AD	DUANE READE	DBA: MELROSE PHARMACY	666 COURTLANDT AVE.	BRONX	NY	10451	10/01/2016	04/01/2019
FQHCLA334U	DUANE READE		1181 LIBERTY AVE	BROOKLYN	NY	11208	10/01/2016	01/03/2018
FQHCLA334U	DUANE READE	57-11 MYRTLE AVE		RIDGEWOOD	NY	11385-4933	10/01/2016	12/12/2017
FQHCLA334U	DUANE READE	84-32 JAMAICA AVENUE		WOODHAVEN	NY	11421	10/01/2016	04/01/2019
FQHCLA334U	DUANE READE	1 REMSEN AVENUE		BROOKLYN	NY	11212-1536	10/01/2016	04/01/2019
FQHCLA334U	DUANE READE	54-11 MYRTLE AVENUE		RIDGEWOOD	NY	11385	10/01/2016	12/13/2017
FQHCLA334U	DUANE READE	750 NEW YORK AVE		BROOKLYN	NY	11203	10/01/2016	04/01/2019
FQHCLA334A	DUANE READE	279 W 125TH STREET		NEW YORK	NY	10027-4408	10/01/2016	07/20/2018
FQHCLA334U	DUANE READE	724 FLATBUSH AVENUE		BROOKLYN	NY	11226	07/01/2018	04/01/2019
FQHCLA334A	DUANE READE	135 EAST 125TH STREET		NEW YORK	NY	10035	10/01/2018	04/01/2019
FQHCLA334A	DUANE READE	135 EAST 125TH STREET		NEW YORK	NY	10035	10/01/2018	07/20/2018
FQHCLA334AD	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2018	04/01/2019
FQHCLA334A	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2018	04/01/2019
FQHCLA334U	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2018	04/01/2019
FQHCLA334AH	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2018	04/01/2019
FQHCLA334AN	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2018	04/01/2019
FQHCLA334	FIRST HEALTH PHARMACY	PGU PHARMACY INC	1229 FRANKLIN AVE	BRONX	NY	10456	04/01/2017	09/20/2017
FQHCLA334	GIANT PITKIN PHARMACY INC	DBA HEALTH MART PITKIN PHARMACY	2232 PITKIN AVE	BROOKLYN	NY	11207	10/01/2016	04/01/2018
FQHCLA334U	GIANT PITKIN PHARMACY INC	DBA HEALTH MART PITKIN PHARMACY	2232 PITKIN AVE	BROOKLYN	NY	11207	01/01/2018	04/01/2019
FQHCLA334N	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334M	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	01/01/2018
FQHCLA334L	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334K	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334J	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334H	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	04/01/2016	04/01/2019
FQHCLA334G	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334F	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334E	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334D	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334C	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	01/01/2016	04/01/2019
FQHCLA334B	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334A	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2019
FQHCLA334	HARLEM HOSPITAL CENTER	c/o Outpatient Pharmacy	46 West 137th Street	New York	NY	10037	10/01/2015	04/01/2018
FQHCLA334	HEALTHONE PHARMACY, INC	119 PENNSYLVANIA AVE		BROOKLYN	NY	11207-2993	10/01/2016	12/21/2017
FQHCLA334U	HEALTHONE PHARMACY, INC	119 PENNSYLVANIA AVE		BROOKLYN	NY	11207-2993	01/01/2018	12/21/2017
