Covered Entity Details

FQHCLA344C Tri-County Family Medicine Program, Inc. (Active) - information as of 5/17/2025 10:40:54 PM

Main Details

Name

Tri-County Family Medicine Program, Inc.

Subdivision Name

TCFM Dansville

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-018383

340B ID

FQHCLA344C

Grant Number

LALCS00181

Additional Details

Current Program Status

Active

Registration Date

10/3/2016

Participating Start Date

1/1/2017

Participating Approval Date

11/25/2016

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Tri-County Family Medicine Program, Inc.
Karen Stone, Chief Executive Officer
(585) 432-2301

Primary Contact

Tri-County Family Medicine Program, Inc.
Laurie Wright, 340B and Administrative Manager
(585) 204-0964

Addresses

Street Address

60 Red Jacket St Ste 1
Dansville, NY 14437-1758

Billing Address

Tri-County Family Medicine Program, Inc.
PO Box 601
Dansville, NY 14437

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?
No

Shipping Addresses

Shipping Address 1

Tri-County Family Medicine Program, Inc. / Tri-County Pharmacy
60 Red Jacket Street
Suite 8
Dansville, NY 14437-1758

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05072	225 MAIN STREET	DANSVILLE	NY	14437	10/10/2017	01/01/2018		10/10/2017
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05074	100 E. NAPLES ST.	WAYLAND	NY	14572	10/10/2017	01/01/2018		10/10/2017
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00232	277 E. MAIN ST.	AVON	NY	14414	10/14/2020	01/01/2021		01/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05073	15 HONEOYE COMMONS	HONEOYE	NY	14471	01/14/2021	04/01/2021		04/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01925	1259 ROUTE 332	FARMINGTON	NY	14425	01/14/2021	04/01/2021		04/01/2021
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00586	525 SPENCERPORT RD GATES SHOPPING PLZ	ROCHESTER	NY	14606	07/14/2021	10/01/2021		10/01/2021
Contract Detail	CVS ALBANY, L.L.C.	CVS PHARMACY # 17445	4300 VETERANS MEMORIAL DR	BATAVIA	NY	14020	07/14/2021	10/01/2021		10/01/2021
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/14/2021	04/01/2021		04/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/14/2021	04/01/2021		04/01/2021
Contract Detail	ECKERD CORPORATION	RITE AID #10879	12 PARK DRIVE	HORNELL	NY	14843	10/10/2017	01/01/2018	02/28/2018	02/28/2018
Contract Detail	NUNDA FAMILY PHARMACY LLC	12 NORTH STATE STREET	ATTN: SUPERVISING PHARMACIST	NUNDA	NY	14517-0518	07/14/2017	10/01/2017	01/03/2018	01/15/2018
Contract Detail	QUINLAN'S PHARMACY INC	QUINLAN'S MEDICAL EQUIPMENT AND SUPPLY	107 N MAIN ST	WAYLAND	NY	14572-1033	01/17/2017	04/01/2017		01/17/2017
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #1871	40 EAST STATE STREET	MT MORRIS	NY	14510	10/09/2017	01/01/2018	02/28/2018	02/28/2018
