Covered Entity Details

CH045211C FIRST CHOICE PRIMARY CARE, INC. (Active) - information as of 4/25/2025 6:36:21 PM

Main Details

Name

FIRST CHOICE PRIMARY CARE, INC.

Subdivision Name

Ingram Pye Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014896

340B ID

CH045211C

Grant Number

H80CS08242

Additional Details

Current Program Status

Active

Registration Date

10/7/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/16/2015

Last Recertification Date

2/17/2025

Contacts

Authorizing Official

First Choice Primary Care
Katherine McLeod, CEO
(478) 254-7204

Primary Contact

First Choice Primary Care
Claudette Slade, CFO
(478) 254-7212

Addresses

Street Address

855 Anthony Rd
Macon, GA 31204-6266

Billing Address

First Choice Primary Care
PO Box 4363
Macon, GA 31208-4363

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
GA	003165499A	1740666767

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	FIRST CHOICE COMMUNITY PHARMACY	770 WALNUT STREET SUITE 100		MACON	GA	31201	01/15/2019	04/01/2019	09/01/2021	09/06/2022
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	04/11/2024	07/01/2024		07/01/2024
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04765	4080 BLOOMFIELD RD.	MACON	GA	31206	07/09/2024	10/01/2024		10/01/2024
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03773	802 NORTH HOUSTON ROAD	WARNER ROBINS	GA	31093	07/09/2024	10/01/2024		10/01/2024
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07504	4585 HARTLEY BRIDGE RD.	MACON	GA	31216	07/09/2024	10/01/2024		10/01/2024
Contract Detail	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	07/14/2017	10/01/2017	12/04/2019	12/04/2019
Contract Detail	KROGER DRUGSTORE	#410	400 PIO NONO AVENUE	MACON	GA	31204	07/14/2017	10/01/2017	04/30/2018	12/18/2018
Contract Detail	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	07/14/2017	10/01/2017		10/01/2017
Contract Detail	KROGER DRUGSTORE #411	4628 PRESIDENTIAL PKWY		MACON	GA	31206	07/14/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WAL-MART PHARMACY 10-1153	6020 HARRISON ROAD		MACON	GA	31206	04/15/2024	07/01/2024		07/01/2024
Contract Detail	WAL-MART PHARMACY 10-1367	2720 WATSON BLVD		WARNER ROBINS	GA	31093	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WAL-MART PHARMACY 10-2890	5955 ZEBULON RD		MACON	GA	31210	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #10634	6035 ZEBULON RD	MACON	GA	31210-2032	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #11348	2835 WATSON BLVD	WARNER ROBINS	GA	31093	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS #10884	1081 GA HIGHWAY 96	WARNER ROBINS	GA	31088	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06560	3888 VINEVILLE AVE	MACON	GA	31204-1865	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07229	4305 MERCER UNIVERSITY DRIVE	MACON	GA	31206-4117	07/09/2024	10/01/2024		10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06561	1880 WATSON BLVD	WARNER ROBINS	GA	31093-3612	07/09/2024	10/01/2024	02/17/2025	02/17/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH0452110	Terminated	BPS-H80-005608	FIRST CHOICE PRIMARY CARE , INC	FIRST CHOICE PRIMARY CARE INC	770 WALNUT STREET	MACON	GA
CH045211A	Active	BPS-H80-013543	FIRST CHOICE PRIMARY CARE, INC.	First Choice Primary Care Warner Robins New Access Point	207 GREEN ST	WARNER ROBINS	GA
CH045211C	Active	BPS-H80-014896	FIRST CHOICE PRIMARY CARE, INC.	Ingram Pye Health Center	855 Anthony Rd	Macon	GA