FQHCLA334	HISPANIOLA PHARMACEUTICAL GROUP INC	D/B/A SOUTH BRONX PHARMACY	411 EAST 138TH STREET	BRONX	NY	10454	10/01/2016	12/21/2017
FQHCLA334AD	HISPANIOLA PHARMACEUTICAL GROUP INC	D/B/A SOUTH BRONX PHARMACY	411 EAST 138TH STREET	BRONX	NY	10454	01/01/2018	04/01/2019
FQHCLA334AN	JACOBI MEDICAL CENTER	NYC-HEALTH & HOSP.CORP	ATTN: PHARMACY DEPARTMENT 1400 PELHAM PKWY SOUTH	BRONX	NY	10461	10/01/2018	04/01/2019
FQHCLA334U	JEWEL OF FLUSHING RX INC.	70-35 PARSONS BLVD.		FLUSHING	NY	11365-3049	07/01/2018	04/01/2019
FQHCLA334AN	JEWEL OF FLUSHING RX INC.	70-35 PARSONS BLVD.		FLUSHING	NY	11365-3049	07/01/2018	04/01/2019
FQHCLA334	JOSEPH KRAMER INC	DBA:KRAMER, JOSEPH, INC. (X-REF.)	309 SAINT ANN'S AVE	BRONX	NY	10454	10/01/2016	04/01/2018
FQHCLA334AD	JOSEPH KRAMER INC	DBA:KRAMER, JOSEPH, INC. (X-REF.)	309 SAINT ANN'S AVE	BRONX	NY	10454	01/01/2018	04/01/2019
FQHCLA334AN	JOSEPH KRAMER INC	DBA:KRAMER, JOSEPH, INC. (X-REF.)	309 SAINT ANN'S AVE	BRONX	NY	10454	04/01/2018	04/01/2019
FQHCLA334	K&R UNITED CORP	K & R UNITED CORP	227 AVENUE B	NEW YORK	NY	10009-3358	10/01/2017	04/01/2018
FQHCLA334AH	K&R UNITED CORP	K & R UNITED CORP	227 AVENUE B	NEW YORK	NY	10009-3358	01/01/2018	08/31/2018
FQHCLA334U	KALA PHARMACY INC	9311 CHURCH AVE		BROOKLYN	NY	11212-1645	10/01/2018	10/25/2018
FQHCLA334U	KINGS COUNTY MED CNTR	C/O MAIN PHARMACY	451 CLARKSON AVE	BROOKLYN	NY	11203	10/01/2018	04/01/2019
FQHCLA334AD	LEROY PHARMACY II LLC	239 E 198TH ST		BRONX	NY	10458-3147	10/01/2018	04/01/2019
FQHCLA334	LG DRUGS INC.	DBA: GENA CARE PHARMACY	173 CHAUNCEY ST GENA CARE PHARMACY	BROOKLYN	NY	11233-2154	07/01/2017	04/01/2018
FQHCLA334U	LG DRUGS INC.	DBA: GENA CARE PHARMACY	173 CHAUNCEY ST GENA CARE PHARMACY	BROOKLYN	NY	11233-2154	01/01/2018	04/01/2019
FQHCLA334AN	LINCOLN MEDICAL & MENTAL HEALTH CENTER	234 E 149TH ST	CENTRAL PHARMACY	BRONX	NY	10451-5504	10/01/2018	04/01/2019
FQHCLA334AD	LINCOLN MEDICAL & MENTAL HEALTH CENTER	234 E 149TH ST	CENTRAL PHARMACY	BRONX	NY	10451-5504	10/01/2018	04/01/2019
FQHCLA334	LINCOLN PLACE PHARMACY INC	1135 EASTERN PKWY		BROOKLYN	NY	11213	04/01/2017	04/01/2018
FQHCLA334U	LINCOLN PLACE PHARMACY INC	1135 EASTERN PKWY		BROOKLYN	NY	11213	01/01/2018	04/01/2019
FQHCLA334AH	LINDEN RX INC	D/B/A BROOKDALE PHARMACY	2568 LINDEN BLVD	BROOKLYN	NY	11208	07/01/2018	07/20/2018
FQHCLA334	LIVONIA PHARMACY INC	625A LIVONIA AVE		BROOKLYN	NY	11207	10/01/2016	04/01/2018
FQHCLA334U	LIVONIA PHARMACY INC	625A LIVONIA AVE		BROOKLYN	NY	11207	01/01/2018	04/01/2019
FQHCLA334	LOISAIDA RX INC	D/B/A LOISAIDA DRUGS & SURGICAL	273 E 3RD ST	NEW YORK	NY	10009	01/01/2017	04/01/2018
FQHCLA334AH	LOISAIDA RX INC	D/B/A LOISAIDA DRUGS & SURGICAL	273 E 3RD ST	NEW YORK	NY	10009	01/01/2018	04/01/2019
FQHCLA334	LUMIT RX INC.	DBA: LUMIT PHARMACY	200 E 167TH ST	BRONX	NY	10456	07/01/2017	04/01/2018
FQHCLA334AD	LUMIT RX INC.	DBA: LUMIT PHARMACY	200 E 167TH ST	BRONX	NY	10456	01/01/2018	04/01/2019