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #686	9519 FOSTER WHEELER ROAD	DANSVILLE	NY	14437	10/09/2017	01/01/2018	02/28/2018	02/28/2018
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #3983	338 WEST WASHINGTON STREET	BATH	NY	14810	10/09/2017	01/01/2018	07/31/2023	09/28/2023
Contract Detail	RITE AID OF NEW YORK, INC.	RITE AID #782	128 NORTH CENTER STREET	PERRY	NY	14530	10/09/2017	01/01/2018	02/28/2018	02/28/2018
Contract Detail	TOPS MARKETS	TOPS PHARMACY #539	309 W MORRIS STREET	BATH	NY	14810	10/12/2023	01/01/2024		01/01/2024
Contract Detail	TOPS MARKETS LLC	TOPS PHARMACY #520	35 FRANKLIN PLAZA	DANSVILLE	NY	14437	04/14/2021	07/01/2021		07/01/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/10/2017	01/01/2018		10/10/2017
Contract Detail	WAL-MART PHARMACY 10-1966	4235 VETERAN DRIVE		GENESEO	NY	14454	01/16/2017	04/01/2017		01/16/2017
Contract Detail	WAL-MART PHARMACY 10-2326	1000 STATE ROUTE 36		HORNELL	NY	14843	01/16/2017	04/01/2017		07/14/2022
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/14/2017	10/01/2017		07/13/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19760	12 PARK DR	HORNELL	NY	14843	03/01/2018	04/01/2018		03/01/2018
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17396	21 E STATE ST	MOUNT MORRIS	NY	14510	03/01/2018	04/01/2018		03/01/2018
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19766	9519 FOSTER WHEELER RD	DANSVILLE	NY	14437	03/01/2018	04/01/2018		03/01/2018
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19739	128 N CENTER ST	PERRY	NY	14530	03/01/2018	04/01/2018		03/01/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18364	135 W MAIN ST	HONEOYE FALLS	NY	14472	04/11/2019	07/01/2019	12/31/2023	12/31/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11716	321 W. WASHINGTON ST.	BATH	NY	14810-1017	10/13/2023	01/01/2024		01/01/2024
Contract Detail	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	07/14/2017	10/01/2017	10/10/2017	10/10/2017
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/13/2023	04/01/2023		04/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/13/2023	01/01/2024		01/01/2024
Contract Detail	WEGMANS FOOD MARKETS, INC.	4287 GENESEE VALLEY PLAZA	ATTN: PHARMACY	GENESEO	NY	14454	10/13/2017	01/01/2018		07/14/2022
Contract Detail	WEGMANS FOOD MARKETS, INC.	2851 BROADWAY	ATTN: PHARMACY	CHEEKTOWAGA	NY	14227	04/12/2019	07/01/2019	04/01/2021	04/02/2021
Contract Detail	WEGMANS FOOD MARKETS, INC.	1000 HIGHWAY 36 NORTH	ATTN: PHARMACY	HORNELL	NY	14843	04/12/2019	07/01/2019		07/13/2022
Contract Detail	WEGMANS FOOD MARKETS, INC.	745 CALKINS ROAD	ATTN: PHARMACY	ROCHESTER	NY	14623	04/12/2019	07/01/2019		07/13/2022
Contract Detail	WEGMANS FOOD MARKETS, INC.	2873 BROADWAY ST	SUITE 100	CHEEKTOWAGA	NY	14227-1036	02/11/2021	02/11/2021	10/02/2023	10/06/2023

