Covered Entity Details

RWII60608 Alliance Care 360 (Active) - information as of 5/15/2025 11:40:19 PM

Main Details

Name

Alliance Care 360

Subdivision Name

Type

Ryan White Part B

340B ID

RWII60608

Grant Number

X07HA00013-27-00

Additional Details

Current Program Status

Active

Registration Date

1/13/2016

Participating Start Date

4/1/2016

Participating Approval Date

2/10/2016

Last Recertification Date

2/14/2025

Time Period the Assistance was Received

4/1/2023 - 3/31/2025

Contacts

Authorizing Official

Alliance Care 360
Ariq Cabbler, Executive Director/Chief Executive Officer
(312) 808-1044 Ext: 101

Primary Contact

Alliance Care 360
Kenosha Chastang PharmD MBA JD, 340B compliance officer
(312) 808-1044 Ext: 103

Addresses

Street Address

2929 S Wabash Avenue
Suite
202
Chicago, IL 60616-2327

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
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?
No

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	904 PROSPECT PHARMACY INC	D/B/A BOCA PHARMACY	904 PROSPECT AVE	BRONX	NY	10459-3929	04/15/2016	07/01/2016	06/01/2018	06/01/2018
Contract Detail	ABN HEALTHCARE, INC.	DBA: XCELRX	150 FENCL LN SUITE 2B	HILLSIDE	IL	60162	01/17/2017	04/01/2017	01/01/2021	04/15/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	08/03/2022	10/01/2022		10/01/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	08/03/2022	10/01/2022		10/01/2022
Contract Detail	AMERICAN DRUG STORES		DBA: OSCO DRUG #3344 1220 S. ASHLAND AVENUE	CHICAGO	IL	60608	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES		DBA OSCO DRUG #3223 7523 WEST LAKE STREET	RIVER FOREST	IL	60305	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES		DBA: OSCO DRUG #3345 1224 S WABASH	CHICAGO	IL	60605	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES		DBA OSCO DRUG #3514 3531 N BROADWAY	CHICAGO	IL	60657	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES		DBA OSCO DRUG #3170 5324 S PULASKI ROAD	CHICAGO	IL	60632	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES		DBA OSCO DRUG #3407 5532 N CLARK STREET	CHICAGO	IL	60640	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES		DBA OSCO DRUG #3063 763 E 162ND STREET	SOUTH HOLLAND	IL	60473	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES		DBA OSCO DRUG #3176 9402 S ASHLAND	CHICAGO	IL	60620	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES LLC	DBA OSCO DRUG 4060	7910 S CICEREO AVE	BURBANK	IL	60459	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES LLC	OSCO DRUG #3082	6014 S COTTAGE GROVE AVE	CHICAGO	IL	60637	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES LLC	DBA OSCO DRUG 230	7530 S STONY ISLAND AVE	CHICAGO	IL	60649	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AMERICAN DRUG STORES LLC	DBA OSCO DRUG 3223	7523 LAKE ST	RIVER FOREST	IL	60305	01/15/2020	04/01/2020	12/10/2020	12/11/2020
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	04/15/2021	07/01/2021	04/01/2021	04/15/2021
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	04/15/2021	07/01/2021		07/01/2021
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/15/2020	07/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/15/2020	07/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/14/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK PUERTO RICO SPECIALTY PHARMACY,	CAREMARK PUERTO RICO SPECIALTY PHARMACY	6020 AVE ROBERTO SANCHEZ VILELLA	CAROLINA	PR	00982	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/08/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	CONFIDENTIAL DRUG	8250 BASH STREET	SUITE D	INDIANAPOLIS	IN	46250	04/16/2018	07/01/2018	05/14/2019	05/14/2019
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/13/2023	01/01/2024		01/01/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	08/03/2022	10/01/2022		10/01/2022
Contract Detail	HEALTHFINITY & BEYOND, LLC	DBA M & R PRESCRIPTION CENTER	1959 E 71ST ST	CHICAGO	IL	60649-2005	01/15/2019	04/01/2019	11/01/2019	04/30/2020
