Covered Entity Details

CH05320AB HealthNet, Inc. (Terminated) - information as of 6/28/2025 12:21:38 AM

Main Details

Name

HealthNet, Inc.

Subdivision Name

Vision Academy at Riverside School-Based Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014767

340B ID

CH05320AB

Grant Number

H80CS00114

Additional Details

Current Program Status

Terminated

Registration Date

10/2/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/21/2015

Last Recertification Date

2/3/2024

Termination Date
Termination Reason

1/1/2025
Business decision by the Covered Entity

Contacts

Authorizing Official

HealthNet Inc
Varon Edward Cantrell, Chief Medical Officer
(317) 957-2015

Primary Contact

HealthNet, Inc.
Andrew Gonzales, Director, Pharmacy Services
(317) 957-2066

Addresses

Street Address

1751 E Riverside Dr
Indianapolis, IN 46202-2010

Billing Address

HealthNet Accounts Payable
3403 E Raymond St
Indianapolis, IN 46203

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
IN	100117700S	1780634964

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	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/15/2024	07/01/2024	01/01/2025	01/01/2025
Contract Detail	KROGER PHARMACY #66	5173 W WASHINGTON STREET		INDIANAPOLIS	IN	46241	10/13/2023	01/01/2024	01/01/2025	01/01/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02931	5199 N KEYSTONE	INDIANAPOLIS	IN	46205	10/13/2023	01/01/2024	01/01/2025	01/01/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH053200	Active	BPS-H80-019632	HealthNet, Inc.	HealthNet Administration/HealthNet Specialty Care at Barrington	3403 E Raymond St	Indianapolis	IN
CH05320A	Active	BPS-H80-000792	HealthNet, Inc.	Barrington Health Center	3401 E Raymond St	Indianapolis	IN
CH05320AA	Active	BPS-H80-013500	HealthNet, Inc.	Wheeler Shelter for Men	520 E Market St	Indianapolis	IN
CH05320AB	Terminated	BPS-H80-014767	HealthNet, Inc.	Vision Academy at Riverside School-Based Health Center	1751 E Riverside Dr	Indianapolis	IN
CH05320AC	Terminated	BPS-H80-017156	HEALTHNET, INC.	Northwest Health Center	2944 Clifton Street	Indianapolis	IN
CH05320AD	Active	BPS-H80-007331	HealthNet, Inc.	Julian Center Shelter	-	Indianapolis	IN
CH05320AE	Active	BPS-H80-027581	HealthNet, Inc.	HealthNet Administration Northeast	3908 Meadows Dr Ste C	Indianapolis	IN
CH05320AF	Terminated	BPS-H80-028210	HealthNet, Inc.	KIPP Indy Legacy Clinic	2255 Ralston Ave Rm 106	Indianapolis	IN
CH05320AG	Active	BPS-H80-029600	HealthNet, Inc.	Bloomington Health and Dental Center	811 W 2nd St	Bloomington	IN
CH05320AH	Active	BPS-H80-032911	HealthNet, Inc.	Crispus Attucks Clinic	1140 Dr Martin Luther King Jr St	Indianapolis	IN
CH05320AJ	Active	BPS-H80-034029	HealthNet, Inc.	HealthNet Mobile Health Center	6425 Olivia Ln Unit 409	Indianapolis	IN
CH05320AK	Active	BPS-H80-034413	HealthNet, Inc.	Wheeler Mission Center for Men Clinic	215 S Westplex Ave RM 3	Bloomington	IN
CH05320AL	Active	BPS-H80-035684	HealthNet, Inc.	Middle Way House Clinic	338 S Washington St	Bloomington	IN
CH05320AM	Terminated	BPS-H80-035817	Health Net, Inc.	Liberty Grove Schools School-Based Health Center	1002 W 25th St RM 105	Indianapolis	IN
CH05320AN	Active	BPS-H80-038706	Health Net, Inc.	HealthNet Homeless Initiative Program - Bloomington	822 W 1st St, Ste 5	Bloomington	IN
CH05320AP	Active	BPS-H80-038843	Health Net, Inc.	Outreach, Inc. Clinic	2416 E New York St	Indianapolis	IN
CH05320AQ	Active	BPS-H80-012217	Health Net, Inc.	HealthNet Healthy Families	6029 W 10th St	Indianapolis	IN
CH05320AR	Active	BPS-H80-039053	Health Net, Inc.	Monroe County Public Library Clinic	303 East Kirkwood Ave, Room 2B	Bloomington	IN
CH05320AS	Active	BPS-H80-039054	Health Net, Inc.	Crawford Apartments Clinic	2440 South Henderson St, Rooms 122 and124	Bloomington	IN
CH05320B	Active	BPS-H80-008866	HealthNet, Inc.	Southwest Health Center	1522 W Morris St	Indianapolis	IN
CH05320C	Active	BPS-H80-000641	HealthNet, Inc.	Southeast Health Center	901 Shelby St	Indianapolis	IN
CH05320D	Active	BPS-H80-002018	HealthNet, Inc.	Martindale-Brightwood Health Center	2855 N Keystone Ave Ste 100	Indianapolis	IN
CH05320F	Active	BPS-H80-009240	HealthNet, Inc.	Peoples Health Center	2340 E 10th St	Indianapolis	IN
CH05320G	Active	BPS-H80-033607	HealthNet, Inc.	Downtown Health Center	1801 N Senate Blvd Ste 310	Indianapolis	IN
CH05320H	Terminated	BPS-H80-010667	HEALTHNET INC	Eastside Health Center (C.A.F.E)	8902 East 38th Street	Indianapolis	IN
CH05320J	Active	BPS-H80-037268	HealthNet, Inc.	Speedway Health & Dental Center	6020 Crawfordsville Rd	Indianapolis	IN
CH05320K	Active	BPS-H80-005440	HealthNet, Inc.	Tech Teen Clinic	1500 E Michigan St	Indianapolis	IN
CH05320L	Terminated	BPS-H80-001741	HEALTHNET INC	GEORGE WASHINGTON COMMUNITY SCH	2215 W Washington St	Indianapolis	IN
CH05320M	Terminated	BPS-H80-001480	HealthNet, Inc.	Harshman Middle School	1501 E 10th St	Indianapolis	IN
CH05320N	Active	BPS-H80-012614	HealthNet, Inc.	Northeast Health Center	3908 Meadows Dr	Indianapolis	IN