FQHCLA334U	MARG PHARMACY	76 GRAHAM AVE.		BROOKLYN	NY	11206-4017	10/01/2018	10/25/2018
FQHCLA334AN	MEDICINE CENTER RX LLC	92 E 167TH ST		BRONX	NY	10452-8203	10/01/2016	10/31/2017
FQHCLA334	MEDICINE CENTER RX LLC	92 E 167TH ST		BRONX	NY	10452-8203	10/01/2016	10/18/2017
FQHCLA334AD	MEDICINE CENTER RX LLC	92 E 167TH ST		BRONX	NY	10452-8203	01/01/2018	07/13/2018
FQHCLA334	MEDIEXPRESS PHARMACY CORP	78 CLINTON STREET	STORE SOUTH	NEW YORK	NY	10002	10/01/2017	04/01/2018
FQHCLA334AH	MEDIEXPRESS PHARMACY CORP	78 CLINTON STREET	STORE SOUTH	NEW YORK	NY	10002	01/01/2018	04/01/2019
FQHCLA334	MEDILANE PHARMACY CORP	204 CLINTON STREET		NEW YORK	NY	10002	10/01/2016	04/01/2018
FQHCLA334AH	MEDILANE PHARMACY CORP	204 CLINTON STREET		NEW YORK	NY	10002	01/01/2018	04/01/2019
FQHCLA334AH	MEDLY PHARMACY INC.	DBA MEDLY PHARMACY	31 DEBEVOISE ST	BROOKLYN	NY	11206-4196	10/01/2018	04/01/2019
FQHCLA334U	MEDLY PHARMACY INC.	DBA MEDLY PHARMACY	31 DEBEVOISE ST	BROOKLYN	NY	11206-4196	10/01/2018	10/25/2018
FQHCLA334	MORALES PHARMACY INC	DBA - MOSCOSO PHARMACY	1412-A JEROME AVE	BRONX	NY	10452	10/01/2016	04/01/2018
FQHCLA334AD	MORALES PHARMACY INC	DBA - MOSCOSO PHARMACY	1412-A JEROME AVE	BRONX	NY	10452	01/01/2018	07/10/2018
FQHCLA334AN	MORALES PHARMACY INC	DBA - MOSCOSO PHARMACY	1412-A JEROME AVE	BRONX	NY	10452	04/01/2018	04/01/2019
FQHCLA334	MORRIS CARE INC	D/B/A MORRIS PHARMACY	255B E 165TH ST	BRONX	NY	10456-6057	10/01/2016	04/01/2018
FQHCLA334AD	MORRIS CARE INC	D/B/A MORRIS PHARMACY	255B E 165TH ST	BRONX	NY	10456-6057	01/01/2018	04/01/2019
FQHCLA334AN	MORRIS CARE INC	D/B/A MORRIS PHARMACY	255B E 165TH ST	BRONX	NY	10456-6057	04/01/2018	04/01/2019
FQHCLA334	MOSUZ INC	DBA: BELMONT PHARMACY	102 A BELMONT AVE	BROOKLYN	NY	11212-1121	10/01/2016	04/01/2018
FQHCLA334U	MOSUZ INC	DBA: BELMONT PHARMACY	102 A BELMONT AVE	BROOKLYN	NY	11212-1121	01/01/2018	04/01/2019
FQHCLA334	NEW GENERATION PHARMACY LLC	D/B/A GENERATION PHARMACY	31-33 OLIVER ST # 3	NEW YORK	NY	10038	10/01/2016	04/01/2018
FQHCLA334AH	NEW GENERATION PHARMACY LLC	D/B/A GENERATION PHARMACY	31-33 OLIVER ST # 3	NEW YORK	NY	10038	01/01/2018	04/01/2019
FQHCLA334	NEW RONSON DRUG INC	237 UTICA AVE		BROOKLYN	NY	11213	04/01/2017	04/01/2018
FQHCLA334U	NEW RONSON DRUG INC	237 UTICA AVE		BROOKLYN	NY	11213	01/01/2018	04/01/2019
FQHCLA334AN	NORTH CENTRAL BRONX HOSPITAL	3424 KOSSUTH AVE	ATT PHARMACY DEPT	BRONX	NY	10467	10/01/2018	04/01/2019
FQHCLA334	PEOPLE CHOICE PHARMACY INC	527 GRAND ST		NEW YORK	NY	10002-4103	10/01/2016	04/01/2018
FQHCLA334AH	PEOPLE CHOICE PHARMACY INC	527 GRAND ST		NEW YORK	NY	10002-4103	01/01/2018	04/01/2019
FQHCLA334	PINEBROOK RX INC.	DBA: PINEBROOK PHARMACY	1183 JEROME AVE	BRONX	NY	10452	10/01/2016	04/01/2018
FQHCLA334AD	PINEBROOK RX INC.	DBA: PINEBROOK PHARMACY	1183 JEROME AVE	BRONX	NY	10452	01/01/2018	04/01/2019
