340B Drug Pricing Program Database


CH10100B MOSES LAKE COMMUNITY HEALTH CENTER (Active) - information as of 4/25/2025 8:34:23 PM

Main Details
MOSES LAKE COMMUNITY HEALTH CENTER
Ephrata Community Dental Clinic
HRSA-Funded Health Center
BPS-H80-037606
CH10100B
H80CS00702


Additional Details
Active
10/13/2015
1/1/2016
10/16/2015
2/10/2025

Contacts

Moses Lake Community Health Center
Sheila Berschauer, CEO
(509) 765-0674 Ext: 2411

Moses Lake Community Health Center
Bothaina Mousa, Director of Pharmacy
(509) 765-0675 Ext: 3232

Addresses

457 1st Avenue NW
EPHRATA, WA 98823

Moses Lake Community Health Center
605 Coolidge Street
Moses Lake, WA 98837


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WA60224201568507671,1629564679
Shipping Addresses

Same as Street Address
Contract Pharmacies
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH101000ActiveBPS-H80-001599MOSES LAKE COMMUNITY HEALTH CENTERMOSES LAKE COMMUNITY HEALTH CENTER605 S Coolidge St Moses LakeWA
CH10100AActiveBPS-H80-004042MOSES LAKE COMMUNITY HEALTH CENTERQUINCY COMMUNITY HEALTH CENTER1450 1st Ave SW QuincyWA
CH10100BActiveBPS-H80-037606MOSES LAKE COMMUNITY HEALTH CENTEREphrata Community Dental Clinic457 1st Avenue NW EPHRATAWA
CH10100CActiveBPS-H80-032926Moses Lake Community Health CenterQuincy Student Health & Wellness Center403 Jackrabbit St NE QuincyWA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH101000ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/01/2025  
CH101000ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/01/2025  
CH101000ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/01/2025  
CH101000ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/01/2025  
CH101000ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/01/2025  
CH101000ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/01/2025  
CH101000BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2025  
CH101000BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2025  
CH101000BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2025  
CH101000BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620304/01/2025  
CH101000BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/01/2025  
CH101000DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654104/01/2025  
CH101000ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111204/01/2025  
CH101000EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313404/01/2025  
CH101000EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/01/2025  
CH101000EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/01/2025  
CH101000GENOA HEALTHCARE LLC6 E 1ST AVE
SPOKANEWA9920204/01/2025  
CH101000GENOA HEALTHCARE LLC402 S 4TH AVE, STE E127
YAKIMAWA9890204/01/2025  
CH101000OPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/01/2025  
CH101000OPTUM INFUSION SERVICES 501, INC.8131 W BOSTIAN RD STE. A345
WOODINVILLEWA9807204/01/2025  
CH101000OPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/01/2025  
CH101000OPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276504/01/2025  
CH101000OPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/01/2025  
CH101000OPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302504/01/2025  
CH101000OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520404/01/2025  
CH101000OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/01/2025  
CH101000OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/01/2025  
CH101000OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/01/2025  
CH101000OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/01/2025  
CH101000OPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265504/01/2025  
CH101000OPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/01/2025  