CH045211D	Active	BPS-H80-014893	FIRST CHOICE PRIMARY CARE, INC.	FCPC Bibb County Health Dept	171 EMERY HWY	MACON	GA
CH045211E	Active	BPS-H80-018274	FIRST CHOICE PRIMARY CARE, INC.	Daybreak Center Suite A	174 Walnut Street	Macon	GA
CH045211F	Active	BPS-H80-039556	FIRST CHOICE PRIMARY CARE, INC.	FCPC South Macon	3061 Houston Ave.	Macon	GA
CH045211G	Active	BPS-H80-030072	FIRST CHOICE PRIMARY CARE, INC.	First Choice Primary Care Poplar St	400 Poplar Street	Macon	GA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH045211G	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/01/2025
CH0452110	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	01/01/2014	04/30/2015
CH045211A	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	07/01/2014	04/30/2015
CH0452110	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2018	04/01/2024
CH045211G	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2023
CH045211G	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2025
CH045211G	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2025
CH045211G	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2025
CH045211G	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2025
CH045211G	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2025
CH045211G	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2025
CH045211G	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2025
CH045211G	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2025
CH045211G	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2025
CH045211G	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2025
CH045211G	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	01/01/2025
CH045211A	COLISEUM PARK PROFESSIONAL	380 HOSPITAL DR STE 175A		MACON	GA	31217	10/01/2015	01/02/2018
CH045211G	COLISEUM PARK PROFESSIONAL	380 HOSPITAL DR STE 175A		MACON	GA	31217	01/27/2023
CH045211G	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2025
CH045211G	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2025
CH045211G	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2025
CH0452110	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	07/01/2018	04/01/2024
CH045211G	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	04/01/2023
CH0452110	FIRST CHOICE COMMUNITY PHARMACY	770 WALNUT STREET SUITE 100		MACON	GA	31201	04/01/2016	09/01/2021
CH045211E	FIRST CHOICE COMMUNITY PHARMACY	770 WALNUT STREET SUITE 100		MACON	GA	31201	10/01/2016	09/01/2021
CH045211A	FIRST CHOICE COMMUNITY PHARMACY	770 WALNUT STREET SUITE 100		MACON	GA	31201	04/01/2019	09/01/2021
CH045211F	FIRST CHOICE COMMUNITY PHARMACY	770 WALNUT STREET SUITE 100		MACON	GA	31201	04/01/2019	09/01/2021
CH045211D	FIRST CHOICE COMMUNITY PHARMACY	770 WALNUT STREET SUITE 100		MACON	GA	31201	04/01/2019	09/01/2021
CH045211C	FIRST CHOICE COMMUNITY PHARMACY	770 WALNUT STREET SUITE 100		MACON	GA	31201	04/01/2019	09/01/2021
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01374	800 HWY 96	WARNER ROBINS	GA	31088	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01586	3001 RICHARD B. RUSSELL PARKWAY	WARNER ROBINS	GA	31088	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02472	1390 PIO NONO AVENUE	MACON	GA	31204	10/01/2019	08/31/2022
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03772	4291 MERCER UNIVERSITY DRIVE	MACON	GA	31204	10/01/2019	08/31/2022
