Covered Entity Details

CH02161X MORRIS HEIGHTS HEALTH CENTER INC (Active) - information as of 4/25/2025 8:34:53 PM

Main Details

Name

MORRIS HEIGHTS HEALTH CENTER INC

Subdivision Name

PS/MS 29

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013996

340B ID

CH02161X

Grant Number

H80CS00472

Additional Details

Current Program Status

Active

Registration Date

10/14/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/21/2015

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

Morris Height Health Center
Douglas Colon, Sr. Managing Director/Controller Finance
(718) 716-4400

Primary Contact

Morris Height Health Center
Roosevelt Mathews, Clinical Pharmacist
(718) 716-4400 Ext: 1003

Addresses

Street Address

758 Courtlandt Ave
Bronx, NY 10451-4308

Billing Address

Morris Heights Health Center, Inc.
85 W. Burnside Avenue
Bronx, NY 10453-4015

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
NY		1184694291

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	Last Updated On
Contract Detail	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	04/17/2017	07/01/2017	10/01/2018	10/15/2018
Contract Detail	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	04/17/2017	07/01/2017	10/01/2018	10/15/2018
Contract Detail	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	08/01/2017	10/01/2017	10/01/2018	10/15/2018
Contract Detail	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	04/17/2017	07/01/2017	10/01/2018	10/15/2018
Contract Detail	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	01/14/2016	04/01/2016	01/01/2017	12/21/2016
Contract Detail	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	12/21/2016	01/01/2017	04/01/2018	03/29/2018