CH05320P	Active	BPS-H80-013504	HealthNet, Inc.	Interfaith Hospitality Network	1850 N Arsenal Ave	Indianapolis	IN
CH05320Q	Active	BPS-H80-013498	HealthNet, Inc.	Holy Family Shelter	907 N Holmes Ave	Indianapolis	IN
CH05320R	Active	BPS-H80-006922	HealthNet, Inc.	Dayspring Center Clinic	1537 Central Ave	Indianapolis	IN
CH05320S	Terminated	BPS-H80-006745	HEALTHNET INC	WHEELER MISSION SHELTER FOR MEN (a/k/a WHEELER MISSION DOWNTOWN)	245 N DELAWARE ST	INDIANAPOLIS	IN
CH05320T	Terminated	BPS-H80-006674	HEALTHNET INC	PATHWAY TO RECOVERY	2135 N Alabama St	Indianapolis	IN
CH05320U	Active	BPS-H80-006310	HealthNet, Inc.	Salvation Army Harbor Light Center Clinic	2400 N Tibbs Ave	Indianapolis	IN
CH05320V	Active	BPS-H80-005900	HealthNet, Inc.	Salvation Army Family Shelter Clinic (women and children)	540 N Alabama St	Indianapolis	IN
CH05320W	Active	BPS-H80-038622	HealthNet, Inc.	Homeless Initiative Program (HIP)	901 Shelby St.	Indianapolis	IN
CH05320X	Terminated	BPS-H80-014392	HealthNet, Inc.	KIPP School Based Health Center	1740 E 30th St	Indianapolis	IN
CH05320Y	Active	BPS-H80-013503	HealthNet, Inc.	Wheeler Shelter for Women and Children	3208 E Michigan St	Indianapolis	IN
CH05320Z	Terminated	BPS-H80-014766	HealthNet, Inc.	Avondale Meadows Academy School-Based Health Center	3980 Meadows Dr	Indianapolis	IN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH05320AF	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2024	01/01/2025
CH053200	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2024
CH05320L	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2024	01/01/2025
CH05320AB	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2024	01/01/2025
CH053200	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2024
CH053200	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2024
CH05320M	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2024	01/01/2025
CH053200	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2024
CH053200	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2024
CH05320K	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2024
CH053200	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2024
CH05320AH	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2024
CH053200	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2025
CH053200	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	07/01/2017
CH053200	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2019
CH053200	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	10/01/2023
CH053200	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	10/01/2018	03/09/2021
CH053200	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/01/2018	03/09/2021
CH053200	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH053200	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2024
CH053200	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2024
CH053200	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2024
CH05320V	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2024
CH053200	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2024
CH05320X	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2024	01/01/2025
CH05320U	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2024
CH053200	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2024
CH053200	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2021
CH05320AJ	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2024
CH053200	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2021
CH05320J	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2024
CH053200	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2021
CH05320W	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2024
CH053200	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2021
CH05320C	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2024
CH053200	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2021
CH05320D	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2024
CH053200	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2021
CH05320N	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2024
CH053200	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2021
CH05320F	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2024
CH053200	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2021
CH05320G	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2024
CH053200	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2021
CH05320B	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH053200	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2021
CH053200	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	04/01/2025
CH053200	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	04/01/2025
CH053200	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2021
CH053200	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2021
CH053200	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2021
CH053200	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/01/2018
CH05320P	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2024
CH053200	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/01/2017	05/28/2020