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
FQHCLA344	Active	BPS-LAL-018387	Tri-County Family Medicine Program, Inc.	Tri-County Family Medicine Program, Inc. - Admin	10869 State Route 36	Dansville	NY
FQHCLA344A	Active	BPS-LAL-018385	Tri-County Family Medicine Program, Inc.	TCFM Nunda	61 N State St	Nunda	NY
FQHCLA344B	Active	BPS-LAL-018384	Tri-County Family Medicine Program, Inc.	TCFM Geneseo	50 E South St Ste 700	Geneseo	NY
FQHCLA344C	Active	BPS-LAL-018383	Tri-County Family Medicine Program, Inc.	TCFM Dansville	60 Red Jacket St Ste 1	Dansville	NY
FQHCLA344D	Active	BPS-LAL-018382	Tri-County Family Medicine Program, Inc.	TCFM Cohocton	25 Park Ave	Cohocton	NY
FQHCLA344E	Active	BPS-LAL-018386	Tri-County Family Medicine Program, Inc.	TCFM Wayland	200 N Main St	Wayland	NY
FQHCLA344F	Active	BPS-LAL-033542	Tri-County Family Medicine Program, Inc.	TCFM Canaseraga	12 N Church St	Canaseraga	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA344	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05072	225 MAIN STREET	DANSVILLE	NY	14437	01/01/2018
FQHCLA344A	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05072	225 MAIN STREET	DANSVILLE	NY	14437	01/01/2018
FQHCLA344B	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05072	225 MAIN STREET	DANSVILLE	NY	14437	01/01/2018
FQHCLA344C	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05072	225 MAIN STREET	DANSVILLE	NY	14437	01/01/2018
FQHCLA344D	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05072	225 MAIN STREET	DANSVILLE	NY	14437	01/01/2018
FQHCLA344E	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05072	225 MAIN STREET	DANSVILLE	NY	14437	01/01/2018
FQHCLA344	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05074	100 E. NAPLES ST.	WAYLAND	NY	14572	01/01/2018
FQHCLA344A	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05074	100 E. NAPLES ST.	WAYLAND	NY	14572	01/01/2018
FQHCLA344B	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05074	100 E. NAPLES ST.	WAYLAND	NY	14572	01/01/2018
FQHCLA344C	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05074	100 E. NAPLES ST.	WAYLAND	NY	14572	01/01/2018
FQHCLA344D	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05074	100 E. NAPLES ST.	WAYLAND	NY	14572	01/01/2018
FQHCLA344E	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05074	100 E. NAPLES ST.	WAYLAND	NY	14572	01/01/2018
FQHCLA344	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00232	277 E. MAIN ST.	AVON	NY	14414	01/01/2021
FQHCLA344A	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00232	277 E. MAIN ST.	AVON	NY	14414	01/01/2021
FQHCLA344B	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00232	277 E. MAIN ST.	AVON	NY	14414	01/01/2021
FQHCLA344C	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00232	277 E. MAIN ST.	AVON	NY	14414	01/01/2021
FQHCLA344D	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00232	277 E. MAIN ST.	AVON	NY	14414	01/01/2021
FQHCLA344E	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00232	277 E. MAIN ST.	AVON	NY	14414	01/01/2021
FQHCLA344	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05073	15 HONEOYE COMMONS	HONEOYE	NY	14471	04/01/2021
