Yes
| Contract Detail | AVS RX | DBA: RUBIN CHEMISTS |
828 NOSTRAND AVE
| BROOKLYN | NY | 11216-4403 | 07/28/2015 | 10/01/2015 | | 07/01/2019 | 07/01/2019 |
| Details | State | Update | | To Be Terminated | Terminated | 7/1/2019 12:05 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 3/29/2019 12:00:00 AM | 4/16/2019 7:58 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 4/16/2019 7:58 AM |
| Terminations | Termination Comments | Update | Termination Request | | Termed due to merger. | 4/16/2019 7:58 AM |
| Terminations | Termination Date | Update | Termination Request | | 7/1/2019 12:00:00 AM | 4/16/2019 7:58 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 4/1/2019 12:00:00 AM | 4/16/2019 7:58 AM |
| Terminations | Termination Reason | Update | Termination Request | | Other | 4/16/2019 7:58 AM |
| Details | Last Recertification Date | Update | Recertification | 2/20/2018 1:53:39 PM | 2/22/2019 2:31:27 PM | 2/22/2019 2:31 PM |
| Addresses | Billing Address | Update | Change Request | Brightpoint Health
248 W. 35th Street
7th floor
New York, NY 10001 | Brightpoint Health
71 W 23rd Street
8th Floor
New York, NY 10010 | 6/18/2018 2:40 PM |
| Details | Last Recertification Date | Update | Recertification | 1/26/2017 12:00:00 AM | 2/20/2018 1:53:39 PM | 2/20/2018 1:53 PM |
| Contacts | Authorizing Official | Insert | Change Request | | Quinones, Christopher
CAO
Brightpoint Health
7186818700-4424 | 10/12/2017 12:30 PM |
| Details | Is Authorizing Official EHB Data | Update | Change Request | False | | 10/12/2017 12:30 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Muniz-Cadorette, Jasmine
340B Program Specialisst
Brightpoint Health
7186818700-4460 | Muniz-Cadorette, Jasmine
340B Program Specialist
Brightpoint Health
7186818700-4460 | 9/21/2017 10:51 AM |
| Contacts | Primary Contact | Update | | Muniz-Cadorette, Jasmine
340B Program Specialisst
7186818700-4460 | Muniz-Cadorette, Jasmine
340B Program Specialisst
Brightpoint Health
7186818700-4460 | 9/21/2017 10:48 AM |
| Contacts | Primary Contact | Update | | Gillen, Sara
VP, Business Operations
7186818700-4427 | Muniz-Cadorette, Jasmine
340B Program Specialisst
7186818700-4460 | 5/29/2017 7:11 AM |
| Contacts | Signed By | Insert | | | Murphy, Carol
COO
7186818700-4418 | 5/29/2017 7:11 AM |
| Addresses | Main Address | Insert | | |
1669 Bedford Avenue
Brooklyn, NY 11225-2009 | 5/29/2017 7:11 AM |
| Addresses | Billing Address | Insert | | | Brightpoint Health
248 W. 35th Street
7th floor
New York, NY 10001 | 5/29/2017 7:11 AM |
| Details | Last Recertification Date | Update | | 3/7/2016 12:00:00 AM | 1/26/2017 12:00:00 AM | 1/26/2017 10:52 AM |
| Contacts | Primary Contact | Insert | | | Gillen, Sara
VP, Business Operations
7186818700-4427 | 5/23/2016 6:06 PM |
| Details | Entity Subname | Update | | Bedford Health Center | Bedford Avenue Clinic | 4/20/2016 4:53 PM |
| Details | Entity Name | Update | | Brightpoint Health | HELP/PSI Services Corp. | 4/6/2016 2:56 PM |
| Details | Last Recertification Date | Update | | | 3/7/2016 12:00:00 AM | 3/7/2016 9:04 AM |
| Details | Entity Name | Update | | HELP/PSI SERVICES CORP. | Brightpoint Health | 12/10/2015 1:34 PM |
| Details | Entity Subname | Update | | Bedford Mental Health Clinic | Bedford Health Center | 12/10/2015 1:34 PM |
| Dates | Participating Approval Date | Update | | | 7/28/2015 12:00:00 AM | 7/28/2015 12:45 PM |
| Details | State | Update | | Pending | Active | 7/28/2015 12:45 PM |
| Dates | Start Date | Update | | | 10/1/2015 12:00:00 AM | 7/28/2015 12:45 PM |
| Details | 340B ID | Update | | ONLINE_REG_53970 | CHC24139-05 | 7/28/2015 8:38 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_53970 | 7/15/2015 3:36 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/15/2015 3:36 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 02952812 | 7/15/2015 3:36 PM |
| Medicaid Billing | Medicaid: State | Insert | | | NY | 7/15/2015 3:36 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1003093436 | 7/15/2015 3:36 PM |
| Details | Last Recertification Date | Insert | | | | 7/15/2015 3:36 PM |
| Details | Grant Number | Insert | | | H80CS24139 | 7/15/2015 3:36 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 7/15/2015 3:36 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 7/15/2015 3:36 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/15/2015 3:36 PM |
| Details | Medicare Provider Number | Insert | | | | 7/15/2015 3:36 PM |
| Details | Entity Name | Insert | | | HELP/PSI SERVICES CORP. | 7/15/2015 3:36 PM |
| Details | Program Code | Insert | | | CH | 7/15/2015 3:36 PM |
| Details | Entity Subname | Insert | | | Bedford Mental Health Clinic | 7/15/2015 3:36 PM |
| Dates | Participating Approval Date | Insert | | | | 7/15/2015 3:36 PM |
| Details | State | Insert | | | Pending | 7/15/2015 3:36 PM |
| Dates | Registration Date | Insert | | | 7/15/2015 12:00:00 AM | 7/15/2015 3:36 PM |
| Dates | Signed By Date | Insert | | | 7/15/2015 12:00:00 AM | 7/15/2015 3:36 PM |
| Dates | Start Date | Insert | | | | 7/15/2015 3:36 PM |
| Terminations | Termination Comments | Insert | | | | 7/15/2015 3:36 PM |
| Terminations | Termination Date | Insert | | | | 7/15/2015 3:36 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/15/2015 3:36 PM |
| Terminations | Termination Reason | Insert | | | | 7/15/2015 3:36 PM |