CH05320AK	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2024
CH053200	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2024
CH053200	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2024
CH053200	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2024
CH053200	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2024
CH053200	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2024
CH053200	GENOA HEALTHCARE LLC	6655 EAST US HIGHWAY 36		AVON	IN	46123	07/01/2022	04/01/2023
CH053200	HOOK-SUPERX L.L.C.	DBA: CVS/PHARMACY # 06553	2320 CUNNINGHAM RD.	INDIANAPOLIS	IN	46224	07/01/2019
CH05320J	HOOK-SUPERX L.L.C.	DBA: CVS/PHARMACY # 06553	2320 CUNNINGHAM RD.	INDIANAPOLIS	IN	46224	01/01/2024
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06595	3808 EAST WASHINGTON ST	INDIANAPOLIS	IN	46201	04/01/2018
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06613	4401 E. 10TH ST.	INDIANAPOLIS	IN	46201	04/01/2018
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06583	1715 MAIN STREET	BEECH GROVE	IN	46107	04/01/2018
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02311	2215 SOUTH SHELBY STREET	INDIANAPOLIS	IN	46203	04/01/2018
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 07052	2029 W WASHINGTON ST	INDIANAPOLIS	IN	46222	04/01/2018	11/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06561	3425 W. 16TH ST.	INDIANAPOLIS	IN	46222	01/01/2019	07/15/2021
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06612	5110 E. 38TH ST.	INDIANAPOLIS	IN	46218	01/01/2019	03/20/2025
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 00045	6975 N. PENDLETON PIKE	INDIANAPOLIS	IN	46226	01/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08643	1030 N ARLINGTON AVE	INDIANAPOLIS	IN	46219	01/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06594	8935 EAST 21ST STREET	INDIANAPOLIS	IN	46219	01/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 00684	7930 MADISON AVE.	INDIANAPOLIS	IN	46227	01/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08685	5208 W. WASHINGTON STREET	INDIANAPOLIS	IN	46241	01/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06548	3705 KENTUCKY AVE	INDIANAPOLIS	IN	46221	01/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06549	1545 NORTH MERIDIAN ST.	INDIANAPOLIS	IN	46202	01/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06547	5310 ROCKVILLE RD.	INDIANAPOLIS	IN	46224	01/01/2019	09/09/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 05423	7935 BROOKVILLE RD.	INDIANAPOLIS	IN	46239	07/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 04633	1233 NORTH STATE ST.	GREENFIELD	IN	46140	07/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06592	6005 EAST WASHINGTON STREET	INDIANAPOLIS	IN	46219	07/01/2019	08/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06648	655 S. US HIGHWAY 31	GREENWOOD	IN	46142	07/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06558	2975 LAFAYETTE ROAD	INDIANAPOLIS	IN	46222	07/01/2019	09/09/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06580	5611 GEORGETOWN RD.	INDIANAPOLIS	IN	46254	07/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 07791	8330 CRAWFORDSVILLE ROAD	INDIANAPOLIS	IN	46234	07/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06573	2330 EAST 46TH ST.	INDIANAPOLIS	IN	46205	07/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 04468	7935 S EMERSON AVENUE SUITE B	INDIANAPOLIS	IN	46237	07/01/2019
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06587	505 EAST THOMPSON ROAD	INDIANAPOLIS	IN	46227	01/01/2020	09/09/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 03195	1000 N. COLLEGE AVE.	BLOOMINGTON	IN	47404	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02734	1299 WEST SOUTHPORT RD	INDIANAPOLIS	IN	46217	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06557	5502 WEST 38TH ST.	INDIANAPOLIS	IN	46254	01/01/2020	09/09/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06567	111 WEST 38TH STREET	INDIANAPOLIS	IN	46208	01/01/2020	01/02/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 03297	4935 S. ARLINGTON	INDIANAPOLIS	IN	46237	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06603	5005 EAST 56TH ST.	INDIANAPOLIS	IN	46226	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08665	3910 W. 3RD ST.	BLOOMINGTON	IN	47404	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 07634	3805 N. GERMAN CHURCH RD.	INDIANAPOLIS	IN	46235	01/01/2020	09/09/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06698	2650 S. WALNUT ST.	BLOOMINGTON	IN	47401	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA CVS/PHARMACY # 10676	121 EAST KIRKWOOD AVENUE	BLOOMINGTON	IN	47408	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06697	2701 EAST 3RD ST.	BLOOMINGTON	IN	47401	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06610	8405 SOUTHEASTERN AVE.	INDIANAPOLIS	IN	46239	01/01/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06554	7325 W. 10TH ST.	INDIANAPOLIS	IN	46214	01/01/2020	09/09/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06604	175 N. ILLINOIS ST.	INDIANAPOLIS	IN	46204	05/05/2020	04/15/2021
