Covered Entity Details

CH05682C COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC (Active) - information as of 6/21/2025 12:08:08 AM

Main Details

Name

COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC

Subdivision Name

THE COMMUNITY DENTAL CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-001332

340B ID

CH05682C

Grant Number

H80CS00197

Additional Details

Current Program Status

Active

Registration Date

10/13/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/21/2015

Last Recertification Date

2/20/2025

Contacts

Authorizing Official

Community Action Agency of Columbiana County
Thomas E Andrews, CEO
(330) 424-7221 Ext: 104

Primary Contact

Community Action Agency of Columbiana County
Jenna E Wonner, COO
(330) 424-7221 Ext: 103

Addresses

Street Address

38722 Saltwell Rd
Lisbon, OH 44432-8303

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OH	0968663	1821041401

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH056820	Active	BPS-H80-003836	COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC	DBA LISBON COMMUNITY HEALTH CENTER	7880 Lincole Pl	Lisbon	OH
CH05682A	Active	BPS-H80-019379	COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC	CAA Health, Behavioral Health, and Dental Center at East Liverpool	16480 Saint Clair Ave	East Liverpool	OH
CH05682B	Active	BPS-H80-011537	COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC	Salineville Community Health Center at Melhorn	103 W Main St	Salineville	OH
CH05682C	Active	BPS-H80-001332	COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC	THE COMMUNITY DENTAL CENTER	38722 Saltwell Rd	Lisbon	OH
CH05682D	Terminated	BPS-H80-017415	COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC	CAA Health and Behavioral Health at East Liverpool	236 West Sixth Street	East Liverpool	OH
CH05682E	Active	BPS-H80-022101	COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC	CAA East Liverpool Campus Building #2	16494 St. Clair Avenue	East Liverpool	OH
CH05682F	Active	BPS-H80-036389	Community Action Agency Of Columbiana County, Inc.	CAA Health Center at Salem	2376 Southeast Blvd	Salem	OH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH056820	DAVIS BROTHERS PHARMACY	LEGAL BUSINESS NAME: DAVIS BROTHERS PHA	615 N CHESTER ST	NEW CUMBERLAND	WV	26047	10/01/2022	04/25/2023
CH056820	DAVIS BROTHERS PHARMACY - CHESTER	559 CAROLINA AVE STE B		CHESTER	WV	26034	10/01/2022	04/25/2023
CH056820	GIANT EAGLE PHARMACY #1664	2401 E. STATE STREET		SALEM	OH	44460	07/01/2016
CH056820	HERCHE BLOOR PHARMACY	104 E 5TH ST		EAST LIVERPOOL	OH	43920	10/01/2022
CH056820	RITE AID OF OHIO, INC.	RITE AID #2449	25 WEST MAIN STREET	EAST PALESTINE	OH	44413	01/01/2014	08/20/2024
CH056820	RITE AID OF OHIO, INC.	RITE AID #3181	14973 SOUTH AVENUE	COLUMBIANA	OH	44408	01/01/2014	04/15/2024
CH056820	RITE AID OF OHIO, INC.	RITE AID #3060	614 BRADSHAW AVENUE	EAST LIVERPOOL	OH	43920	07/01/2019	08/20/2024
CH056820	RITE AID OF OHIO, INC.	RITE AID #3603	220 THIRD STREET	WELLSVILLE	OH	43968	07/01/2019	08/20/2024
CH056820	THE LANE DRUG COMPANY	RITE AID #2418	7844 STATE ROUTE 45	LISBON	OH	44432	01/01/2014	08/20/2024
CH056820	THE LANE DRUG COMPANY	RITE AID #2357	2229 EAST STATE STREET	SALEM	OH	44460	01/01/2014	08/20/2024
CH056820	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH056820	WAL-MART PHARMACY 10-1707	16280 DRESDEN DR		EAST LIVERPOOL	OH	43920	04/01/2014
CH056820	WAL-MART PHARMACY 10-2910	2875 E STATE STREET		SALEM	OH	44460	04/01/2014	07/14/2015
CH056820	WAL-MART PHARMACY 10-2910	2875 E STATE STREET		SALEM	OH	44460	10/01/2022
CH056820	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH056820	WALGREEN CO.	DBA: WALGREENS # 09377	2124 E STATE ST	SALEM	OH	44460-2455	01/01/2015
CH056820	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CH056820	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2015	06/24/2015
CH056820	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	01/01/2015	06/24/2015
CH056820	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH056820	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	2/14/2024 3:26:26 PM	2/20/2025 11:57:20 AM	2/20/2025 11:57 AM
Details	Last Recertification Date	Update	Recertification	2/22/2023 9:01:22 AM	2/14/2024 3:26:26 PM	2/14/2024 3:26 PM