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH021610	Active	BPS-H80-003295	MORRIS HEIGHTS HEALTH CENTER INC	MORRIS HEIGHTS HEALTH CENTER	85 W Burnside Ave	Bronx	NY
CH02161AA	Active	BPS-H80-017748	MORRIS HEIGHTS HEALTH CENTER INC	The Marie Curie School for Medicine, Nursing, and Health Professions	120 West 231st Street	Bronx	NY
CH02161AB	Active	BPS-H80-018072	MORRIS HEIGHTS HEALTH CENTER INC	In-Tech Academy (MS/High School 368)	2975 Tibbett Avenue	Bronx	NY
CH02161AC	Active	BPS-H80-018485	MORRIS HEIGHTS HEALTH CENTER INC	Bronx Medical and Wellness Center (MHHC at 1227-1229 Edward Grant Highway)	1229 Edward Grant Highway	Bronx	NY
CH02161AD	Active	BPS-H80-021112	MORRIS HEIGHTS HEALTH CENTER INC	JHS 162 - Lola Rodriguez de Tio (x162 Campus)	600 Saint Ann's Avenue	Bronx	NY
CH02161AE	Active	BPS-H80-032851	Morris Heights Health Center, Inc.	MHHC at Flatbush Avenue	1095 Flatbush Avenue, First Floor	Brooklyn	NY
CH02161AF	Active	BPS-H80-032876	Morris Heights Health Center, Inc.	MHHC Urgent Care	1 W Burnside Ave	Bronx	NY
CH02161B	Active	BPS-H80-004262	MORRIS HEIGHTS HEALTH CENTER INC	Women's Health Pavilion	70 W Burnside Ave	Bronx	NY
CH02161C	Active	BPS-H80-005401	MORRIS HEIGHTS HEALTH CENTER INC	SCHOOL BASED HLTH CTR - MS 399	120 E 184th St	Bronx	NY
CH02161D	Active	BPS-H80-004295	MORRIS HEIGHTS HEALTH CENTER INC	PUBLIC SCHOOL 306(SBHC)	40 W Tremont Ave	Bronx	NY
CH02161E	Active	BPS-H80-000735	MORRIS HEIGHTS HEALTH CENTER INC	CIS 303/232	1700 Macombs Rd	Bronx	NY
CH02161F	Active	BPS-H80-004795	MORRIS HEIGHTS HEALTH CENTER INC	MORRIS HEIGHTS HC @ Walton	25 E 183rd St	Bronx	NY
CH02161G	Active	BPS-H80-002645	MORRIS HEIGHTS HEALTH CENTER INC	SBHC CES 126	175 W 166TH ST	BRONX	NY
CH02161H	Active	BPS-H80-004994	MORRIS HEIGHTS HEALTH CENTER INC	MORRIS HEIGHTS HC @ ST. ANN'S	625 E 137th St	Bronx	NY
CH02161J	Active	BPS-H80-010480	MORRIS HEIGHTS HEALTH CENTER INC	Harrison Circle	57-69 W. Burnside Avenue	Bronx	NY
CH02161K	Active	BPS-H80-014868	MORRIS HEIGHTS HEALTH CENTER INC	Mott Hall Campus	250 East 164th Street	Bronx	NY
CH02161L	Active	BPS-H80-014783	MORRIS HEIGHTS HEALTH CENTER INC	The Grace Dodge Campus	2474 CROTONA AVE	BRONX	NY
CH02161M	Active	BPS-H80-014005	MORRIS HEIGHTS HEALTH CENTER INC	PS 79	125 E 181st St	Bronx	NY
CH02161N	Active	BPS-H80-014000	MORRIS HEIGHTS HEALTH CENTER INC	International Community HS	345 Brook Ave	Bronx	NY
CH02161P	Active	BPS-H80-013997	MORRIS HEIGHTS HEALTH CENTER INC	PS/MS 279	2100 Walton Ave	Bronx	NY
CH02161Q	Active	BPS-H80-013208	MORRIS HEIGHTS HEALTH CENTER INC	MHHC at 779 Melrose Avenue	779 Melrose Avenue	Bronx	NY
CH02161R	Active	BPS-H80-012806	MORRIS HEIGHTS HEALTH CENTER INC	Vanguard Health Center	825 E 233rd St	Bronx	NY
CH02161S	Active	BPS-H80-012320	MORRIS HEIGHTS HEALTH CENTER INC	Harry S. Truman HS	750 Baychester Ave	Bronx	NY
CH02161T	Active	BPS-H80-012318	MORRIS HEIGHTS HEALTH CENTER INC	Albert Tuitt Educational Campus	921 E 228th St	Bronx	NY
CH02161U	Active	BPS-H80-012317	MORRIS HEIGHTS HEALTH CENTER INC	Banana Kelly HS	965 Longwood Ave	Bronx	NY
CH02161V	Active	BPS-H80-001858	MORRIS HEIGHTS HEALTH CENTER INC	PS 90	1116 Sheridan Ave	Bronx	NY
CH02161W	Active	BPS-H80-000430	MORRIS HEIGHTS HEALTH CENTER INC	PS 396/ MS390	1930 Andrews Ave	Bronx	NY
CH02161X	Active	BPS-H80-013996	MORRIS HEIGHTS HEALTH CENTER INC	PS/MS 29	758 Courtlandt Ave	Bronx	NY
CH02161Y	Active	BPS-H80-012319	MORRIS HEIGHTS HEALTH CENTER INC	Health Opportunities HS	350 Gerard Ave	Bronx	NY
CH02161Z	Active	BPS-H80-015781	MORRIS HEIGHTS HEALTH CENTER INC	TapCo (Theater Arts Production Company [x225], The Angelo Patri Middle School Arts [x391])	2225 Webster Avenue	Bronx	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Carve-In Effective Date	Termination Date
CH021610	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	04/01/2017	10/01/2018
CH02161B	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161F	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161C	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161E	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161G	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161D	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161H	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161J	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161W	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161V	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161U	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161T	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161Y	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161S	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161R	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161Q	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161X	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161P	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161N	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161M	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161L	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161K	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161Z	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161AA	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161AB	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH02161AC	75 BURNSIDE DRUG & SURGICAL	DBA: BURNSIDE PHARMACY	75 W BURNSIDE AVE	BRONX	NY	10453-4015	07/01/2017	10/01/2018
CH021610	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2022
CH021610	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2022
CH021610	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2022
CH021610	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/01/2022
CH021610	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2022
CH021610	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2022
CH021610	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2022
CH021610	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	10/01/2022
CH021610	AVS PHARMACY	D/B/A LEROY PHARMACY	314 E 204TH ST	BRONX	NY	10467	01/01/2020		07/15/2023
CH021610	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	04/01/2017	10/01/2018