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03773	802 NORTH HOUSTON ROAD	WARNER ROBINS	GA	31093	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04545	1615 FOREST HILL RD.	MACON	GA	31210	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04765	4080 BLOOMFIELD RD.	MACON	GA	31206	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5523	5900 WATSON BLVD.	WARNER ROBINS	GA	31093	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05631	805 RUSSELL PKWY.	WARNER ROBINS	GA	31088	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07673	1557 WATSON BOULEVARD	WARNER ROBINS	GA	31093	10/01/2019	08/31/2022
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16719	2929 WATSON BLVD	WARNER ROBINS	GA	31093	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04160	6381 ZEBULON RD.	MACON	GA	31220	10/01/2019	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04255	3012 HARTLEY BRIDGE RD.	MACON	GA	31216	01/01/2021	04/01/2024
CH0452110	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07504	4585 HARTLEY BRIDGE RD.	MACON	GA	31216	01/01/2021	04/01/2024
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05631	805 RUSSELL PKWY.	WARNER ROBINS	GA	31088	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01586	3001 RICHARD B. RUSSELL PARKWAY	WARNER ROBINS	GA	31088	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04255	3012 HARTLEY BRIDGE RD.	MACON	GA	31216	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07504	4585 HARTLEY BRIDGE RD.	MACON	GA	31216	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01374	800 HWY 96	WARNER ROBINS	GA	31088	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03773	802 NORTH HOUSTON ROAD	WARNER ROBINS	GA	31093	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5523	5900 WATSON BLVD.	WARNER ROBINS	GA	31093	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04765	4080 BLOOMFIELD RD.	MACON	GA	31206	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04545	1615 FOREST HILL RD.	MACON	GA	31210	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16719	2929 WATSON BLVD	WARNER ROBINS	GA	31093	04/01/2023
CH045211G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04160	6381 ZEBULON RD.	MACON	GA	31220	04/01/2023
CH045211E	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04765	4080 BLOOMFIELD RD.	MACON	GA	31206	01/01/2024
CH045211D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	01/01/2024
CH045211C	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	07/01/2024
CH045211F	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	07/01/2024
CH045211E	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	07/01/2024
CH045211C	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04765	4080 BLOOMFIELD RD.	MACON	GA	31206	10/01/2024
CH045211C	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03773	802 NORTH HOUSTON ROAD	WARNER ROBINS	GA	31093	10/01/2024
CH045211C	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07504	4585 HARTLEY BRIDGE RD.	MACON	GA	31216	10/01/2024
CH045211D	GEORGIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5523	5900 WATSON BLVD.	WARNER ROBINS	GA	31093	10/01/2024
CH045211D	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16719	2929 WATSON BLVD	WARNER ROBINS	GA	31093	10/01/2024
CH045211D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04255	3012 HARTLEY BRIDGE RD.	MACON	GA	31216	10/01/2024
CH045211D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04545	1615 FOREST HILL RD.	MACON	GA	31210	10/01/2024
CH045211E	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05631	805 RUSSELL PKWY.	WARNER ROBINS	GA	31088	10/01/2024