FQHCLA334AN	PINEBROOK RX INC.	DBA: PINEBROOK PHARMACY	1183 JEROME AVE	BRONX	NY	10452	04/01/2018	04/01/2019
FQHCLA334	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2017	04/01/2018
FQHCLA334AH	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2018	04/01/2019
FQHCLA334	RAY'S PHARMACY INC	DBA: CENTRAL PHARMACY & SURGICALS	423 E 138TH ST GROUND FLOOR	BRONX	NY	10454-3041	10/01/2016	08/09/2016
FQHCLA334	RAYSOL DRUGS INC	1870 LEXINGTON AVE		NEW YORK	NY	10029-2046	10/01/2016	08/09/2016
FQHCLA334AH	RDS PHARMACY INC	225 MADISON ST	ATTN:SUPERVISING PHARMACIST	NEW YORK	NY	10002	10/01/2016	04/01/2019
FQHCLA334	RDS PHARMACY INC	225 MADISON ST	ATTN:SUPERVISING PHARMACIST	NEW YORK	NY	10002	10/01/2016	04/01/2018
FQHCLA334	RITE AID DRUG PALACE, INC.	RITE AID #1711	408 GRAND STREET	NEW YORK	NY	10002	10/01/2016	04/01/2018
FQHCLA334A	RITE AID DRUG PALACE, INC.	RITE AID #1711	408 GRAND STREET	NEW YORK	NY	10002	01/01/2018	08/24/2018
FQHCLA334AH	RITE AID DRUG PALACE, INC.	RITE AID #1711	408 GRAND STREET	NEW YORK	NY	10002	04/01/2018	04/01/2019
FQHCLA334	RITE AID OF NEW YORK, INC.	RITE AID #3526	1111 PENNSYLVANIA AVENUE	BROOKLYN	NY	11207	10/01/2016	04/01/2018
FQHCLA334	RITE AID OF NEW YORK, INC.	RITE AID #3771	85 AVENUE D	NEW YORK	NY	10009	10/01/2016	04/01/2018
FQHCLA334	RITE AID OF NEW YORK, INC.	RITE AID #3815	32 EAST 170TH STREET	BRONX	NY	10452	10/01/2016	04/01/2018
FQHCLA334	RITE AID OF NEW YORK, INC.	RITE AID #4202	7 MADISON STREET	NEW YORK	NY	10038	10/01/2016	04/01/2018
FQHCLA334	RITE AID OF NEW YORK, INC.	RITE AID #4738	1631-43 PITKIN AVENUE	BROOKLYN	NY	11212	10/01/2016	04/01/2018
FQHCLA334	RITE AID OF NEW YORK, INC.	RITE AID #4824	537-539 EAST 138TH STREET	BRONX	NY	10454	10/01/2016	04/01/2018
FQHCLA334	RITE AID OF NEW YORK, INC.	RITE AID #7909	642 WESTCHESTER AVENUE	BRONX	NY	10455	10/01/2016	10/18/2017
FQHCLA334	RITE AID OF NEW YORK, INC.	RITE AID #7760	2170 FREDERICK DOUGLASS BLVD	NEW YORK	NY	10026	10/01/2016	04/01/2018
FQHCLA334AH	RITE AID OF NEW YORK, INC.	RITE AID #3771	85 AVENUE D	NEW YORK	NY	10009	01/01/2018	04/01/2019
FQHCLA334AD	RITE AID OF NEW YORK, INC.	RITE AID #4824	537-539 EAST 138TH STREET	BRONX	NY	10454	01/01/2018	04/01/2019
FQHCLA334A	RITE AID OF NEW YORK, INC.	RITE AID #7760	2170 FREDERICK DOUGLASS BLVD	NEW YORK	NY	10026	01/01/2018	04/01/2019
FQHCLA334U	RITE AID OF NEW YORK, INC.	RITE AID #3526	1111 PENNSYLVANIA AVENUE	BROOKLYN	NY	11207	01/01/2018	03/13/2018
FQHCLA334AD	RITE AID OF NEW YORK, INC.	RITE AID #3815	32 EAST 170TH STREET	BRONX	NY	10452	01/01/2018	03/13/2018
FQHCLA334AD	RITE AID OF NEW YORK, INC.	RITE AID #7909	642 WESTCHESTER AVENUE	BRONX	NY	10455	01/01/2018	01/10/2018
FQHCLA334AH	RITE AID OF NEW YORK, INC.	RITE AID #4202	7 MADISON STREET	NEW YORK	NY	10038	01/01/2018	04/01/2019
FQHCLA334U	RITE AID OF NEW YORK, INC.	RITE AID #4738	1631-43 PITKIN AVENUE	BROOKLYN	NY	11212	01/01/2018	04/01/2019