FQHCLA344A	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05073	15 HONEOYE COMMONS	HONEOYE	NY	14471	04/01/2021
FQHCLA344B	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05073	15 HONEOYE COMMONS	HONEOYE	NY	14471	04/01/2021
FQHCLA344C	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05073	15 HONEOYE COMMONS	HONEOYE	NY	14471	04/01/2021
FQHCLA344D	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05073	15 HONEOYE COMMONS	HONEOYE	NY	14471	04/01/2021
FQHCLA344E	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05073	15 HONEOYE COMMONS	HONEOYE	NY	14471	04/01/2021
FQHCLA344	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01925	1259 ROUTE 332	FARMINGTON	NY	14425	04/01/2021
FQHCLA344A	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01925	1259 ROUTE 332	FARMINGTON	NY	14425	04/01/2021
FQHCLA344B	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01925	1259 ROUTE 332	FARMINGTON	NY	14425	04/01/2021
FQHCLA344C	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01925	1259 ROUTE 332	FARMINGTON	NY	14425	04/01/2021
FQHCLA344D	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01925	1259 ROUTE 332	FARMINGTON	NY	14425	04/01/2021
FQHCLA344E	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01925	1259 ROUTE 332	FARMINGTON	NY	14425	04/01/2021
FQHCLA344	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00586	525 SPENCERPORT RD GATES SHOPPING PLZ	ROCHESTER	NY	14606	10/01/2021
FQHCLA344A	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00586	525 SPENCERPORT RD GATES SHOPPING PLZ	ROCHESTER	NY	14606	10/01/2021
FQHCLA344B	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00586	525 SPENCERPORT RD GATES SHOPPING PLZ	ROCHESTER	NY	14606	10/01/2021
FQHCLA344C	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00586	525 SPENCERPORT RD GATES SHOPPING PLZ	ROCHESTER	NY	14606	10/01/2021
FQHCLA344D	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00586	525 SPENCERPORT RD GATES SHOPPING PLZ	ROCHESTER	NY	14606	10/01/2021
FQHCLA344E	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00586	525 SPENCERPORT RD GATES SHOPPING PLZ	ROCHESTER	NY	14606	10/01/2021
FQHCLA344	CVS ALBANY, L.L.C.	CVS PHARMACY # 17445	4300 VETERANS MEMORIAL DR	BATAVIA	NY	14020	10/01/2021
FQHCLA344A	CVS ALBANY, L.L.C.	CVS PHARMACY # 17445	4300 VETERANS MEMORIAL DR	BATAVIA	NY	14020	10/01/2021
FQHCLA344B	CVS ALBANY, L.L.C.	CVS PHARMACY # 17445	4300 VETERANS MEMORIAL DR	BATAVIA	NY	14020	10/01/2021
FQHCLA344C	CVS ALBANY, L.L.C.	CVS PHARMACY # 17445	4300 VETERANS MEMORIAL DR	BATAVIA	NY	14020	10/01/2021
FQHCLA344D	CVS ALBANY, L.L.C.	CVS PHARMACY # 17445	4300 VETERANS MEMORIAL DR	BATAVIA	NY	14020	10/01/2021
FQHCLA344E	CVS ALBANY, L.L.C.	CVS PHARMACY # 17445	4300 VETERANS MEMORIAL DR	BATAVIA	NY	14020	10/01/2021
FQHCLA344F	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05072	225 MAIN STREET	DANSVILLE	NY	14437	10/01/2022
FQHCLA344F	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05074	100 E. NAPLES ST.	WAYLAND	NY	14572	10/01/2022
FQHCLA344F	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00232	277 E. MAIN ST.	AVON	NY	14414	10/01/2022
FQHCLA344F	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 05073	15 HONEOYE COMMONS	HONEOYE	NY	14471	10/01/2022