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08684	6509 N. KEYSTONE AVE.	INDIANAPOLIS	IN	46220	05/05/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06572	1375 WEST 86TH ST.	INDIANAPOLIS	IN	46260	05/05/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06551	523 SOUTH STATE ROAD 67	MOORESVILLE	IN	46158	05/05/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA CVS/PHARMACY # 3007	6010 SOUTH EMERSON AVENUE	INDIANAPOLIS	IN	46237	05/05/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08637	3350 NORTH HIGH SCHOOL	INDIANAPOLIS	IN	46224	05/05/2020	02/18/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06654	8970 S. MERIDIAN ST.	INDIANAPOLIS	IN	46217	05/05/2020
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06600	1530 N. SHADELAND AVE.	INDIANAPOLIS	IN	46219	07/01/2021	02/16/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06585	5605 NORTH POST RD.	INDIANAPOLIS	IN	46216	07/01/2021
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08690	5920 MADISON AVENUE	INDIANAPOLIS	IN	46227	07/01/2021
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 01367	13090 PETIGRU DR.	CARMEL	IN	46032	07/01/2021
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 05408	5020 N. STATE RD 135	BARGERSVILLE	IN	46106	07/01/2021
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06555	21 WEST MAIN STREET	BROWNSBURG	IN	46112	07/01/2021
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06739	860 WEST MORGAN STREET	SPENCER	IN	47460	04/01/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06703	789 STATE ROAD 39 BY-PASS	MARTINSVILLE	IN	46151	04/01/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06713	4444 STATE RD. WEST 46	BLOOMINGTON	IN	47404	04/01/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06559	7990 E US HIGHWAY 36	AVON	IN	46123	07/01/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06578	7202 N. MICHIGAN RD.	INDIANAPOLIS	IN	46268	07/01/2022	07/07/2023
CH053200	HOOK-SUPERX, L.L.C.	CVS PHARMACY # 16912	4850 E SOUTHPORT RD	INDIANAPOLIS	IN	46237	07/01/2022
CH053200	HOOK-SUPERX, L.L.C.	CVS/PHARMACY #11114	2800 ENTERPRISE ST STE 5	INDIANAPOLIS	IN	46219-1106	07/01/2022	05/15/2023
CH053200	HOOK-SUPERX, L.L.C.	CVS/PHARMACY # 10903	336 SOUTH DELAWARE ST	INDIANAPOLIS	IN	46204	07/01/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06644	640 SOUTH STATE ROAD 135	GREENWOOD	IN	46142	07/01/2022	02/21/2025
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06597	10001 EAST WASHINGTON ST	INDIANAPOLIS	IN	46229	07/01/2022
CH053200	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06637	200 S. HARRISON	SHELBYVILLE	IN	46176	07/01/2022
CH05320D	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08685	5208 W. WASHINGTON STREET	INDIANAPOLIS	IN	46241	01/01/2024
CH05320Y	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 00045	6975 N. PENDLETON PIKE	INDIANAPOLIS	IN	46226	01/01/2024
CH05320B	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06548	3705 KENTUCKY AVE	INDIANAPOLIS	IN	46221	01/01/2024
CH05320G	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06549	1545 NORTH MERIDIAN ST.	INDIANAPOLIS	IN	46202	01/01/2024
CH05320AK	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06697	2701 EAST 3RD ST.	BLOOMINGTON	IN	47401	01/01/2024
CH05320P	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06594	8935 EAST 21ST STREET	INDIANAPOLIS	IN	46219	01/01/2024
CH05320AJ	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06595	3808 EAST WASHINGTON ST	INDIANAPOLIS	IN	46201	01/01/2024
CH05320F	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06613	4401 E. 10TH ST.	INDIANAPOLIS	IN	46201	01/01/2024
CH05320C	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02311	2215 SOUTH SHELBY STREET	INDIANAPOLIS	IN	46203	01/01/2024
CH05320N	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06612	5110 E. 38TH ST.	INDIANAPOLIS	IN	46218	01/01/2024	03/20/2025
CH05320AD	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06573	2330 EAST 46TH ST.	INDIANAPOLIS	IN	46205	01/01/2024
CH05320V	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08643	1030 N ARLINGTON AVE	INDIANAPOLIS	IN	46219	01/01/2024
CH05320AN	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06698	2650 S. WALNUT ST.	BLOOMINGTON	IN	47401	10/01/2024
CH05320AR	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08665	3910 W. 3RD ST.	BLOOMINGTON	IN	47404	10/01/2024
CH05320Q	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 04468	7935 S EMERSON AVENUE SUITE B	INDIANAPOLIS	IN	46237	01/01/2025
CH05320AA	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08690	5920 MADISON AVENUE	INDIANAPOLIS	IN	46227	01/01/2025
CH05320R	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 07791	8330 CRAWFORDSVILLE ROAD	INDIANAPOLIS	IN	46234	01/01/2025
CH05320AE	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 03297	4935 S. ARLINGTON	INDIANAPOLIS	IN	46237	01/01/2025
CH05320W	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06551	523 SOUTH STATE ROAD 67	MOORESVILLE	IN	46158	01/01/2025