FQHCLA334AN	RITE AID OF NEW YORK, INC.	RITE AID #3815	32 EAST 170TH STREET	BRONX	NY	10452	04/01/2018	03/13/2018
FQHCLA334AH	RITE AID OF NEW YORK, INC.	RITE AID #4873	55-60 MYRTLE AVENUE	RIDGEWOOD	NY	11385	07/01/2018	04/01/2019
FQHCLA334AN	RITE AID OF NEW YORK, INC.	RITE AID #3817	57 EAST BURNSIDE AVENUE	BRONX	NY	10453	07/01/2018	11/14/2018
FQHCLA334	RJ PHARMACY, INC.	2111 WILLIAMSBRIDGE RD		BRONX	NY	10461-1601	04/01/2017	09/20/2017
FQHCLA334AD	RJ PHARMACY, INC.	2111 WILLIAMSBRIDGE RD		BRONX	NY	10461-1601	07/01/2018	04/01/2019
FQHCLA334	SAFEWAY PHARMACY INC	493 E 138 STREET		BRONX	NY	10454	10/01/2016	04/01/2018
FQHCLA334AD	SAFEWAY PHARMACY INC	493 E 138 STREET		BRONX	NY	10454	01/01/2018	04/01/2019
FQHCLA334AN	SAFEWAY PHARMACY INC	493 E 138 STREET		BRONX	NY	10454	07/01/2018	04/01/2019
FQHCLA334	SALAAM PHARMACY INC.	155 CRYSTAL ST		BROOKLYN	NY	11208	10/01/2016	04/01/2018
FQHCLA334U	SALAAM PHARMACY INC.	155 CRYSTAL ST		BROOKLYN	NY	11208	01/01/2018	04/01/2019
FQHCLA334	SCRIPT RX INC	DBA -- SCRIPTX PHARMACY	72 E 167TH ST	BRONX	NY	10452	10/01/2016	04/01/2018
FQHCLA334AD	SCRIPT RX INC	DBA -- SCRIPTX PHARMACY	72 E 167TH ST	BRONX	NY	10452	01/01/2018	04/01/2019
FQHCLA334AN	SCRIPT RX INC	DBA -- SCRIPTX PHARMACY	72 E 167TH ST	BRONX	NY	10452	04/01/2018	04/01/2019
FQHCLA334	SEM & SAM CORP	D/B/A OGDEN PHARMACY	1071 OGDEN AVE	BRONX	NY	10452-4601	10/01/2016	04/01/2018
FQHCLA334AD	SEM & SAM CORP	D/B/A OGDEN PHARMACY	1071 OGDEN AVE	BRONX	NY	10452-4601	01/01/2018	04/01/2019
FQHCLA334AN	SEM & SAM CORP	D/B/A OGDEN PHARMACY	1071 OGDEN AVE	BRONX	NY	10452-4601	04/01/2018	04/01/2019
FQHCLA334	SIMS PHARMA INC	SIMS PHARMACY	1711 PITKIN AVE	BROOKLYN	NY	11212	07/01/2017	04/01/2018
FQHCLA334U	SIMS PHARMA INC	SIMS PHARMACY	1711 PITKIN AVE	BROOKLYN	NY	11212	01/01/2018	04/01/2019
FQHCLA334AH	SIMS PHARMA INC	SIMS PHARMACY	1711 PITKIN AVE	BROOKLYN	NY	11212	04/01/2018	04/01/2019
FQHCLA334	SUZMO INC.	589 SUTTER AVENUE		BROOKLYN	NY	11207	10/01/2016	04/01/2018
FQHCLA334U	SUZMO INC.	589 SUTTER AVENUE		BROOKLYN	NY	11207	01/01/2018	07/09/2018
FQHCLA334	UMAMAH-PITKIN PHARMACY INC	UMAMAH-PITKIN PHARMACY INC.	2231 PITKIN AVE	BROOKLYN	NY	11207-3620	10/01/2016	04/01/2018
FQHCLA334U	UMAMAH-PITKIN PHARMACY INC	UMAMAH-PITKIN PHARMACY INC.	2231 PITKIN AVE	BROOKLYN	NY	11207-3620	01/01/2018	04/01/2019
FQHCLA334AH	UMAMAH-PITKIN PHARMACY INC	UMAMAH-PITKIN PHARMACY INC.	2231 PITKIN AVE	BROOKLYN	NY	11207-3620	07/01/2018	04/01/2019
FQHCLA334	VALUE PHARMACY INC.	257 BROADWAY		LYNBROOK	NY	11563	07/01/2017	04/01/2018
FQHCLA334AH	VALUE PHARMACY INC.	257 BROADWAY		LYNBROOK	NY	11563	01/01/2018	04/04/2018
FQHCLA334AN	WALGREEN EASTERN CO. INC.	DBA: WALGREENS	244 E 161ST STREET	BRONX	NY	10451	10/01/2016	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC	DBA: WALGREENS	1847 ROCKAWAY PKWY.	BROOKLYN	NY	11236-5307	10/01/2016	04/01/2019