FQHCLA344F	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 01925	1259 ROUTE 332	FARMINGTON	NY	14425	10/01/2022
FQHCLA344F	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 00586	525 SPENCERPORT RD GATES SHOPPING PLZ	ROCHESTER	NY	14606	10/01/2022
FQHCLA344F	CVS ALBANY, L.L.C.	CVS PHARMACY # 17445	4300 VETERANS MEMORIAL DR	BATAVIA	NY	14020	10/01/2022
FQHCLA344	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2021
FQHCLA344A	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2021
FQHCLA344B	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2021
FQHCLA344C	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2021
FQHCLA344D	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2021
FQHCLA344E	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2021
FQHCLA344F	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2022
FQHCLA344	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2021
FQHCLA344A	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2021
FQHCLA344B	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2021
FQHCLA344C	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2021
FQHCLA344D	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2021
FQHCLA344E	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2021
FQHCLA344F	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2022
FQHCLA344	ECKERD CORPORATION	RITE AID #10879	12 PARK DRIVE	HORNELL	NY	14843	01/01/2018	02/28/2018
FQHCLA344A	ECKERD CORPORATION	RITE AID #10879	12 PARK DRIVE	HORNELL	NY	14843	01/01/2018	02/28/2018
FQHCLA344B	ECKERD CORPORATION	RITE AID #10879	12 PARK DRIVE	HORNELL	NY	14843	01/01/2018	02/28/2018
FQHCLA344C	ECKERD CORPORATION	RITE AID #10879	12 PARK DRIVE	HORNELL	NY	14843	01/01/2018	02/28/2018
FQHCLA344D	ECKERD CORPORATION	RITE AID #10879	12 PARK DRIVE	HORNELL	NY	14843	01/01/2018	02/28/2018
FQHCLA344E	ECKERD CORPORATION	RITE AID #10879	12 PARK DRIVE	HORNELL	NY	14843	01/01/2018	02/28/2018
FQHCLA344F	ECKERD CORPORATION	RITE AID #10879	12 PARK DRIVE	HORNELL	NY	14843	10/01/2022	10/01/2022
FQHCLA344	NUNDA FAMILY PHARMACY LLC	12 NORTH STATE STREET	ATTN: SUPERVISING PHARMACIST	NUNDA	NY	14517-0518	10/01/2017	01/03/2018
FQHCLA344D	NUNDA FAMILY PHARMACY LLC	12 NORTH STATE STREET	ATTN: SUPERVISING PHARMACIST	NUNDA	NY	14517-0518	10/01/2017	01/03/2018
FQHCLA344C	NUNDA FAMILY PHARMACY LLC	12 NORTH STATE STREET	ATTN: SUPERVISING PHARMACIST	NUNDA	NY	14517-0518	10/01/2017	01/03/2018
FQHCLA344B	NUNDA FAMILY PHARMACY LLC	12 NORTH STATE STREET	ATTN: SUPERVISING PHARMACIST	NUNDA	NY	14517-0518	10/01/2017	01/03/2018
FQHCLA344A	NUNDA FAMILY PHARMACY LLC	12 NORTH STATE STREET	ATTN: SUPERVISING PHARMACIST	NUNDA	NY	14517-0518	10/01/2017	01/03/2018
FQHCLA344E	NUNDA FAMILY PHARMACY LLC	12 NORTH STATE STREET	ATTN: SUPERVISING PHARMACIST	NUNDA	NY	14517-0518	10/01/2017	01/03/2018
FQHCLA344	QUINLAN'S PHARMACY INC	QUINLAN'S MEDICAL EQUIPMENT AND SUPPLY	107 N MAIN ST	WAYLAND	NY	14572-1033	04/01/2017
FQHCLA344D	QUINLAN'S PHARMACY INC	QUINLAN'S MEDICAL EQUIPMENT AND SUPPLY	107 N MAIN ST	WAYLAND	NY	14572-1033	04/01/2017
FQHCLA344C	QUINLAN'S PHARMACY INC	QUINLAN'S MEDICAL EQUIPMENT AND SUPPLY	107 N MAIN ST	WAYLAND	NY	14572-1033	04/01/2017