Details	Last Recertification Date	Update	Recertification	2/16/2022 3:48:01 PM	2/22/2023 9:01:22 AM	2/22/2023 9:01 AM
Details	Last Recertification Date	Update	Recertification	2/9/2021 4:17:06 PM	2/16/2022 3:48:01 PM	2/16/2022 3:48 PM
Medicaid Billing	NPI: State	Update	Recertification		OH	2/9/2021 4:17 PM
Details	Last Recertification Date	Update	Recertification	2/6/2020 10:30:21 AM	2/9/2021 4:17:06 PM	2/9/2021 4:17 PM
Details	Last Recertification Date	Update	Recertification	2/5/2019 9:11:12 AM	2/6/2020 10:30:21 AM	2/6/2020 10:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/3/2019 3:52 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0968663	10/3/2019 3:52 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	10/3/2019 3:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1821041401	10/3/2019 3:52 PM
Details	Last Recertification Date	Update	Recertification	2/20/2018 3:29:08 PM	2/5/2019 9:11:12 AM	2/5/2019 9:11 AM
Contacts	Primary Contact	Update	Recertification	Wonner, Jenna E COO Community Action Agency of Columbiana County 3304247221-103	Wonner, Jenna E COO Community Action Agency of Columbiana County 3304247221-103	2/20/2018 3:29 PM
Details	Last Recertification Date	Update	Recertification	1/31/2017 12:00:00 AM	2/20/2018 3:29:08 PM	2/20/2018 3:29 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/20/2018 3:29 PM
Contacts	Authorizing Official	Update	AO Change Request	Wonner, Jenna E COO Community Action Agency of Columbiana County 3304247221-103	Andrews, Thomas E CEO Community Action Agency of Columbiana County 3304247221-104	2/20/2018 12:11 PM
Contacts	Authorizing Official	Update	Change Request	PETTIBON, MARY ANN COO 3304245686	Wonner, Jenna E COO Community Action Agency of Columbiana County 3304247221-103	2/5/2018 1:38 PM
Contacts	Primary Contact	Update	Change Request	PETTIBON, MARY ANN COO 3304245686	Wonner, Jenna E COO Community Action Agency of Columbiana County 3304247221-103	2/5/2018 1:38 PM
Contacts	Signed By	Update	Change Request	PETTIBON, MARY ANN COO 3304245686	Wonner, Jenna E COO Community Action Agency of Columbiana County 3304247221-103	2/5/2018 1:38 PM
Contacts	Authorizing Official	Insert			PETTIBON, MARY ANN COO 3304245686	7/14/2017 12:46 PM
Contacts	Primary Contact	Insert			PETTIBON, MARY ANN COO 3304245686	7/14/2017 12:46 PM
Contacts	Signed By	Insert			PETTIBON, MARY ANN COO 3304245686	7/14/2017 12:46 PM
Addresses	Main Address	Insert			38722 Saltwell Rd Lisbon, OH 44432-8303	1/31/2017 3:03 PM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	1/31/2017 12:00:00 AM	1/31/2017 3:03 PM
Details	Last Recertification Date	Update			2/12/2016 12:00:00 AM	2/12/2016 12:12 PM
Dates	Participating Approval Date	Update			10/21/2015 12:00:00 AM	10/21/2015 10:25 AM
Details	State	Update		Pending	Active	10/21/2015 10:25 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/21/2015 10:25 AM
Details	340B ID	Update		ONLINE_REG_55167	CH05682C	10/13/2015 2:37 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_55167	10/13/2015 9:58 AM
Details	Last Recertification Date	Insert				10/13/2015 9:58 AM
Details	Grant Number	Insert			H80CS00197	10/13/2015 9:58 AM
Details	340B ID	Insert			ONLINE_REG	10/13/2015 9:58 AM
Details	Is Authorizing Official EHB Data	Insert			False	10/13/2015 9:58 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/13/2015 9:58 AM
Details	Medicare Provider Number	Insert				10/13/2015 9:58 AM
Details	Entity Name	Insert			COMMUNITY ACTION AGENCY OF COLUMBIANA COUNTY INC	10/13/2015 9:58 AM
Details	Program Code	Insert			CH	10/13/2015 9:58 AM
Details	Entity Subname	Insert			THE COMMUNITY DENTAL CENTER	10/13/2015 9:58 AM
Dates	Participating Approval Date	Insert				10/13/2015 9:58 AM
Details	State	Insert			Pending	10/13/2015 9:58 AM
Dates	Registration Date	Insert			10/13/2015 12:00:00 AM	10/13/2015 9:58 AM
Dates	Signed By Date	Insert			10/13/2015 12:00:00 AM	10/13/2015 9:58 AM
Dates	Start Date	Insert				10/13/2015 9:58 AM
Terminations	Termination Comments	Insert				10/13/2015 9:58 AM
Terminations	Termination Date	Insert				10/13/2015 9:58 AM
Terminations	Termination Effective Date	Insert				10/13/2015 9:58 AM
Terminations	Termination Reason	Insert				10/13/2015 9:58 AM

340B Drug Pricing Program Database