CH045211D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01374	800 HWY 96	WARNER ROBINS	GA	31088	10/01/2024
CH045211D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04160	6381 ZEBULON RD.	MACON	GA	31220	10/01/2024
CH045211D	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01586	3001 RICHARD B. RUSSELL PARKWAY	WARNER ROBINS	GA	31088	10/01/2024
CH045211A	GRAVES PHARMACY	770 PINE ST STE 100		MACON	GA	31201-7565	10/01/2015	01/02/2018
CH045211G	GRAVES PHARMACY	770 PINE ST STE 100		MACON	GA	31201-7565	07/01/2024
CH0452110	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2017	12/04/2019
CH045211A	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2017	12/04/2019
CH045211D	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2017	12/04/2019
CH045211C	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2017	12/04/2019
CH045211E	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2017	12/04/2019
CH0452110	KROGER DRUGSTORE	#410	400 PIO NONO AVENUE	MACON	GA	31204	10/01/2017	04/30/2018
CH045211A	KROGER DRUGSTORE	#410	400 PIO NONO AVENUE	MACON	GA	31204	10/01/2017	04/30/2018
CH045211D	KROGER DRUGSTORE	#410	400 PIO NONO AVENUE	MACON	GA	31204	10/01/2017	04/30/2018
CH045211C	KROGER DRUGSTORE	#410	400 PIO NONO AVENUE	MACON	GA	31204	10/01/2017	04/30/2018
CH045211E	KROGER DRUGSTORE	#410	400 PIO NONO AVENUE	MACON	GA	31204	10/01/2017	04/30/2018
CH0452110	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	10/01/2017	04/01/2024
CH045211A	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	10/01/2017
CH045211D	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	10/01/2017
CH045211C	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	10/01/2017
CH045211E	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	10/01/2017
CH045211G	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	07/01/2023
CH0452110	KROGER DRUGSTORE #411	4628 PRESIDENTIAL PKWY		MACON	GA	31206	10/01/2017	04/01/2024
CH045211A	KROGER DRUGSTORE #411	4628 PRESIDENTIAL PKWY		MACON	GA	31206	10/01/2017
CH045211D	KROGER DRUGSTORE #411	4628 PRESIDENTIAL PKWY		MACON	GA	31206	10/01/2017
CH045211C	KROGER DRUGSTORE #411	4628 PRESIDENTIAL PKWY		MACON	GA	31206	10/01/2017
CH045211E	KROGER DRUGSTORE #411	4628 PRESIDENTIAL PKWY		MACON	GA	31206	10/01/2017
CH045211G	KROGER DRUGSTORE #411	4628 PRESIDENTIAL PKWY		MACON	GA	31206	07/01/2023
CH045211G	MACON PHARMACY	A & A PHARMACY LLC	4683 LOG CABIN DR	MACON	GA	31204	04/01/2024
CH045211A	MEDICINE STOP	1544 WATSON BLVD.		WARNER ROBINS	GA	31093	01/01/2017	11/02/2018
CH045211G	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/01/2024
CH045211G	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	04/01/2024
CH045211G	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/01/2024
CH045211G	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/01/2024
CH0452110	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	01/01/2014	04/30/2015
CH045211A	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	07/01/2014	04/30/2015
CH045211G	POWELLS BLOOMFIELD PHCY INC-CORP	4839 BLOOMFIELD RD.		MACON	GA	31206	01/27/2023
CH045211G	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2025
CH045211G	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2025
CH045211G	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2025