FQHCLA344B	QUINLAN'S PHARMACY INC	QUINLAN'S MEDICAL EQUIPMENT AND SUPPLY	107 N MAIN ST	WAYLAND	NY	14572-1033	04/01/2017
FQHCLA344A	QUINLAN'S PHARMACY INC	QUINLAN'S MEDICAL EQUIPMENT AND SUPPLY	107 N MAIN ST	WAYLAND	NY	14572-1033	04/01/2017
FQHCLA344E	QUINLAN'S PHARMACY INC	QUINLAN'S MEDICAL EQUIPMENT AND SUPPLY	107 N MAIN ST	WAYLAND	NY	14572-1033	04/01/2017
FQHCLA344F	QUINLAN'S PHARMACY INC	QUINLAN'S MEDICAL EQUIPMENT AND SUPPLY	107 N MAIN ST	WAYLAND	NY	14572-1033	10/01/2022
FQHCLA344	RITE AID OF NEW YORK, INC.	RITE AID #1871	40 EAST STATE STREET	MT MORRIS	NY	14510	01/01/2018	02/28/2018
FQHCLA344A	RITE AID OF NEW YORK, INC.	RITE AID #1871	40 EAST STATE STREET	MT MORRIS	NY	14510	01/01/2018	02/28/2018
FQHCLA344B	RITE AID OF NEW YORK, INC.	RITE AID #1871	40 EAST STATE STREET	MT MORRIS	NY	14510	01/01/2018	02/28/2018
FQHCLA344C	RITE AID OF NEW YORK, INC.	RITE AID #1871	40 EAST STATE STREET	MT MORRIS	NY	14510	01/01/2018	02/28/2018
FQHCLA344D	RITE AID OF NEW YORK, INC.	RITE AID #1871	40 EAST STATE STREET	MT MORRIS	NY	14510	01/01/2018	02/28/2018
FQHCLA344E	RITE AID OF NEW YORK, INC.	RITE AID #1871	40 EAST STATE STREET	MT MORRIS	NY	14510	01/01/2018	02/28/2018
FQHCLA344	RITE AID OF NEW YORK, INC.	RITE AID #686	9519 FOSTER WHEELER ROAD	DANSVILLE	NY	14437	01/01/2018	02/28/2018
FQHCLA344A	RITE AID OF NEW YORK, INC.	RITE AID #686	9519 FOSTER WHEELER ROAD	DANSVILLE	NY	14437	01/01/2018	02/28/2018
FQHCLA344B	RITE AID OF NEW YORK, INC.	RITE AID #686	9519 FOSTER WHEELER ROAD	DANSVILLE	NY	14437	01/01/2018	02/28/2018
FQHCLA344C	RITE AID OF NEW YORK, INC.	RITE AID #686	9519 FOSTER WHEELER ROAD	DANSVILLE	NY	14437	01/01/2018	02/28/2018
FQHCLA344D	RITE AID OF NEW YORK, INC.	RITE AID #686	9519 FOSTER WHEELER ROAD	DANSVILLE	NY	14437	01/01/2018	02/28/2018
FQHCLA344E	RITE AID OF NEW YORK, INC.	RITE AID #686	9519 FOSTER WHEELER ROAD	DANSVILLE	NY	14437	01/01/2018	02/28/2018
FQHCLA344	RITE AID OF NEW YORK, INC.	RITE AID #3983	338 WEST WASHINGTON STREET	BATH	NY	14810	01/01/2018	07/31/2023
FQHCLA344A	RITE AID OF NEW YORK, INC.	RITE AID #3983	338 WEST WASHINGTON STREET	BATH	NY	14810	01/01/2018	07/31/2023
FQHCLA344B	RITE AID OF NEW YORK, INC.	RITE AID #3983	338 WEST WASHINGTON STREET	BATH	NY	14810	01/01/2018	07/31/2023
FQHCLA344C	RITE AID OF NEW YORK, INC.	RITE AID #3983	338 WEST WASHINGTON STREET	BATH	NY	14810	01/01/2018	07/31/2023
FQHCLA344D	RITE AID OF NEW YORK, INC.	RITE AID #3983	338 WEST WASHINGTON STREET	BATH	NY	14810	01/01/2018	07/31/2023
FQHCLA344E	RITE AID OF NEW YORK, INC.	RITE AID #3983	338 WEST WASHINGTON STREET	BATH	NY	14810	01/01/2018	07/31/2023
FQHCLA344	RITE AID OF NEW YORK, INC.	RITE AID #782	128 NORTH CENTER STREET	PERRY	NY	14530	01/01/2018	02/28/2018
FQHCLA344A	RITE AID OF NEW YORK, INC.	RITE AID #782	128 NORTH CENTER STREET	PERRY	NY	14530	01/01/2018	02/28/2018
FQHCLA344B	RITE AID OF NEW YORK, INC.	RITE AID #782	128 NORTH CENTER STREET	PERRY	NY	14530	01/01/2018	02/28/2018
FQHCLA344C	RITE AID OF NEW YORK, INC.	RITE AID #782	128 NORTH CENTER STREET	PERRY	NY	14530	01/01/2018	02/28/2018
FQHCLA344D	RITE AID OF NEW YORK, INC.	RITE AID #782	128 NORTH CENTER STREET	PERRY	NY	14530	01/01/2018	02/28/2018