CH05320K	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 00684	7930 MADISON AVE.	INDIANAPOLIS	IN	46227	01/01/2025
CH05320N	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06573	2330 EAST 46TH ST.	INDIANAPOLIS	IN	46205	07/01/2025
CH05320W	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06548	3705 KENTUCKY AVE	INDIANAPOLIS	IN	46221	07/01/2025
CH05320AE	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06613	4401 E. 10TH ST.	INDIANAPOLIS	IN	46201	07/01/2025
CH05320A	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06583	1715 MAIN STREET	BEECH GROVE	IN	46107	07/01/2025
CH05320AD	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06572	1375 WEST 86TH ST.	INDIANAPOLIS	IN	46260	07/01/2025
CH053200	JPCHC PHARMACY LLC	5317 E 16TH ST		INDIANAPOLIS	IN	46218	04/01/2025
CH05320A	JPCHC PHARMACY LLC	5317 E 16TH ST		INDIANAPOLIS	IN	46218	07/01/2025
CH053200	KROGER #J-820	4445 EAST 10TH STREET		INDIANAPOLIS	IN	46201	04/01/2014
CH05320M	KROGER #J-820	4445 EAST 10TH STREET		INDIANAPOLIS	IN	46201	01/01/2024	01/01/2025
CH053200	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2017
CH053200	KROGER PHARMACY	#116	680 TWIN AIRE DRIVE	INDIANAPOLIS	IN	46203	04/01/2014
CH053200	KROGER PHARMACY	3361 KENTUCKY AVE		INDIANAPOLIS	IN	46221	04/01/2014
CH053200	KROGER PHARMACY	5718 CRAWFORDSVILLE RD		INDIANAPOLIS	IN	46224	10/01/2017
CH05320L	KROGER PHARMACY	3361 KENTUCKY AVE		INDIANAPOLIS	IN	46221	01/01/2024	01/01/2025
CH05320X	KROGER PHARMACY	5718 CRAWFORDSVILLE RD		INDIANAPOLIS	IN	46224	01/01/2024	01/01/2025
CH05320AF	KROGER PHARMACY	#116	680 TWIN AIRE DRIVE	INDIANAPOLIS	IN	46203	01/01/2024	01/01/2025
CH05320AP	KROGER PHARMACY	3361 KENTUCKY AVE		INDIANAPOLIS	IN	46221	10/01/2024
CH053200	KROGER PHARMACY #330	1825 N KINSER PIKE		BLOOMINGTON	IN	47404	01/01/2020	06/30/2023
CH053200	KROGER PHARMACY #66	5173 W WASHINGTON STREET		INDIANAPOLIS	IN	46241	01/01/2016
CH05320AB	KROGER PHARMACY #66	5173 W WASHINGTON STREET		INDIANAPOLIS	IN	46241	01/01/2024	01/01/2025
CH05320AQ	KROGER PHARMACY #66	5173 W WASHINGTON STREET		INDIANAPOLIS	IN	46241	10/01/2024
CH053200	KROGER PHARMACY #995	5350 E. THOMPSON RD		INDIANAPOLIS	IN	46237	10/01/2017
CH053200	KROGER PHARMACY J-100	7101 E. 10TH STREET		INDIANAPOLIS	IN	46219	04/01/2014
CH053200	KROGER PHARMACY J-91	528 S COLLEGE AVE		BLOOMINGTON	IN	47403-1517	01/01/2020
CH05320AL	KROGER PHARMACY J-91	528 S COLLEGE AVE		BLOOMINGTON	IN	47403-1517	01/01/2024
CH053200	KROGER PHARMACY J-993	1330 W. SOUTHPORT ROAD		INDIANAPOLIS	IN	46217	10/01/2017	06/30/2023
CH053200	KROGER PHARMACY J927	4202 S. EAST ST		INDIANAPOLIS	IN	46227	04/01/2014
CH05320U	KROGER PHARMACY J927	4202 S. EAST ST		INDIANAPOLIS	IN	46227	01/01/2024
CH053200	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2018
CH053200	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	04/01/2017
CH053200	MEIJER PHARMACY #129	5349 PIKE PLAZA RD		INDIANAPOLIS	IN	46254-3008	04/01/2017
CH053200	MEIJER PHARMACY #133	10841 US 36 ROCKVILLE ROAD		AVON	IN	46123	04/01/2017
CH053200	MEIJER PHARMACY #134	5325 E SOUTHPORT ROAD		INDIANAPOLIS	IN	46237-9336	04/01/2017
CH053200	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	04/01/2017
CH053200	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	04/01/2017
CH053200	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	07/01/2022	08/16/2023
CH053200	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/01/2025
CH053200	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/01/2025
CH053200	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	07/01/2022
CH053200	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CH053200	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/01/2025
CH053200	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	04/01/2025
CH053200	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/01/2025
CH053200	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/01/2025
CH053200	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/01/2025
CH053200	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	04/01/2025
CH053200	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	04/01/2025
CH053200	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/01/2025
CH053200	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	04/01/2025
CH053200	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/01/2025
CH053200	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2022
CH053200	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	07/01/2022	04/01/2023
CH053200	PHARMACY I EXPRESS	730 W 2ND ST		BLOOMINGTON	IN	47403-2210	01/01/2021
CH05320AG	PHARMACY I EXPRESS	730 W 2ND ST		BLOOMINGTON	IN	47403-2210	01/01/2024
CH053200	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018
CH053200	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/01/2018	10/01/2022
CH053200	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2021
CH05320AG	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2024
CH053200	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2021
CH053200	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2021