FQHCLA334AN	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01013	5564 BROADWAY	BRONX	NY	10463	10/01/2016	04/01/2019
FQHCLA334AN	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02778	2095 DUTCH BROADWAY	ELMONT	NY	11003	10/01/2016	04/01/2019
FQHCLA334AN	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1031 WESTCHESTER AVE.	BRONX	NY	10459	10/01/2016	04/01/2019
FQHCLA334AN	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2817 THIRD AVE.	BRONX	NY	10455	10/01/2016	01/03/2018
FQHCLA334AN	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	5001 CHURCH AVE.	BROOKLYN	NY	11203-1320	10/01/2016	04/01/2019
FQHCLA334AH	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09936	7815 NORTHERN BLVD	JACKSON HEIGHTS	NY	11372-1221	10/01/2016	04/01/2019
FQHCLA334AH	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16078	205 8TH AVENUE	NEW YORK	NY	10011	10/01/2016	04/01/2019
FQHCLA334AD	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2817 THIRD AVE.	BRONX	NY	10455	10/01/2016	01/03/2018
FQHCLA334U	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1134 E. NEW YORK AVE.	BROOKLYN	NY	11212	10/01/2016	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11141	1366 BROADWAY	BROOKLYN	NY	11221	10/01/2016	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	5001 CHURCH AVE.	BROOKLYN	NY	11203-1320	10/01/2016	12/12/2017
FQHCLA334U	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	5802 METROPOLITAN AVE.	RIDGEWOOD	NY	11385	10/01/2016	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #12007	1404 ROCKAWAY PKWY.	BROOKLYN	NY	11236-2322	10/01/2016	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	DBA WALGREENS	1242 LIBERTY AVE.	BROOKLYN	NY	11208	10/01/2016	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	WALGREENS #15352	1281 FULTON ST.	BROOKLYN	NY	11216	10/01/2016	04/01/2019
FQHCLA334AN	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19889	32 E 170TH STREET	BRONX	NY	10452	04/01/2018	04/01/2019
FQHCLA334AD	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19889	32 E 170TH STREET	BRONX	NY	10452	03/29/2018	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	WALGREENS # 18228	1111 PENNSYLVANIA AVE	BROOKLYN	NY	11207-9000	04/01/2018	04/01/2019
FQHCLA334AD	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1031 WESTCHESTER AVE.	BRONX	NY	10459	07/01/2018	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	WALGREENS #17979	78-14 LINDEN BLVD	HOWARD BEACH	NY	11414	10/01/2018	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	WALGREENS #18412	9602 ROCKAWAY BLVD.	OZONE PARK	NY	11417	10/01/2018	04/01/2019
FQHCLA334A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04564	159-34 JAMAICA AVE	JAMAICA	NY	11432-6001	10/01/2018	04/01/2019
FQHCLA334A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01013	5564 BROADWAY	BRONX	NY	10463	10/01/2018	04/01/2019
FQHCLA334U	WALGREEN EASTERN CO., INC.	WALGREENS # 18961	4123 AVENUE D	BROOKLYN	NY	11203-5705	10/01/2018	04/01/2019