CH045211G	PROCARE PHARMACY, L.L.C.	CVS/PHARMACY #48637	2700 NORTHEAST EXPY NE STE B800 BUILDING B	ATLANTA	GA	30345	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC	PUBLIX PHARMACY #1008	1114 HIGHWAY 96	KATHLEEN	GA	31047	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1233	275 PERRY PKWY	PERRY	GA	31069	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1263	5451 BOWMAN RD	MACON	GA	31210	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1291	6015 WATSON BLVD.	BYRON	GA	31008	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1435	3330 INNER PERIMETER RD.	VALDOSTA	GA	31602	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1622	510 GA HWY 247 SOUTH	BONAIRE	GA	31005	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1700	5581 THOMASTON ROAD	MACON	GA	31220	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	01/01/2025
CH045211G	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	01/01/2025
CH0452110	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2018	04/01/2024
CH045211G	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2023
CH0452110	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2018	04/01/2024
CH045211G	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/01/2023
CH045211A	THE MEDICINE SHOPPE	1550 WATSON BLVD		WARNER ROBINS	GA	31093	10/01/2015	10/07/2016
CH045211G	U SAVE IT PHARMACY - MACON 2	1425 GEORGIA AVE	STE 102	MACON	GA	31201	01/27/2023
CH045211G	U SAVE IT PHARMACY INC #13	3576 PIO NONO AVENUE		MACON	GA	31206	01/27/2023
CH0452110	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019	04/01/2024
CH045211G	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2023
CH0452110	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	10/01/2019	04/01/2024
CH045211G	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	04/01/2023
CH045211C	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	10/01/2024
CH045211D	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	10/01/2024
CH0452110	WAL-MART PHARMACY 10-1153	6020 HARRISON ROAD		MACON	GA	31206	04/01/2019	04/01/2024
CH045211G	WAL-MART PHARMACY 10-1153	6020 HARRISON ROAD		MACON	GA	31206	04/01/2023
CH045211F	WAL-MART PHARMACY 10-1153	6020 HARRISON ROAD		MACON	GA	31206	01/01/2024
CH045211C	WAL-MART PHARMACY 10-1153	6020 HARRISON ROAD		MACON	GA	31206	07/01/2024
CH045211E	WAL-MART PHARMACY 10-1153	6020 HARRISON ROAD		MACON	GA	31206	10/01/2024
CH045211D	WAL-MART PHARMACY 10-1153	6020 HARRISON ROAD		MACON	GA	31206	10/01/2024
CH0452110	WAL-MART PHARMACY 10-1367	2720 WATSON BLVD		WARNER ROBINS	GA	31093	10/01/2019	04/01/2024
CH045211G	WAL-MART PHARMACY 10-1367	2720 WATSON BLVD		WARNER ROBINS	GA	31093	04/01/2023
CH045211C	WAL-MART PHARMACY 10-1367	2720 WATSON BLVD		WARNER ROBINS	GA	31093	10/01/2024
CH045211D	WAL-MART PHARMACY 10-1367	2720 WATSON BLVD		WARNER ROBINS	GA	31093	10/01/2024
CH0452110	WAL-MART PHARMACY 10-2890	5955 ZEBULON RD		MACON	GA	31210	10/01/2019	09/30/2023
CH045211G	WAL-MART PHARMACY 10-2890	5955 ZEBULON RD		MACON	GA	31210	04/01/2023	09/30/2023
CH045211C	WAL-MART PHARMACY 10-2890	5955 ZEBULON RD		MACON	GA	31210	10/01/2024
CH045211E	WAL-MART PHARMACY 10-2890	5955 ZEBULON RD		MACON	GA	31210	10/01/2024
CH0452110	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019	04/01/2024
CH045211G	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2023
CH0452110	WALGREEN CO	DBA: WALGREENS #10634	6035 ZEBULON RD	MACON	GA	31210-2032	09/27/2011	04/01/2024
CH0452110	WALGREEN CO	DBA: WALGREENS #11348	2835 WATSON BLVD	WARNER ROBINS	GA	31093	09/27/2011	04/01/2024
CH0452110	WALGREEN CO	DBA: WALGREENS #10884	1081 GA HIGHWAY 96	WARNER ROBINS	GA	31088	04/01/2019	04/01/2024