CH053200	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2021
CH053200	PROCARE PHARMACY, L.L.C.	CVS/PHARMACY #48637	2700 NORTHEAST EXPY NE STE B800 BUILDING B	ATLANTA	GA	30345	04/01/2025
CH053200	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #48611	141 PREBLE STREET	PORTLAND	ME	04101	04/01/2025
CH053200	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2024
CH05320Y	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2024
CH05320AL	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2024
CH053200	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2024
CH05320Z	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	07/01/2024	01/01/2025
CH053200	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	07/01/2024
CH053200	THE KROGER CO	KROGER PHARMACY #905	8150 ROCKVILLE RD	INDIANAPOLIS	IN	46214	10/01/2017
CH053200	THE KROGER CO	KROGER PHARMACY #960	500 SOUTH LIBERTY DRIVE	BLOOMINGTON	IN	47403	01/01/2020	06/30/2023
CH05320AH	THE KROGER CO	KROGER PHARMACY #905	8150 ROCKVILLE RD	INDIANAPOLIS	IN	46214	01/01/2024
CH053200	THE KROGER CO DBA KROGER SAV	#928	1175 COLLEGE MALL ROAD	BLOOMINGTON	IN	47401	01/01/2020
CH05320AS	THE KROGER CO DBA KROGER SAV	#928	1175 COLLEGE MALL ROAD	BLOOMINGTON	IN	47401	10/01/2024
CH053200	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH053200	WAL-MART PHARMACY #10-5804	5835 W. 10TH STREET		INDIANAPOLIS	IN	46224	04/01/2017
CH053200	WAL-MART PHARMACY 10-1459	7245 U.S. HWY 31 SOUTH		INDIANAPOLIS	IN	46227	04/01/2017
CH053200	WAL-MART PHARMACY 10-1580	10617 E WASHINGTON		INDIANAPOLIS	IN	46229	04/01/2017
CH053200	WAL-MART PHARMACY 10-1991	3313 W. STATE RT.45		BLOOMINGTON	IN	47403	01/01/2020
CH053200	WAL-MART PHARMACY 10-3781	4545 W LAFAYETTE		INDIANAPOLIS	IN	46254	01/01/2020
CH053200	WAL-MART PHARMACY 10-4417	8191 UPLAND WAY		CAMBY	IN	46113	04/01/2017
CH053200	WAL-MART PHARMACY 10-5406	8010 E 38TH STREET		INDIANAPOLIS	IN	46226	01/01/2020	06/15/2022
CH053200	WAL-MART PHARMACY 10-5408	3805 S KEYSTONE AVE		INDIANAPOLIS(KEYSTONE)	IN	46227	04/01/2017
CH053200	WAL-MART PHARMACY 10-5443	4650 SOUTH EMERSON AVE.		INDIANAPOLIS	IN	46203	04/01/2017
CH053200	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH053200	WALGREEN CO	DBA: WALGREENS	28727 OREGON ROAD	PERRYSBURG	OH	43551	04/01/2013	08/17/2015
CH053200	WALGREEN CO		DBA WALGREENS 5100 LAKE TERRACE NE	MOUNT VERNON	IL	62864	04/01/2013	08/17/2015
CH053200	WALGREEN CO	DBA: WALGREENS #10487	6745 E SOUTHPORT ROAD	INDIANAPOLIS	IN	46237-9728	01/01/2015
CH05320AF	WALGREEN CO	DBA: WALGREENS #10487	6745 E SOUTHPORT ROAD	INDIANAPOLIS	IN	46237-9728	01/01/2024	01/01/2025
CH053200	WALGREEN CO.	DBA: WALGREENS #21381	2920 E 38TH ST	INDIANAPOLIS	IN	46218	04/01/2011
CH053200	WALGREEN CO.	DBA: WALGREENS #21257	902 E HANNA AVE	INDIANAPOLIS	IN	46227	04/01/2011
CH053200	WALGREEN CO.	DBA: WALGREENS # 02798	3205 E WASHINGTON ST	INDIANAPOLIS	IN	46201	04/01/2011	10/23/2019
CH053200	WALGREEN CO.	DBA: WALGREENS # 03142	3455 MANN ROAD	INDIANAPOLIS	IN	46221	04/01/2011
CH053200	WALGREEN CO.	DBA: WALGREENS # 02956	1808 ALBANY ST	BEECH GROVE	IN	46107	04/01/2011
CH053200	WALGREEN CO.	DBA: WALGREENS #10973	1530 N MERIDIAN ST	INDIANAPOLIS	IN	46202	06/01/2011
CH053200	WALGREEN CO.	DBA: WALGREENS # 02800	8905 E 10TH ST	INDIANAPOLIS	IN	46219	07/01/2013
CH053200	WALGREEN CO.	DBA: WALGREENS # 02931	5199 N KEYSTONE	INDIANAPOLIS	IN	46205	07/01/2013
CH053200	WALGREEN CO.	DBA: WALGREENS # 03065	4555 N SHADELAND AVE	INDIANAPOLIS	IN	46226	07/01/2013	11/09/2023
CH053200	WALGREEN CO.	DBA: WALGREENS # 03068	5720 W WASHINGTON ST	INDIANAPOLIS	IN	46241	07/01/2013	02/21/2017
CH053200	WALGREEN CO.	DBA: WALGREENS # 03194	9050 E. 38TH STREET	INDIANAPOLIS	IN	46235	07/01/2013	08/08/2018
CH053200	WALGREEN CO.	DBA: WALGREENS # 03609	5095 E. THOMPSON RD.	INDIANAPOLIS	IN	46237	07/01/2013	05/20/2025
CH053200	WALGREEN CO.	DBA: WALGREENS # 05804	455 EAST EPLER AVE	INDIANAPOLIS	IN	46227	07/01/2013
CH053200	WALGREEN CO.	DBA: WALGREENS # 06455	115 FIELDS STREET	MOORESVILLE	IN	46158	07/01/2013
CH053200	WALGREEN CO.	DBA: WALGREENS # 09278	11025 E WASHINGTON ST	INDIANAPOLIS	IN	46229	07/01/2013	02/28/2024
CH053200	WALGREEN CO.	DBA: WALGREENS # 12151	7235 W. 10TH STREET	INDIANAPOLIS	IN	46214	07/01/2013
CH053200	WALGREEN CO.	DBA: WALGREENS #13874	985 N. ARLINGTON AVE	INDIANAPOLIS	IN	46219	07/01/2013
CH053200	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #16317	335 MASSACHUSETTS AVENUE	INDIANAPOLIS	IN	46204	07/01/2013
CH053200	WALGREEN CO.	WALGREENS #10929	1650 EAST RAYMOND STREET	INDIANAPOLIS	IN	46203-4143	07/01/2013	11/05/2019
CH053200	WALGREEN CO.	DBA: WALGREENS # 02796	3003 KESSLER BLVD NORTH DR	INDIANAPOLIS	IN	46222	01/01/2015
CH053200	WALGREEN CO.	DBA: WALGREENS # 05264	6269 W 38TH ST	INDIANAPOLIS	IN	46254	01/01/2015	02/21/2017
CH053200	WALGREEN CO.	DBA: WALGREENS # 05753	7975 E US HWY 36	AVON	IN	46123-7975	01/01/2015
CH053200	WALGREEN CO.	DBA: WALGREENS # 07031	9240 ROCKVILLE RD	INDIANAPOLIS	IN	46234-2558	01/01/2015
CH053200	WALGREEN CO.	DBA: WALGREENS #15116	5580 GEORGETOWN ROAD	INDIANAPOLIS	IN	46254	01/01/2015