FQHCLA334AD	WALGREEN EASTERN CO., INC.	RITE AID #07909	642 WESTCHESTER AVE	BRONX	NY	10455	10/01/2018	04/01/2019
FQHCLA334AN	WALGREEN EASTERN CO., INC.	WALGREENS #18322	3012 3RD AVE	BRONX	NY	10455	10/01/2018	04/01/2019
FQHCLA334AH	WALGREEN EASTERN CO., INC.	WALGREENS #18204	355 KNICKERBOCKER AVE	BROOKLYN	NY	11237-3740	10/01/2018	04/01/2019
FQHCLA334AD	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16512	3462 JEROME AVE.	BRONX	NY	10467	10/01/2018	04/01/2019
FQHCLA334A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02055	109-62 FRANCIS LEWIS BLVD	QUEENS VILLAGE	NY	11429	10/01/2018	04/01/2019
FQHCLA334AN	WALGREEN EASTERN CO., INC.	RITE AID #04555	88 FEATHERBED LANE	BRONX	NY	10452	10/01/2018	04/01/2019
FQHCLA334AN	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2018	04/01/2019
FQHCLA334U	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2018	04/01/2019
FQHCLA334A	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2018	04/01/2019
FQHCLA334AD	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2018	04/01/2019
FQHCLA334AH	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	04/01/2018	04/01/2019
FQHCLA334AD	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2018	04/01/2019
FQHCLA334AN	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2018	04/01/2019
FQHCLA334AH	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2018	04/01/2019
FQHCLA334A	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	04/01/2018	04/01/2019
FQHCLA334U	WOODHULL PRESCRIPTION CENTER	WOODHULL RX CENTER	755 FLUSHING AVE	BROOKLYN	NY	11206-4419	10/01/2018	10/25/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/31/2018 12:00:00 AM	1/7/2019 9:30 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/7/2019 9:30 AM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	1/7/2019 9:30 AM
Terminations	Termination Effective Date	Update	Termination Request		12/31/2018 12:00:00 AM	1/7/2019 9:30 AM
Terminations	Termination Reason	Update	Termination Request		Change of covered entity type (non-hospital)	1/7/2019 9:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2018 9:16 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0343288	2/21/2018 9:16 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	2/21/2018 9:16 AM
Details	Last Recertification Date	Update	Recertification	1/31/2017 12:00:00 AM	2/21/2018 9:16:06 AM	2/21/2018 9:16 AM
Details	Grant Number	Update	Recertification	LAL000169	LALCS00169	2/21/2018 9:16 AM
Addresses	Billing Address	Update	Change Request	Morrisania D&TC 1225 Gerard Ave Bronx, NY 10452-8001	Gouverneur Healthcare Services 227 Madison Street New York, NY 10002	12/7/2017 5:28 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1548208127	12/7/2017 5:28 PM
Contacts	Primary Contact	Update	Change Request	Lee, Anita Chief Operating Officier 7189602632	Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	10/4/2017 1:07 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		10/4/2017 1:07 PM