CH02161B	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161F	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161C	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161E	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161G	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161D	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161H	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161J	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161W	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161V	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161U	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161T	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161Y	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161S	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161R	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161Q	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161X	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161P	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161N	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161M	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161L	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161K	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161Z	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161AA	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161AB	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH02161AC	AVSV PHARMACY INC.	64 W BURNSIDE AVE		BRONX	NY	10453-4018	07/01/2017	10/01/2018
CH021610	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	10/01/2022
CH021610	BROOK PHARMACY INC	DBA: BROOK SPECIALTY PHARMACY	700 BROOK AVE	BRONX	NY	10455-1357	07/01/2023
CH021610	CAREWAY RX INC	CAREWAY PHARMACY	1174 FLATBUSH AVE	BROOKLYN	NY	11226-7005	10/01/2021
CH021610	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161B	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161F	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161C	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161E	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161G	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161D	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161H	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161J	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161W	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161V	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161U	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161T	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161Y	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161S	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161R	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161Q	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161X	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161P	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161N	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161M	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161L	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161K	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161Z	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161AA	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161AB	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH02161AC	CASA DE VIDA INC.		52 W BURNSIDE AVE	BRONX	NY	10453	10/01/2017	10/01/2018
CH021610	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	10/01/2022
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02430	224 EAST 161ST STREET	BRONX	NY	10451	01/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02437	732 ALLERTON AVENUE	BRONX	NY	10467	01/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02438	282 EAST 149TH STREET	BRONX	NY	10451	01/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02551	3125 BAINBRIDGE AVENUE	BRONX	NY	10467	01/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03096	3775 E. TREMONT AVE.	BRONX	NY	10465	01/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY #8940	1688 WESTCHESTER AVE	BRONX	NY	10472	01/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 8969	50-56 EAST 167TH ST.	BRONX	NY	10452	01/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA CVS/PHARMACY # 4539	25-43 PROSPECT ST.	YONKERS	NY	10701	10/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02164	211 EAST SANDFORD BLVD.	MOUNT VERNON	NY	10550	10/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02737	115 W. 125TH STREET	NEW YORK	NY	10027	10/01/2020
CH021610	CVS ALBANY, L.L.C.	CVS/PHARMACY # 10112	288 ST. NICHOLAS AVE.	NEW YORK	NY	10027	10/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02433	2112 WHITE PLAINS ROAD	BRONX	NY	10462	10/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02697	3681 BRUCKNER BLVD.	BRONX	NY	10461	10/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02773	130 DYCKMAN STREET	NEW YORK	NY	10040	10/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03224	130 LENOX AVE.	NEW YORK	NY	10026	10/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 07067	1916 WILLIAMSBRIDGE ROAD	BRONX	NY	10461	10/01/2020
CH021610	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 07087	132 BRONX RIVER ROAD	YONKERS	NY	10704	10/01/2020
CH021610	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2020
CH021610	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2020
CH021610	DUANE READE	DBA: MELROSE PHARMACY	666 COURTLANDT AVE.	BRONX	NY	10451	10/03/2012		12/21/2016
CH021610	DUANE READE	133-141 DYCKMAN STREET		NEW YORK	NY	10040	10/03/2012		12/21/2016
CH021610	DUANE READE	58 E. FORDHAM ROAD		BRONX	NY	10468	10/03/2012		12/21/2016
CH021610	DUANE READE	320 W 145TH STREET		NEW YORK	NY	10039	10/03/2012		12/21/2016
CH021610	DUANE READE	1-13 EAST KINGSBRIDGE RD		BRONX	NY	10468	10/03/2012		12/21/2016
CH021610	DUANE READE	4 AMSTERDAM AVENUE		NEW YORK	NY	10023	10/03/2012		12/21/2016
CH021610	DUANE READE		1650 GRAND CONCOURSE	BRONX	NY	10457-7606	10/03/2012		10/15/2015
CH021610	DUANE READE		3225 THIRD AVE	BRONX	NY	10451	10/03/2012		12/21/2016
CH021610	DUANE READE	2108 3RD AVENUE		NEW YORK	NY	10029-2103	10/03/2012		12/21/2016
CH021610	DUANE READE		1888 WESTCHESTER AVENUE	BRONX	NY	10472	10/03/2012		12/21/2016
CH021610	DUANE READE	DBA: DUANE READE	3387 BROADWAY	NEW YORK	NY	10031	10/03/2012		12/21/2016
CH021610	DUANE READE		4234 BRONX BLVD	BRONX	NY	10466-2611	10/03/2012		12/21/2016
CH021610	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	04/01/2017	10/01/2018