CH045211A	WALGREEN CO	DBA: WALGREENS #10884	1081 GA HIGHWAY 96	WARNER ROBINS	GA	31088	04/01/2019
CH045211G	WALGREEN CO	DBA: WALGREENS #10634	6035 ZEBULON RD	MACON	GA	31210-2032	04/01/2023
CH045211G	WALGREEN CO	DBA: WALGREENS #11348	2835 WATSON BLVD	WARNER ROBINS	GA	31093	04/01/2023
CH045211G	WALGREEN CO	DBA: WALGREENS #10884	1081 GA HIGHWAY 96	WARNER ROBINS	GA	31088	04/01/2023
CH045211C	WALGREEN CO	DBA: WALGREENS #10634	6035 ZEBULON RD	MACON	GA	31210-2032	10/01/2024
CH045211C	WALGREEN CO	DBA: WALGREENS #11348	2835 WATSON BLVD	WARNER ROBINS	GA	31093	10/01/2024
CH045211C	WALGREEN CO	DBA: WALGREENS #10884	1081 GA HIGHWAY 96	WARNER ROBINS	GA	31088	10/01/2024
CH045211E	WALGREEN CO	DBA: WALGREENS #10634	6035 ZEBULON RD	MACON	GA	31210-2032	10/01/2024
CH0452110	WALGREEN CO.	DBA: WALGREENS # 06561	1880 WATSON BLVD	WARNER ROBINS	GA	31093-3612	09/27/2011	04/01/2024
CH0452110	WALGREEN CO.	DBA: WALGREENS # 06560	3888 VINEVILLE AVE	MACON	GA	31204-1865	09/27/2011	04/01/2024
CH0452110	WALGREEN CO.	DBA: WALGREENS # 06780	2495 PIO NONO AVENUE	MACON	GA	31206-2829	09/27/2011	11/08/2019
CH0452110	WALGREEN CO.	DBA: WALGREENS # 06950	1280 GRAY HWY	MACON	GA	31211-1921	09/27/2011	11/09/2023
CH0452110	WALGREEN CO.	DBA: WALGREENS # 07229	4305 MERCER UNIVERSITY DRIVE	MACON	GA	31206-4117	09/27/2011	04/01/2024
CH0452110	WALGREEN CO.	DBA: WALGREENS # 09643	102 RUSSELL PKWY	WARNER ROBINS	GA	31088-6165	04/01/2018	04/01/2024
CH0452110	WALGREEN CO.	DBA: WALGREENS #11793	1100 BALL STREET	PERRY	GA	31069	04/01/2019	04/01/2024
CH045211A	WALGREEN CO.	DBA: WALGREENS #11793	1100 BALL STREET	PERRY	GA	31069	04/01/2019
CH045211G	WALGREEN CO.	DBA: WALGREENS # 06561	1880 WATSON BLVD	WARNER ROBINS	GA	31093-3612	04/01/2023	02/17/2025
CH045211G	WALGREEN CO.	DBA: WALGREENS # 06560	3888 VINEVILLE AVE	MACON	GA	31204-1865	04/01/2023
CH045211G	WALGREEN CO.	DBA: WALGREENS # 06950	1280 GRAY HWY	MACON	GA	31211-1921	04/01/2023	11/09/2023
CH045211G	WALGREEN CO.	DBA: WALGREENS # 07229	4305 MERCER UNIVERSITY DRIVE	MACON	GA	31206-4117	04/01/2023
CH045211G	WALGREEN CO.	DBA: WALGREENS #11793	1100 BALL STREET	PERRY	GA	31069	04/01/2023	01/17/2023
CH045211G	WALGREEN CO.	DBA: WALGREENS # 09643	102 RUSSELL PKWY	WARNER ROBINS	GA	31088-6165	04/01/2023
CH045211C	WALGREEN CO.	DBA: WALGREENS # 06560	3888 VINEVILLE AVE	MACON	GA	31204-1865	10/01/2024
CH045211C	WALGREEN CO.	DBA: WALGREENS # 07229	4305 MERCER UNIVERSITY DRIVE	MACON	GA	31206-4117	10/01/2024
CH045211C	WALGREEN CO.	DBA: WALGREENS # 06561	1880 WATSON BLVD	WARNER ROBINS	GA	31093-3612	10/01/2024	02/17/2025
CH045211D	WALGREEN CO.	DBA: WALGREENS # 06560	3888 VINEVILLE AVE	MACON	GA	31204-1865	10/01/2024
CH045211D	WALGREEN CO.	DBA: WALGREENS # 07229	4305 MERCER UNIVERSITY DRIVE	MACON	GA	31206-4117	10/01/2024
CH045211G	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH045211G	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/8/2024 5:04:40 PM	2/17/2025 3:09:40 PM	2/17/2025 3:09 PM
Details	Last Recertification Date	Update	Recertification	2/2/2023 4:24:18 PM	2/8/2024 5:04:40 PM	2/8/2024 5:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/22/2023 10:10 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003165499A	5/22/2023 10:10 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/22/2023 10:10 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1740666767	5/22/2023 10:10 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	5/22/2023 10:10 AM
Details	Last Recertification Date	Update	Recertification	2/3/2022 4:02:43 PM	2/2/2023 4:24:18 PM	2/2/2023 4:24 PM