Contacts	Authorizing Official	Update	Profile Change Request	Albertson, Paul Vice President Elmhurst Hospital 2127482256	Albertson, Paul Vice President New York City Health and Hospitals 2127482256	9/21/2017 5:59 PM
Contacts	Authorizing Official	Update	Change Request	Albertson, Paul Vice President 2127482256	Albertson, Paul Vice President Elmhurst Hospital 2127482256	9/20/2017 11:54 AM
Contacts	Authorizing Official	Insert			Albertson, Paul Vice President 2127482256	8/14/2017 11:29 AM
Contacts	Signed By	Insert			Martin, Antonio Ececutive Vice President & Chief Operating Officier 2127883479	8/14/2017 11:24 AM
Addresses	Main Address	Insert			34 Spring St New York, NY 10012-4107	4/18/2017 7:25 AM
Addresses	Billing Address	Insert			Morrisania D&TC 1225 Gerard Ave Bronx, NY 10452-8001	4/18/2017 7:25 AM
Addresses	Shipping Address	Insert			Gouverneur Healthcare Services 227 Madison Street New York, NY 10002	4/18/2017 7:25 AM
Details	Last Recertification Date	Update		3/2/2016 12:00:00 AM	1/31/2017 12:00:00 AM	1/31/2017 10:00 AM
Contacts	Primary Contact	Insert			Lee, Anita Chief Operating Officier 7189602632	9/29/2016 8:10 AM
Details	Last Recertification Date	Update			3/2/2016 12:00:00 AM	3/3/2016 10:27 AM
Dates	Participating Approval Date	Update			4/22/2015 12:00:00 AM	4/22/2015 9:51 AM
Details	State	Update		Pending	Active	4/22/2015 9:51 AM
Dates	Start Date	Update			7/1/2015 12:00:00 AM	4/22/2015 9:51 AM
Details	340B ID	Update		ONLINE_REG_51661	FQHCLA334AG	4/21/2015 7:57 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_51661	4/15/2015 3:27 PM
Details	Last Recertification Date	Insert				4/15/2015 3:27 PM
Details	Grant Number	Insert			LAL000169	4/15/2015 3:27 PM
Details	340B ID	Insert			ONLINE_REG	4/15/2015 3:27 PM
Details	Is Authorizing Official EHB Data	Insert			False	4/15/2015 3:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2015 3:27 PM
Details	Medicare Provider Number	Insert				4/15/2015 3:27 PM
Details	Entity Name	Insert			NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	4/15/2015 3:27 PM
Details	Program Code	Insert			FQHCLA	4/15/2015 3:27 PM
Details	Entity Subname	Insert			Judson Health Center	4/15/2015 3:27 PM
Dates	Participating Approval Date	Insert				4/15/2015 3:27 PM
Details	State	Insert			Pending	4/15/2015 3:27 PM
Dates	Registration Date	Insert			4/15/2015 12:00:00 AM	4/15/2015 3:27 PM
Dates	Signed By Date	Insert			4/15/2015 12:00:00 AM	4/15/2015 3:27 PM
Dates	Start Date	Insert				4/15/2015 3:27 PM
Terminations	Termination Comments	Insert				4/15/2015 3:27 PM
Terminations	Termination Date	Insert				4/15/2015 3:27 PM
Terminations	Termination Effective Date	Insert				4/15/2015 3:27 PM
Terminations	Termination Reason	Insert				4/15/2015 3:27 PM

340B Drug Pricing Program Database