CH02161B	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161F	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161C	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161E	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161G	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161D	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161H	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161J	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161W	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161V	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161U	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161T	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161Y	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161S	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161R	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161Q	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161X	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161P	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161N	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161M	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161L	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161K	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161Z	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161AA	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161AB	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH02161AC	E JEROME PHARMACY INC	1 E 183RD ST		BRONX	NY	10453-1242	07/01/2017	10/01/2018
CH021610	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2022
CH021610	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2022
CH021610	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2022
CH021610	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2022
CH021610	KAMRAN PHARMACY INC	D/B/A FAMILY PHARMACY	1101 FLATBUSH AVE	BROOKLYN	NY	11226-6141	10/01/2021
CH021610	LACROSS DRUGS, INC.	530 EAST 138TH STREET		BRONX	NY	10454	04/01/2022
CH021610	LIFE STAR PHARMACY INC	1215 JEROME AVE		BRONX	NY	10452	01/01/2020
CH021610	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161B	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161F	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161C	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161E	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161G	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161D	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161H	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161J	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161W	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161V	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161U	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161T	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161Y	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161S	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161R	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161Q	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161X	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161P	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161N	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161M	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161L	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161K	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	04/01/2016	01/01/2017
CH02161Z	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	10/01/2016	01/01/2017
CH02161AA	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	10/01/2016	01/01/2017
CH02161AB	LINDENWOOD RX CENTER INC	LIRX	1380 LORING AVE C/O PHARMACY	BROOKLYN	NY	11208	01/01/2017	01/01/2017
CH021610	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	10/01/2022
CH021610	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161B	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161F	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161C	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161E	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161G	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161D	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161H	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161J	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161W	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161V	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161U	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	04/01/2017	04/01/2018
CH02161T	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161Y	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161S	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161R	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161Q	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161X	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161P	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161N	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161M	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161L	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161K	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161Z	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161AA	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161AB	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	01/01/2017	04/01/2018
CH02161AC	MHHC PHARMACY, INC.	57 W BURNSIDE AVE		BRONX	NY	10453-4038	04/01/2017	04/01/2018
CH021610	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	10/01/2022
CH021610	PARK PLAZA PHARMA INC	DBA: PARK PLAZA PHARMACY	1773 UNIVERSITY AVENUE	BRONX	NY	10453-6961	01/01/2019
CH021610	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	10/01/2022
CH021610	PRAYOSHA PHARMACY CORP	PRAYOSHA PHARMACY CORP	54 EAST 183RD STREET	BRONX	NY	10453-1239	10/01/2019
CH021610	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2020
CH021610	RHESAK CORP	D/B/A YOGI PHARMACY	1985 UNIVERSITY AVENUE	BRONX	NY	10453	01/01/2020
CH021610	RITE AID OF NEW YORK, INC.	RITE AID #3980	1179 EAST 233RD STREET	BRONX	NY	10466	01/01/2019
CH021610	RITE AID OF NEW YORK, INC.	RITE AID #3817	57 EAST BURNSIDE AVENUE	BRONX	NY	10453	01/01/2019
CH021610	RITE AID OF NEW YORK, INC.	RITE AID #4294	4159 WHITE PLAINS ROAD	BRONX	NY	10466	01/01/2019
CH021610	RITE AID OF NEW YORK, INC.	RITE AID #4267	1091 OGDEN AVENUE	BRONX	NY	10452	10/01/2020
CH021610	RITE AID OF NEW YORK, INC.	RITE AID #4824	537-539 EAST 138TH STREET	BRONX	NY	10454	10/01/2020
CH021610	RITE AID OF NEW YORK, INC.	RITE AID #7906	840 WESTCHESTER AVE	BRONX	NY	10459	10/01/2020
CH021610	RIVER PARK RX LLC	RIVER PARK PHARMACY	1818 CEDAR AVE	BRONX	NY	10453	01/01/2019
CH021610	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	10/01/2022
CH021610	UPGRADE PHARMACY INC	UPGRADE PHARMACY INC	679 E 138TH ST	BRONX	NY	10454-3307	07/01/2021
CH021610	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01013	5564 BROADWAY	BRONX	NY	10463	10/03/2012		12/21/2016
CH021610	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07627	3575 BOSTON RD	BRONX	NY	10469-2518	10/03/2012		12/21/2016
CH021610	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2817 THIRD AVE.	BRONX	NY	10455	10/03/2012		12/21/2016
CH021610	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10411	406 E. FORDHAM RD.	BRONX	NY	10458	10/03/2012		12/21/2016