CH053200	WALGREEN CO.	DBA: WALGREENS # 15032	1290 N STATE RD 135	GREENWOOD	IN	46142	07/01/2017
CH053200	WALGREEN CO.	DBA: WALGREENS # 02830	6961 MADISON AVE	INDIANAPOLIS	IN	46227	07/01/2017	07/01/2017
CH053200	WALGREEN CO.	DBA: WALGREENS # 06454	20 W MAIN ST	BROWNSBURG	IN	46112	10/01/2017
CH053200	WALGREEN CO.	DBA: WALGREENS # 07174	1195 N STATE STREET	GREENFIELD	IN	46140-1207	10/01/2017
CH05320A	WALGREEN CO.	WALGREENS #10929	1650 EAST RAYMOND STREET	INDIANAPOLIS	IN	46203-4143	12/19/2006	11/05/2019
CH05320C	WALGREEN CO.	WALGREENS #10929	1650 EAST RAYMOND STREET	INDIANAPOLIS	IN	46203-4143	12/19/2006	11/05/2019
CH05320D	WALGREEN CO.	WALGREENS #10929	1650 EAST RAYMOND STREET	INDIANAPOLIS	IN	46203-4143	12/19/2006	11/05/2019
CH05320B	WALGREEN CO.	WALGREENS #10929	1650 EAST RAYMOND STREET	INDIANAPOLIS	IN	46203-4143	12/19/2006	11/05/2019
CH053200	WALGREEN CO.	WALGREENS #16443	26 N. ARSENAL AVE.	INDIANAPOLIS	IN	46201	01/01/2018	02/19/2021
CH053200	WALGREEN CO.	DBA: WALGREENS # 11248	3545 W 86TH STREET	INDIANAPOLIS	IN	46268	04/01/2018
CH05320C	WALGREEN CO.	DBA: WALGREENS # 06455	115 FIELDS STREET	MOORESVILLE	IN	46158	01/01/2024
CH05320L	WALGREEN CO.	DBA: WALGREENS # 06454	20 W MAIN ST	BROWNSBURG	IN	46112	01/01/2024	01/01/2025
CH05320AB	WALGREEN CO.	DBA: WALGREENS # 02931	5199 N KEYSTONE	INDIANAPOLIS	IN	46205	01/01/2024	01/01/2025
CH05320F	WALGREEN CO.	DBA: WALGREENS # 07174	1195 N STATE STREET	GREENFIELD	IN	46140-1207	01/01/2024
CH05320J	WALGREEN CO.	DBA: WALGREENS # 05753	7975 E US HWY 36	AVON	IN	46123-7975	01/01/2024
CH05320AH	WALGREEN CO.	DBA: WALGREENS # 03609	5095 E. THOMPSON RD.	INDIANAPOLIS	IN	46237	01/01/2024	05/20/2025
CH05320AJ	WALGREEN CO.	DBA: WALGREENS # 03065	4555 N SHADELAND AVE	INDIANAPOLIS	IN	46226	01/01/2024	11/09/2023
CH05320K	WALGREEN CO.	DBA: WALGREENS # 02956	1808 ALBANY ST	BEECH GROVE	IN	46107	01/01/2024
CH05320M	WALGREEN CO.	DBA: WALGREENS #15116	5580 GEORGETOWN ROAD	INDIANAPOLIS	IN	46254	01/01/2024	01/01/2025
CH05320R	WALGREEN CO.	DBA: WALGREENS # 12151	7235 W. 10TH STREET	INDIANAPOLIS	IN	46214	01/01/2024
CH05320AD	WALGREEN CO.	DBA: WALGREENS # 02796	3003 KESSLER BLVD NORTH DR	INDIANAPOLIS	IN	46222	01/01/2024
CH05320AA	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #16317	335 MASSACHUSETTS AVENUE	INDIANAPOLIS	IN	46204	01/01/2024
CH05320B	WALGREEN CO.	DBA: WALGREENS # 15032	1290 N STATE RD 135	GREENWOOD	IN	46142	01/01/2024
CH05320W	WALGREEN CO.	DBA: WALGREENS #21257	902 E HANNA AVE	INDIANAPOLIS	IN	46227	01/01/2024
CH05320AE	WALGREEN CO.	DBA: WALGREENS #13874	985 N. ARLINGTON AVE	INDIANAPOLIS	IN	46219	01/01/2024
CH05320P	WALGREEN CO.	DBA: WALGREENS # 07031	9240 ROCKVILLE RD	INDIANAPOLIS	IN	46234-2558	01/01/2024
CH05320N	WALGREEN CO.	DBA: WALGREENS # 05804	455 EAST EPLER AVE	INDIANAPOLIS	IN	46227	01/01/2024
CH05320U	WALGREEN CO.	DBA: WALGREENS # 09278	11025 E WASHINGTON ST	INDIANAPOLIS	IN	46229	01/01/2024	03/01/2024
CH05320Q	WALGREEN CO.	DBA: WALGREENS # 03142	3455 MANN ROAD	INDIANAPOLIS	IN	46221	01/01/2024
CH05320Z	WALGREEN CO.	DBA: WALGREENS #21381	2920 E 38TH ST	INDIANAPOLIS	IN	46218	01/01/2024	01/01/2025
CH05320G	WALGREEN CO.	DBA: WALGREENS #10973	1530 N MERIDIAN ST	INDIANAPOLIS	IN	46202	01/01/2024
CH05320D	WALGREEN CO.	DBA: WALGREENS # 11248	3545 W 86TH STREET	INDIANAPOLIS	IN	46268	01/01/2024
CH05320AM	WALGREEN CO.	DBA: WALGREENS # 09278	11025 E WASHINGTON ST	INDIANAPOLIS	IN	46229	04/01/2024	01/01/2025
CH05320AJ	WALGREEN CO.	DBA: WALGREENS #13874	985 N. ARLINGTON AVE	INDIANAPOLIS	IN	46219	07/01/2024
CH053200	Walgreens Central Fill #21399	4132Plainfield Rd	Ste 110	Indianapolis	IN	46231-7021	04/01/2023
CH05320V	Walgreens Central Fill #21399	4132Plainfield Rd	Ste 110	Indianapolis	IN	46231-7021	01/01/2024
CH053200	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013
CH053200	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	08/17/2015
CH053200	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018
CH053200	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/01/2018
CH053200	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/01/2018	10/01/2021
CH053200	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/01/2018
CH053200	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/01/2018
CH05320AD	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2024
CH05320Q	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2024
CH05320AE	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2024
CH053200	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CH05320R	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2024
CH053200	WALMART PHARMACY 10-4054	4837 KENTUCKY AVENUE		INDIANAPOLIS	IN	46221	10/01/2018
CH053200	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH053200	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/19/2024 12:00:00 AM	12/20/2024 7:57 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/20/2024 7:57 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	12/20/2024 7:57 AM