CH101000OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/01/2025  
CH101000OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/01/2025  
CH101000OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/01/2025  
CH101000RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255004/01/2025  
CH101000RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2025  
CH101000SAFEWAY INCSAFEWAY PHARMACY #3252 601 S. PIONEER WAY
MOSES LAKEWA98837-480110/01/2013  
CH101000SAFEWAY INCSAFEWAY PHARMACY #1544 1150 BASIN STREET SW
EPHRATAWA9882307/01/2023  
CH10100ASAFEWAY INCSAFEWAY PHARMACY #1544 1150 BASIN STREET SW
EPHRATAWA9882307/01/2023 07/01/2023
CH101000SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2025  
CH101000SHOPKO PHARMACY #2794814 13TH AVENUE SW
QUINCYWA9884810/01/2017 09/30/2018
CH10100ASHOPKO PHARMACY #2794814 13TH AVENUE SW
QUINCYWA9884804/25/2014 09/30/2018
CH101000THRIFTY PAYLESS, INC.RITE AID #5293 500 SOUTH PIONEER WAY
MOSES LAKEWA9883710/01/2013  
CH101000THRIFTY PAYLESS, INC.RITE AID #6347 250 BASIN STREET SW
EPHRATAWA9882310/01/2013  
CH10100CTHRIFTY PAYLESS, INC.RITE AID #5293 500 SOUTH PIONEER WAY
MOSES LAKEWA9883704/01/2024  
CH101000WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2017  
CH101000WAL-MART PHARMACY 10-20071005 NORTH STRATFORD ROAD
MOSES LAKEWA9883707/01/2014  
CH10100BWAL-MART PHARMACY 10-20071005 NORTH STRATFORD ROAD
MOSES LAKEWA9883704/01/2024  
CH10100AWAL-MART PHARMACY 10-32601399 NAT WASHINGTON WAY
EPHRATAWA9882307/01/2014 01/10/2024
CH101000WAL-MART PHARMACY 10-32601399 NAT WASHINGTON WAY
EPHRATAWA9882304/01/2023 04/17/2025
CH101000WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2017  
CH101000WALGREEN CO.DBA: WALGREENS #02647 200 E. BROADWAY AVE.
MOSES LAKEWA9883709/27/2012  
CH101000WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275601/01/2024  
CH101000Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/13/2024 8:58:01 AM2/10/2025 11:59:30 AM2/10/2025 11:59 AM
Medicaid BillingNPI: NumberDeleteChange Request1699862813 (WA) 12/6/2024 7:27 PM
AddressesBilling AddressInsertRecertification Moses Lake Community Health Center 605 Coolidge Street Moses Lake, WA 988372/13/2024 8:58 AM
AddressesMain AddressUpdateRecertification 204 12TH AVE SW EPHRATA, WA 98823 457 1st Avenue NW EPHRATA, WA 988232/13/2024 8:58 AM
DetailsLast Recertification DateUpdateRecertification1/30/2023 5:35:26 PM2/13/2024 8:58:01 AM2/13/2024 8:58 AM
ContactsPrimary ContactUpdateContract Pharmacy RegistrationMousa, Bothaina Director of Pharmacy Moses Lake Community Health Center 5097650675Mousa, Bothaina Director of Pharmacy Moses Lake Community Health Center 5097650675-323210/9/2023 3:09 AM
ContactsPrimary ContactUpdateChange RequestDann, Don Pharmacy Supervisor Moses Lake Community Health Center 5097650674Mousa, Bothaina Director of Pharmacy Moses Lake Community Health Center 50976506755/16/2023 5:43 PM
Medicaid BillingNPI: NumberInsertRecertification 16998628131/30/2023 5:35 PM
Medicaid BillingNPI: StateInsertRecertification WA1/30/2023 5:35 PM
DetailsLast Recertification DateUpdateRecertification2/1/2022 4:15:15 PM1/30/2023 5:35:26 PM1/30/2023 5:35 PM
AddressesMain AddressUpdateChange Request 204 12TH AVE SW EPHRATA, WA 98823-2197 204 12TH AVE SW EPHRATA, WA 9882312/22/2022 6:33 PM
DetailsLast Recertification DateUpdateRecertification2/2/2021 8:19:25 PM2/1/2022 4:15:15 PM2/1/2022 4:15 PM
Medicaid BillingNPI: NumberInsertChange Request 162956467910/14/2021 7:16 PM
Medicaid BillingNPI: StateInsertChange Request WA10/14/2021 7:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1568507671 ( ) 2/2/2021 8:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15685076712/2/2021 8:19 PM