Contract Detail	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	04/15/2021	07/01/2021		07/01/2021
Contract Detail	LONGS DRUGS OF LEXINGTON SC INC		1216 WEST MAIN ST	LEXINGTON	SC	29072	04/15/2021	07/01/2021		07/01/2021
Contract Detail	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	08/03/2022	10/01/2022		10/01/2022
Contract Detail	PHYSICIAN'S RX PHARMACY, LLC	PHYSICIANS RX PHARMACY, LLC	9701 APOLLO DRIVE #400	LARGO	MD	20774	10/13/2017	01/01/2018	07/01/2020	07/08/2020
Contract Detail	PHYSICIANS RX PHARMACY OF CLINTON, INC.	PHYSICIANS RX PHARMACY CLINTON	9131 PISCATAWAY ROAD SUITE 670	CLINTON	MD	20735	10/13/2017	01/01/2018	07/01/2020	07/08/2020
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/15/2020	07/01/2020	01/29/2021	09/12/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #11338	10160 INTERNATIONAL BLVD.	WEST CHESTER	OH	45246	04/15/2020	07/01/2020	01/29/2021	09/12/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/13/2020	10/01/2020	01/29/2021	09/12/2022
Contract Detail	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/17/2017	04/01/2017	12/31/2019	12/11/2020
Contract Detail	SCHNUCKS MARKETS INC	DBA SCHNUCKS PHARMACY 318	2239 E. COOK STREET SUITE 101	SPRINGFIELD	IL	62703	01/17/2017	04/01/2017	06/01/2018	06/01/2018
Contract Detail	SCHNUCKS PHARMACY	SCHNUCK MARKETS, INC.	6410 EAST STATE STREET	ROCKFORD	IL	61108	01/17/2017	04/01/2017	06/01/2018	06/01/2018
Contract Detail	SCHNUCKS PHARMACY #754	SCHNUCK MARKETS, INC.	2642 CHARLES STREET	ROCKFORD	IL	61108	01/17/2017	04/01/2017	06/01/2018	06/01/2018
Contract Detail	TONY'S MEDICENTER PHARMACY	H&S PHARMACIES LLC	324 W BROADWAY	STEELEVILLE	IL	62288-1407	10/14/2019	01/01/2020	01/01/2020	01/15/2020
Contract Detail	UNITED RX LLC	150 FENCL LN		HILLSIDE	IL	60162	01/02/2020	04/01/2020		04/01/2020
Contract Detail	UNITED/XCEL-RX LLC	150 FENCL LN STE 2B		HILLSIDE	IL	60162-2041	01/02/2021	04/01/2021		04/01/2021
Contract Detail	UNITED/XCEL-RX LLC	4300 N. UNIVERSITY DR., STE C101		LAUDERHILL	FL	33351	04/15/2025	07/01/2025		04/15/2025
Contract Detail	UPGRADE PHARMACY INC	DBA 303 UPGRADE PHARMACY	303 W LAKE ST STE 302	ADDISON	IL	60101-2586	04/16/2018	07/01/2018	04/01/2019	10/14/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	New Registration	Cabbler, Ariq Executive Director/Chief Executive Officer Alliance Care 360 3128081044	Cabbler, Ariq Executive Director/Chief Executive Officer Alliance Care 360 3128081044-101	4/15/2025 11:36 PM
Details	Last Recertification Date	Update	Recertification	2/7/2024 6:05:59 PM	2/14/2025 11:05:44 PM	2/14/2025 11:05 PM
Addresses	Main Address	Update	Change Request	2929 S Wabash Avenue, Suite 202 Chicago, IL 60616-2327	2929 S Wabash Avenue Suite 202 Chicago, IL 60616-2327	7/29/2024 9:04 AM
Details	Assistance Received From Date	Update	Change Request	7/1/2020 12:00:00 AM	4/1/2023 12:00:00 AM	7/29/2024 9:04 AM
Details	Assistance Received To Date	Update	Change Request	3/31/2024 12:00:00 AM	3/31/2025 12:00:00 AM	7/29/2024 9:04 AM
Details	Grant Number	Update	Change Request	X07HA00013	X07HA00013-27-00	7/29/2024 9:04 AM
Details	Assistance Received To Date	Update	Recertification	6/30/2023 12:00:00 AM	3/31/2024 12:00:00 AM	2/7/2024 6:05 PM
Details	Last Recertification Date	Update	Recertification	2/10/2023 10:50:36 AM	2/7/2024 6:05:59 PM	2/7/2024 6:05 PM
Details	NOFO Number	Update		Minority AIDS Initiative/ADAP Program 23		12/16/2023 10:34 AM
Details	Assistance Received To Date	Update	Recertification	6/30/2022 12:00:00 AM	6/30/2023 12:00:00 AM	2/10/2023 10:50 AM
Details	Last Recertification Date	Update	Recertification	2/5/2022 10:32:51 PM	2/10/2023 10:50:36 AM	2/10/2023 10:50 AM
Details	NOFO Number	Update	Recertification	Minority AIDS Initiative/ADAP Program 2020-2	Minority AIDS Initiative/ADAP Program 23	2/10/2023 10:50 AM