Terminations	Termination Effective Date	Update	Termination Request		12/19/2024 12:00:00 AM	12/20/2024 7:57 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	12/20/2024 7:57 AM
Details	Last Recertification Date	Update	Recertification	2/13/2023 10:29:36 PM	2/3/2024 10:33:25 AM	2/3/2024 10:33 AM
Contacts	Authorizing Official	Update	Group Change Request	Reifenberg, Richard Chief Medical Officer HealthNet 3179572028	Cantrell, Varon Edward Chief Medical Officer HealthNet Inc 3179572015	6/8/2023 3:02 PM
Details	Last Recertification Date	Update	Recertification	2/16/2022 12:07:29 PM	2/13/2023 10:29:36 PM	2/13/2023 10:29 PM
Details	Last Recertification Date	Update	Recertification	2/9/2021 4:13:11 PM	2/16/2022 12:07:29 PM	2/16/2022 12:07 PM
Details	Entity Name	Update	Recertification	HEALTHNET, INC.	HealthNet, Inc.	2/16/2022 12:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1780634964 ( )		2/9/2021 4:13 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780634964	2/9/2021 4:13 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	2/9/2021 4:13 PM
Details	Last Recertification Date	Update	Recertification	2/4/2020 1:16:00 PM	2/9/2021 4:13:11 PM	2/9/2021 4:13 PM
Details	Last Recertification Date	Update	Recertification	2/5/2019 7:33:23 PM	2/4/2020 1:16:00 PM	2/4/2020 1:16 PM
Details	Last Recertification Date	Update	Recertification	2/19/2018 4:10:36 PM	2/5/2019 7:33:23 PM	2/5/2019 7:33 PM
Contacts	Authorizing Official	Update	Change Request	Trainor, Donald Chief Medical Officer HealthNet 3179572032	Reifenberg, Richard Chief Medical Officer HealthNet 3179572028	1/8/2019 10:35 AM
Details	Last Recertification Date	Update	Recertification	2/15/2017 12:00:00 AM	2/19/2018 4:10:36 PM	2/19/2018 4:10 PM
Contacts	Primary Contact	Update	Change Request	TRAINOR, DONALD CHIEF MEDICAL OFFICER HealthNet 3179572032	Gonzales, Andrew Director, Pharmacy Services HealthNet, Inc. 3179572066	12/26/2017 1:30 PM
Contacts	Authorizing Official	Update	Change Request	Diaz, Rick President/ CEO HealthNet Inc 3179572035	Trainor, Donald Chief Medical Officer HealthNet 3179572032	12/26/2017 1:30 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		12/26/2017 1:30 PM
Contacts	Primary Contact	Update		TRAINOR, DONALD CHIEF MEDICAL OFFICER 3179572032	TRAINOR, DONALD CHIEF MEDICAL OFFICER HealthNet 3179572032	10/5/2017 1:56 PM
Contacts	Primary Contact	Update	Change Request	TRAINOR, DONALD CHIEF MEDICAL OFFICER 3179572015	TRAINOR, DONALD CHIEF MEDICAL OFFICER 3179572032	10/4/2017 4:38 PM
Contacts	Authorizing Official	Update		Diaz, Rick President/ CEO 3179572035	Diaz, Rick President/ CEO HealthNet Inc 3179572035	10/4/2017 4:32 PM
Contacts	Authorizing Official	Insert			Diaz, Rick President/ CEO 3179572035	7/27/2017 9:45 AM
Contacts	Signed By	Insert			Brown, Jimmy C. CEO 3177813175	6/29/2017 6:28 PM
Contacts	Primary Contact	Insert			TRAINOR, DONALD CHIEF MEDICAL OFFICER 3179572015	6/29/2017 6:28 PM
Addresses	Main Address	Insert			1751 E RIVERSIDE DR INDIANAPOLIS, IN 46202-2010	2/15/2017 10:31 AM
Addresses	Billing Address	Insert			HealthNet Accounts Payable 3403 E Raymond St Indianapolis, IN 46203	2/15/2017 10:31 AM
Details	Last Recertification Date	Update		2/24/2016 12:00:00 AM	2/15/2017 12:00:00 AM	2/15/2017 10:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/24/2016 3:44 PM
Medicaid Billing	Medicaid: Number	Insert			100117700S	2/24/2016 3:44 PM
Medicaid Billing	Medicaid: State	Insert			IN	2/24/2016 3:44 PM
Medicaid Billing	NPI: Number	Insert			1780634964	2/24/2016 3:44 PM
Details	Last Recertification Date	Update			2/24/2016 12:00:00 AM	2/24/2016 3:44 PM
Dates	Participating Approval Date	Update			10/21/2015 12:00:00 AM	10/21/2015 11:17 AM
Details	State	Update		Pending	Active	10/21/2015 11:17 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/21/2015 11:17 AM
Details	340B ID	Update		ONLINE_REG_54392	CH05320AB	10/19/2015 3:47 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_54392	10/2/2015 3:05 PM
Details	Last Recertification Date	Insert				10/2/2015 3:05 PM
Details	Grant Number	Insert			H80CS00114	10/2/2015 3:05 PM
Details	340B ID	Insert			ONLINE_REG	10/2/2015 3:05 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/2/2015 3:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/2/2015 3:05 PM
Details	Medicare Provider Number	Insert				10/2/2015 3:05 PM
Details	Entity Name	Insert			HEALTHNET, INC.	10/2/2015 3:05 PM
Details	Program Code	Insert			CH	10/2/2015 3:05 PM
Details	Entity Subname	Insert			Vision Academy at Riverside School-Based Health Center	10/2/2015 3:05 PM
Dates	Participating Approval Date	Insert				10/2/2015 3:05 PM
Details	State	Insert			Pending	10/2/2015 3:05 PM
Dates	Registration Date	Insert			10/2/2015 12:00:00 AM	10/2/2015 3:05 PM
Dates	Signed By Date	Insert			10/2/2015 12:00:00 AM	10/2/2015 3:05 PM
Dates	Start Date	Insert				10/2/2015 3:05 PM
Terminations	Termination Comments	Insert				10/2/2015 3:05 PM
Terminations	Termination Date	Insert				10/2/2015 3:05 PM
Terminations	Termination Effective Date	Insert				10/2/2015 3:05 PM
Terminations	Termination Reason	Insert				10/2/2015 3:05 PM

340B Drug Pricing Program Database