Medicaid BillingNPI: StateInsertRecertification WA2/2/2021 8:19 PM
DetailsLast Recertification DateUpdateRecertification2/3/2020 9:11:26 PM2/2/2021 8:19:25 PM2/2/2021 8:19 PM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 2/2/2021 8:19 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestChilson, Sheila CEO Moses Lake Community Health Center 5097650674-2411Berschauer, Sheila CEO Moses Lake Community Health Center 5097650674-24112/3/2020 9:13 PM
ContactsSigned ByUpdateProfile Change RequestChilson, Sheila CEO Moses Lake Community Health Center 5097650674-2411Berschauer, Sheila CEO Moses Lake Community Health Center 5097650674-24112/3/2020 9:13 PM
DetailsLast Recertification DateUpdateRecertification1/31/2019 4:58:49 PM2/3/2020 9:11:26 PM2/3/2020 9:11 PM
DetailsLast Recertification DateUpdateRecertification2/7/2018 3:03:16 PM1/31/2019 4:58:49 PM1/31/2019 4:58 PM
DetailsLast Recertification DateUpdateRecertification1/31/2017 12:00:00 AM2/7/2018 3:03:16 PM2/7/2018 3:03 PM
ContactsPrimary ContactUpdate Dann, Don Pharmacy Supervisor 5097650674Dann, Don Pharmacy Supervisor Moses Lake Community Health Center 50976506741/16/2018 2:15 PM
ContactsAuthorizing OfficialUpdate Chilson, Sheila CEO 5097650674Chilson, Sheila CEO Moses Lake Community Health Center 5097650674-24119/20/2017 3:15 PM
ContactsSigned ByUpdate Chilson, Sheila CEO 5097650674Chilson, Sheila CEO Moses Lake Community Health Center 5097650674-24119/20/2017 3:15 PM
ContactsAuthorizing OfficialInsert  Chilson, Sheila CEO 50976506747/13/2017 9:39 PM
ContactsSigned ByInsert  Chilson, Sheila CEO 50976506747/13/2017 9:39 PM
AddressesMain AddressInsert   204 12TH AVE SW EPHRATA, WA 98823-21971/31/2017 12:47 PM
ContactsPrimary ContactInsert  Dann, Don Pharmacy Supervisor 50976506741/31/2017 12:47 PM
DetailsLast Recertification DateUpdate 2/12/2016 12:00:00 AM1/31/2017 12:00:00 AM1/31/2017 12:46 PM
DetailsLast Recertification DateUpdate  2/12/2016 12:00:00 AM2/12/2016 4:32 PM
DatesParticipating Approval DateUpdate  10/16/2015 12:00:00 AM10/16/2015 3:17 PM
DetailsStateUpdate PendingActive10/16/2015 3:17 PM
DatesStart DateUpdate  1/1/2016 12:00:00 AM10/16/2015 3:17 PM
Details340B IDUpdate ONLINE_REG_55244CH10100B10/16/2015 12:54 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_5524410/13/2015 12:50 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/13/2015 12:50 PM
Medicaid BillingMedicaid: NumberInsert  602242010/13/2015 12:50 PM
Medicaid BillingMedicaid: StateInsert  WA10/13/2015 12:50 PM
Medicaid BillingNPI: NumberInsert  156850767110/13/2015 12:50 PM
DetailsLast Recertification DateInsert   10/13/2015 12:50 PM
DetailsGrant NumberInsert  H80CS0070210/13/2015 12:50 PM
Details340B IDInsert  ONLINE_REG10/13/2015 12:50 PM
DetailsIs Authorizing Official EHB DataInsert  False10/13/2015 12:50 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/13/2015 12:50 PM
DetailsMedicare Provider NumberInsert   10/13/2015 12:50 PM
DetailsEntity NameInsert  MOSES LAKE COMMUNITY HEALTH CENTER10/13/2015 12:50 PM
DetailsProgram CodeInsert  CH10/13/2015 12:50 PM
DetailsEntity SubnameInsert  Ephrata Community Dental Clinic10/13/2015 12:50 PM
DatesParticipating Approval DateInsert   10/13/2015 12:50 PM
DetailsStateInsert  Pending10/13/2015 12:50 PM
DatesRegistration DateInsert  10/13/2015 12:00:00 AM10/13/2015 12:50 PM
DatesSigned By DateInsert  10/13/2015 12:00:00 AM10/13/2015 12:50 PM
DatesStart DateInsert   10/13/2015 12:50 PM
TerminationsTermination CommentsInsert   10/13/2015 12:50 PM
TerminationsTermination DateInsert   10/13/2015 12:50 PM
TerminationsTermination Effective DateInsert   10/13/2015 12:50 PM
TerminationsTermination ReasonInsert   10/13/2015 12:50 PM