Details	Last Recertification Date	Update	Recertification	2/3/2021 3:26:07 PM	2/3/2022 4:02:43 PM	2/3/2022 4:02 PM
Details	Last Recertification Date	Update	Recertification	1/28/2020 9:21:56 AM	2/3/2021 3:26:07 PM	2/3/2021 3:26 PM
Details	Last Recertification Date	Update	Recertification	1/29/2019 6:11:32 PM	1/28/2020 9:21:56 AM	1/28/2020 9:21 AM
Details	Last Recertification Date	Update	Recertification	2/12/2018 12:29:11 PM	1/29/2019 6:11:32 PM	1/29/2019 6:11 PM
Contacts	Primary Contact	Update	Recertification	McLeod, Katherine CEO First Choice Primary Care 4782547204	Slade, Claudette CFO First Choice Primary Care 4782547212	2/12/2018 12:29 PM
Details	Last Recertification Date	Update	Recertification	2/3/2017 12:00:00 AM	2/12/2018 12:29:11 PM	2/12/2018 12:29 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/12/2018 12:29 PM
Contacts	Authorizing Official	Update		McLeod, Katherine CEO 4782547204	McLeod, Katherine CEO First Choice Primary Care 4782547204	10/31/2017 11:11 AM
Contacts	Primary Contact	Update		McLeod, Katherine CEO 4782547204	McLeod, Katherine CEO First Choice Primary Care 4782547204	10/31/2017 11:11 AM
Contacts	Signed By	Update		McLeod, Katherine CEO 4782547204	McLeod, Katherine CEO First Choice Primary Care 4782547204	10/31/2017 11:11 AM
Contacts	Authorizing Official	Insert			McLeod, Katherine CEO 4782547204	7/14/2017 11:22 AM
Contacts	Primary Contact	Insert			McLeod, Katherine CEO 4782547204	7/14/2017 11:22 AM
Contacts	Signed By	Insert			McLeod, Katherine CEO 4782547204	7/14/2017 11:22 AM
Addresses	Main Address	Insert			855 Anthony Rd Macon, GA 31204-6266	2/3/2017 10:18 AM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	2/3/2017 12:00:00 AM	2/3/2017 10:17 AM
Addresses	Billing Address	Insert			First Choice Primary Care PO Box 4363 Macon, GA 31208-4363	4/26/2016 9:57 AM
Details	Last Recertification Date	Update			3/1/2016 12:00:00 AM	3/1/2016 10:30 AM
Dates	Participating Approval Date	Update			10/16/2015 12:00:00 AM	10/16/2015 4:17 PM
Details	State	Update		Pending	Active	10/16/2015 4:17 PM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/16/2015 4:17 PM
Details	340B ID	Update		ONLINE_REG_54710	CH045211C	10/8/2015 2:09 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_54710	10/7/2015 4:02 PM
Details	Last Recertification Date	Insert				10/7/2015 4:02 PM
Details	Grant Number	Insert			H80CS08242	10/7/2015 4:02 PM
Details	340B ID	Insert			ONLINE_REG	10/7/2015 4:02 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/7/2015 4:02 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/7/2015 4:02 PM
Details	Medicare Provider Number	Insert				10/7/2015 4:02 PM
Details	Entity Name	Insert			FIRST CHOICE PRIMARY CARE, INC.	10/7/2015 4:02 PM
Details	Program Code	Insert			CH	10/7/2015 4:02 PM
Details	Entity Subname	Insert			Ingram Pye Health Center	10/7/2015 4:02 PM
Dates	Participating Approval Date	Insert				10/7/2015 4:02 PM
Details	State	Insert			Pending	10/7/2015 4:02 PM
Dates	Registration Date	Insert			10/7/2015 12:00:00 AM	10/7/2015 4:02 PM
Dates	Signed By Date	Insert			10/7/2015 12:00:00 AM	10/7/2015 4:02 PM
Dates	Start Date	Insert				10/7/2015 4:02 PM
Terminations	Termination Comments	Insert				10/7/2015 4:02 PM
Terminations	Termination Date	Insert				10/7/2015 4:02 PM
Terminations	Termination Effective Date	Insert				10/7/2015 4:02 PM
Terminations	Termination Reason	Insert				10/7/2015 4:02 PM

340B Drug Pricing Program Database