Contacts	Primary Contact	Update	Recertification	Chastang PharmD MBA JD, Kenosha 340B compliance officer Alliance Care 360 3128081044	Chastang PharmD MBA JD, Kenosha 340B compliance officer Alliance Care 360 3128081044-103	1/30/2023 12:54 AM
Contacts	Primary Contact	Update	Change Request	Chastang, Kenosha Chastang PharmD MBA JD, Kenosha 340B compliance officer Alliance Care 360 3128081044	Chastang PharmD MBA JD, Kenosha 340B compliance officer Alliance Care 360 3128081044	2/11/2022 9:06 AM
Contacts	Primary Contact	Update	Change Request	Chastang, Kenosha 340B compliance officer Alliance Care 360 3128081044	Chastang, Kenosha Chastang PharmD MBA JD, Kenosha 340B compliance officer Alliance Care 360 3128081044	2/11/2022 8:41 AM
Details	Last Recertification Date	Update	Recertification	3/1/2021 6:24:02 AM	2/5/2022 10:32:51 PM	2/5/2022 10:32 PM
Contacts	Primary Contact	Update	Change Request	Morris, Tammy Board of Directors Brothers Health Collective 3128081044	Chastang, Kenosha 340B compliance officer Alliance Care 360 3128081044	1/19/2022 9:25 AM
Contacts	Authorizing Official	Update	Change Request	Cabbler, Ariq Director BHC 3128081044-101	Cabbler, Ariq Executive Director/Chief Executive Officer Alliance Care 360 3128081044	1/19/2022 9:25 AM
Details	Assistance Received To Date	Update	Change Request	3/31/2021 12:00:00 AM	6/30/2022 12:00:00 AM	1/19/2022 9:25 AM
Details	Entity Name	Update	Change Request	Brothers Health Collective	Alliance Care 360	1/19/2022 9:25 AM
Details	Entity Subname	Update	Change Request	Alliance Care 360		1/19/2022 9:25 AM
Details	Assistance Received From Date	Update	Recertification		7/1/2020 12:00:00 AM	3/1/2021 6:24 AM
Details	Assistance Received To Date	Update	Recertification		3/31/2021 12:00:00 AM	3/1/2021 6:24 AM
Details	Last Recertification Date	Update	Recertification	1/27/2020 10:05:48 AM	3/1/2021 6:24:02 AM	3/1/2021 6:24 AM
Details	NOFO Number	Update	Recertification		Minority AIDS Initiative/ADAP Program 2020-2	3/1/2021 6:24 AM
Details	Entity Subname	Update	Change Request	Brothers Institute for Health Equity	Alliance Care 360	10/20/2020 9:20 AM
Contacts	Authorizing Official	Update		Cabbler, Ariq Director BHC 3128081044	Cabbler, Ariq Director BHC 3128081044-101	7/15/2020 11:07 PM
Contacts	Primary Contact	Update		Morris, Tammy Board of Directors Brothers Health Collective 3128081044-105	Morris, Tammy Board of Directors Brothers Health Collective 3128081044	4/15/2020 10:50 PM
Details	Last Recertification Date	Update	Recertification	1/28/2019 10:27:09 AM	1/27/2020 10:05:48 AM	1/27/2020 10:05 AM
Addresses	Billing Address	Insert	Change Request		Brothers Health Collective 58 E 26th Street 58 E 26th Street Chicago, IL 60616	1/16/2020 9:44 AM
Addresses	Main Address	Update	Change Request	58E 26th St Chicago, IL 60616-2327	2929 S Wabash Avenue, Suite 202 Chicago, IL 60616-2327	1/16/2020 9:44 AM
Contacts	Primary Contact	Update		Morris, Tammy Care Coordinator Brothers Health Collective 3128081044-105	Morris, Tammy Board of Directors Brothers Health Collective 3128081044-105	1/2/2020 8:31 PM
Contacts	Primary Contact	Update	Change Request	Morris, Tammy Care Coordinator Brothers Health Collective 3128081044-105	Morris, Tammy Care Coordinator Brothers Health Collective 3128081044-105	3/25/2019 3:09 PM
Contacts	Authorizing Official	Update	Change Request	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	Cabbler, Ariq Director BHC 3128081044	3/25/2019 1:21 PM
Contacts	Authorizing Official	Update	Profile Change Request	Cabbler, Ariq Malik Executive Director Brothers Health Collective 3128081044-101	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	3/21/2019 10:25 AM
Contacts	Signed By	Update	Profile Change Request	Cabbler, Ariq Malik Executive Director Brothers Health Collective 3128081044-101	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	3/21/2019 10:25 AM