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/6/2024 3:10:38 PM	2/13/2025 5:53:45 PM	2/13/2025 5:53 PM
Details	Last Recertification Date	Update	Recertification	2/2/2023 10:17:08 AM	2/6/2024 3:10:38 PM	2/6/2024 3:10 PM
Contacts	Authorizing Official	Update	AO Change Request	VASQUEZ, MIGUEL SR MANAGING DIRECTOR OF FINANCE MORRIS HEIGHS HEALTH CENTER 6464180667	Colon, Douglas Sr. Managing Director/Controller Finance Morris Height Health Center 7187164400	1/31/2024 6:47 PM
Details	Last Recertification Date	Update	Recertification	2/2/2022 1:54:34 PM	2/2/2023 10:17:08 AM	2/2/2023 10:17 AM
Details	Last Recertification Date	Update	Recertification	2/9/2021 10:05:13 AM	2/2/2022 1:54:34 PM	2/2/2022 1:54 PM
Contacts	Authorizing Official	Update	AO Change Request	Brandsdorfer, Michael CFO Morris Heights Health Center, Inc. 9175947281	VASQUEZ, MIGUEL SR MANAGING DIRECTOR OF FINANCE MORRIS HEIGHS HEALTH CENTER 6464180667	1/11/2022 8:31 AM
Medicaid Billing	NPI: State	Update	Recertification		NY	2/9/2021 10:05 AM
Contacts	Primary Contact	Update	Recertification	Trainer, Lennie Chief Fiscal Officer Morris Heights Health Center 7184831270-1502	Mathews, Roosevelt Clinical Pharmacist Morris Height Health Center 7187164400-1003	2/9/2021 10:05 AM
Details	Last Recertification Date	Update	Recertification	2/4/2020 10:22:27 AM	2/9/2021 10:05:13 AM	2/9/2021 10:05 AM
Contacts	Authorizing Official	Update	AO Change Request	Mathews, Roosevelt Clinical Pharmacist Morris Height Health Center 7187164400-1003	Brandsdorfer, Michael CFO Morris Heights Health Center, Inc. 9175947281	2/8/2021 2:16 PM
Contacts	Authorizing Official	Update	AO Change Request	Jordan, Crystal D. Chief Operating Officer Morris Heights Heath Cener 7184831270-2335	Mathews, Roosevelt Clinical Pharmacist Morris Height Health Center 7187164400-1003	1/21/2021 12:48 PM
Details	Last Recertification Date	Update	Recertification	1/30/2019 10:56:21 AM	2/4/2020 10:22:27 AM	2/4/2020 10:22 AM
Contacts	Authorizing Official	Update	OPA Edit	Phipps, Claudette VP Planning and Development Morris Heights Health Center 7184831270-2312	Jordan, Crystal D. Chief Operating Officer Morris Heights Heath Cener 7184831270-2335	1/28/2020 12:58 PM
Contacts	Primary Contact	Update	OPA Edit	Jordan, Crystal D. Chief Operating Officer Morris Heights Heath Cener 7184831270-2335	Trainer, Lennie Chief Fiscal Officer Morris Heights Health Center 7184831270-1502	1/28/2020 12:58 PM
Contacts	Primary Contact	Update	Profile Change Request	Jordan, Crystal D. Clinical Informatics Administrator Morris Heights Heath Cener 7184831270-2335	Jordan, Crystal D. Chief Operating Officer Morris Heights Heath Cener 7184831270-2335	7/26/2019 11:16 AM
Contacts	Primary Contact	Update	Change Request	Jordan, Crystal Clinical Informatics Administrator Morris Heights Heath Cener 7184831270-2335	Jordan, Crystal D. Clinical Informatics Administrator Morris Heights Heath Cener 7184831270-2335	7/25/2019 2:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1184694291	3/7/2019 6:27 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1184694291 ( )		2/28/2019 10:14 AM
Details	Last Recertification Date	Update	Recertification	2/20/2018 4:04:50 PM	1/30/2019 10:56:21 AM	1/30/2019 10:56 AM