Contacts	Primary Contact	Update	Recertification	Kelly, Wendy Care Coordinator Brothers Health Collective 3128081044	Morris, Tammy Care Coordinator Brothers Health Collective 3128081044-105	1/28/2019 10:27 AM
Details	Last Recertification Date	Update	Recertification	2/27/2018 9:54:05 AM	1/28/2019 10:27:09 AM	1/28/2019 10:27 AM
Contacts	Authorizing Official	Update	New Registration	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	Cabbler, Ariq Malik Executive Director Brothers Health Collective 3128081044-101	4/16/2018 6:10 PM
Contacts	Signed By	Update	New Registration	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	Cabbler, Ariq Malik Executive Director Brothers Health Collective 3128081044-101	4/16/2018 6:10 PM
Addresses	Main Address	Update	Change Request	56E 26th St Chicago, IL 60616-2327	58E 26th St Chicago, IL 60616-2327	3/30/2018 8:20 AM
Addresses	Main Address	Update	Change Request	2517 S Archer ave Chicago, IL 60608-5911	56E 26th St Chicago, IL 60616-2327	3/22/2018 11:26 AM
Contacts	Primary Contact	Update	Recertification	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	Kelly, Wendy Care Coordinator Brothers Health Collective 3128081044	2/27/2018 9:54 AM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/27/2018 9:54:05 AM	2/27/2018 9:54 AM
Details	Entity Subname	Update	Change Request		Brothers Institute for Health Equity	10/12/2017 1:03 PM
Contacts	Authorizing Official	Update		Cabbler, Ariq Executive Director 3128081044-101	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	10/12/2017 12:22 PM
Contacts	Primary Contact	Update		Cabbler, Ariq Executive Director 3128081044-101	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	10/12/2017 12:22 PM
Contacts	Signed By	Update		Cabbler, Ariq Executive Director 3128081044-101	Cabbler, Ariq Executive Director Brothers Health Collective 3128081044-101	10/12/2017 12:22 PM
Contacts	Authorizing Official	Insert			Cabbler, Ariq Executive Director 3128081044-101	4/27/2017 7:59 PM
Contacts	Primary Contact	Insert			Cabbler, Ariq Executive Director 3128081044-101	4/27/2017 7:59 PM
Contacts	Signed By	Insert			Cabbler, Ariq Executive Director 3128081044-101	4/27/2017 7:59 PM
Addresses	Main Address	Insert			2517 S Archer ave Chicago, IL 60608-5911	1/25/2017 4:21 PM
Details	Last Recertification Date	Update			1/25/2017 12:00:00 AM	1/25/2017 4:21 PM
Dates	Participating Approval Date	Update			2/10/2016 12:00:00 AM	2/10/2016 4:13 PM
Details	State	Update		Pending	Active	2/10/2016 4:13 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	2/10/2016 4:13 PM
Details	Grant Number	Update			X07HA00013	1/13/2016 2:43 PM
Details	340B ID	Update		ONLINE_REG_57321	RWII60608	1/13/2016 2:43 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_57321	1/13/2016 2:36 AM
Details	Last Recertification Date	Insert				1/13/2016 2:36 AM
Details	Grant Number	Insert				1/13/2016 2:36 AM
Details	340B ID	Insert			ONLINE_REG	1/13/2016 2:36 AM
Details	Is Authorizing Official EHB Data	Insert				1/13/2016 2:36 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2016 2:36 AM
Details	Medicare Provider Number	Insert				1/13/2016 2:36 AM
Details	Entity Name	Insert			Brothers Health Collective	1/13/2016 2:36 AM
Details	Program Code	Insert			RWII	1/13/2016 2:36 AM
Details	Entity Subname	Insert				1/13/2016 2:36 AM
Dates	Participating Approval Date	Insert				1/13/2016 2:36 AM
Details	State	Insert			Pending	1/13/2016 2:36 AM
Dates	Registration Date	Insert			1/13/2016 12:00:00 AM	1/13/2016 2:36 AM
Dates	Signed By Date	Insert			1/13/2016 12:00:00 AM	1/13/2016 2:36 AM
Dates	Start Date	Insert				1/13/2016 2:36 AM
Terminations	Termination Comments	Insert				1/13/2016 2:36 AM
Terminations	Termination Date	Insert				1/13/2016 2:36 AM
Terminations	Termination Effective Date	Insert				1/13/2016 2:36 AM
Terminations	Termination Reason	Insert				1/13/2016 2:36 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History