Contacts	Primary Contact	Update	Recertification	Phipps, Claudette VP Planning and Development Morris Heights Health Center 7184831270-2312	Jordan, Crystal Clinical Informatics Administrator Morris Heights Heath Cener 7184831270-2335	2/20/2018 4:04 PM
Details	Last Recertification Date	Update	Recertification	2/7/2017 12:00:00 AM	2/20/2018 4:04:50 PM	2/20/2018 4:04 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/20/2018 4:04 PM
Contacts	Authorizing Official	Update		Phipps, Claudette VP Planning and Development 7184831270-2312	Phipps, Claudette VP Planning and Development Morris Heights Health Center 7184831270-2312	2/9/2018 12:03 PM
Contacts	Primary Contact	Update		Phipps, Claudette VP Planning and Development 7184831270-2312	Phipps, Claudette VP Planning and Development Morris Heights Health Center 7184831270-2312	2/9/2018 12:03 PM
Contacts	Authorizing Official	Insert			Phipps, Claudette VP Planning and Development 7184831270-2312	8/1/2017 6:32 PM
Contacts	Primary Contact	Insert			Phipps, Claudette VP Planning and Development 7184831270-2312	8/1/2017 6:32 PM
Addresses	Main Address	Insert			758 Courtlandt Ave Bronx, NY 10451-4308	2/7/2017 4:06 PM
Contacts	Signed By	Insert			Fairweather, Judith L. EVP 7184831207	2/7/2017 4:06 PM
Details	Last Recertification Date	Update		3/7/2016 12:00:00 AM	2/7/2017 12:00:00 AM	2/7/2017 4:06 PM
Addresses	Billing Address	Insert			Morris Heights Health Center, Inc. 85 W. Burnside Avenue Bronx, NY 10453-4015	12/21/2016 12:16 PM
Medicaid Billing	NPI: Number	Insert			1184694291	3/7/2016 8:38 AM
Details	Last Recertification Date	Update			3/7/2016 12:00:00 AM	3/7/2016 8:38 AM
Dates	Participating Approval Date	Update			10/21/2015 12:00:00 AM	10/21/2015 5:23 PM
Details	State	Update		Pending	Active	10/21/2015 5:23 PM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/21/2015 5:23 PM
Details	340B ID	Update		ONLINE_REG_55584	CH02161X	10/20/2015 11:28 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_55584	10/14/2015 12:16 PM
Details	Last Recertification Date	Insert				10/14/2015 12:16 PM
Details	Grant Number	Insert			H80CS00472	10/14/2015 12:16 PM
Details	340B ID	Insert			ONLINE_REG	10/14/2015 12:16 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/14/2015 12:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2015 12:16 PM
Details	Medicare Provider Number	Insert				10/14/2015 12:16 PM
Details	Entity Name	Insert			MORRIS HEIGHTS HEALTH CENTER INC	10/14/2015 12:16 PM
Details	Program Code	Insert			CH	10/14/2015 12:16 PM
Details	Entity Subname	Insert			PS/MS 29	10/14/2015 12:16 PM
Dates	Participating Approval Date	Insert				10/14/2015 12:16 PM
Details	State	Insert			Pending	10/14/2015 12:16 PM
Dates	Registration Date	Insert			10/14/2015 12:00:00 AM	10/14/2015 12:16 PM
Dates	Signed By Date	Insert			10/14/2015 12:00:00 AM	10/14/2015 12:16 PM
Dates	Start Date	Insert				10/14/2015 12:16 PM
Terminations	Termination Comments	Insert				10/14/2015 12:16 PM
Terminations	Termination Date	Insert				10/14/2015 12:16 PM
Terminations	Termination Effective Date	Insert				10/14/2015 12:16 PM
Terminations	Termination Reason	Insert				10/14/2015 12:16 PM

340B Drug Pricing Program Database