FQHCLA344E	RITE AID OF NEW YORK, INC.	RITE AID #782	128 NORTH CENTER STREET	PERRY	NY	14530	01/01/2018	02/28/2018
FQHCLA344F	RITE AID OF NEW YORK, INC.	RITE AID #3983	338 WEST WASHINGTON STREET	BATH	NY	14810	10/01/2022	07/31/2023
FQHCLA344	TOPS MARKETS	TOPS PHARMACY #539	309 W MORRIS STREET	BATH	NY	14810	01/01/2024
FQHCLA344A	TOPS MARKETS	TOPS PHARMACY #539	309 W MORRIS STREET	BATH	NY	14810	01/01/2024
FQHCLA344B	TOPS MARKETS	TOPS PHARMACY #539	309 W MORRIS STREET	BATH	NY	14810	01/01/2024
FQHCLA344C	TOPS MARKETS	TOPS PHARMACY #539	309 W MORRIS STREET	BATH	NY	14810	01/01/2024
FQHCLA344D	TOPS MARKETS	TOPS PHARMACY #539	309 W MORRIS STREET	BATH	NY	14810	01/01/2024
FQHCLA344E	TOPS MARKETS	TOPS PHARMACY #539	309 W MORRIS STREET	BATH	NY	14810	01/01/2024
FQHCLA344F	TOPS MARKETS	TOPS PHARMACY #539	309 W MORRIS STREET	BATH	NY	14810	01/01/2024
FQHCLA344	TOPS MARKETS LLC	TOPS PHARMACY #520	35 FRANKLIN PLAZA	DANSVILLE	NY	14437	07/01/2021
FQHCLA344A	TOPS MARKETS LLC	TOPS PHARMACY #520	35 FRANKLIN PLAZA	DANSVILLE	NY	14437	07/01/2021
FQHCLA344B	TOPS MARKETS LLC	TOPS PHARMACY #520	35 FRANKLIN PLAZA	DANSVILLE	NY	14437	07/01/2021
FQHCLA344C	TOPS MARKETS LLC	TOPS PHARMACY #520	35 FRANKLIN PLAZA	DANSVILLE	NY	14437	07/01/2021
FQHCLA344D	TOPS MARKETS LLC	TOPS PHARMACY #520	35 FRANKLIN PLAZA	DANSVILLE	NY	14437	07/01/2021
FQHCLA344E	TOPS MARKETS LLC	TOPS PHARMACY #520	35 FRANKLIN PLAZA	DANSVILLE	NY	14437	07/01/2021
FQHCLA344F	TOPS MARKETS LLC	TOPS PHARMACY #520	35 FRANKLIN PLAZA	DANSVILLE	NY	14437	10/01/2022
FQHCLA344	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018
FQHCLA344A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018
FQHCLA344B	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018
FQHCLA344C	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018
FQHCLA344D	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018
FQHCLA344E	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2018
FQHCLA344F	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2022
FQHCLA344	WAL-MART PHARMACY 10-1966	4235 VETERAN DRIVE		GENESEO	NY	14454	04/01/2017
FQHCLA344D	WAL-MART PHARMACY 10-1966	4235 VETERAN DRIVE		GENESEO	NY	14454	04/01/2017
FQHCLA344C	WAL-MART PHARMACY 10-1966	4235 VETERAN DRIVE		GENESEO	NY	14454	04/01/2017
FQHCLA344B	WAL-MART PHARMACY 10-1966	4235 VETERAN DRIVE		GENESEO	NY	14454	04/01/2017
FQHCLA344A	WAL-MART PHARMACY 10-1966	4235 VETERAN DRIVE		GENESEO	NY	14454	04/01/2017
FQHCLA344E	WAL-MART PHARMACY 10-1966	4235 VETERAN DRIVE		GENESEO	NY	14454	04/01/2017
FQHCLA344F	WAL-MART PHARMACY 10-1966	4235 VETERAN DRIVE		GENESEO	NY	14454	10/01/2022
FQHCLA344	WAL-MART PHARMACY 10-2326	1000 STATE ROUTE 36		HORNELL	NY	14843	04/01/2017
FQHCLA344D	WAL-MART PHARMACY 10-2326	1000 STATE ROUTE 36		HORNELL	NY	14843	04/01/2017
FQHCLA344C	WAL-MART PHARMACY 10-2326	1000 STATE ROUTE 36		HORNELL	NY	14843	04/01/2017
FQHCLA344B	WAL-MART PHARMACY 10-2326	1000 STATE ROUTE 36		HORNELL	NY	14843	04/01/2017
FQHCLA344A	WAL-MART PHARMACY 10-2326	1000 STATE ROUTE 36		HORNELL	NY	14843	04/01/2017
FQHCLA344E	WAL-MART PHARMACY 10-2326	1000 STATE ROUTE 36		HORNELL	NY	14843	04/01/2017
FQHCLA344F	WAL-MART PHARMACY 10-2326	1000 STATE ROUTE 36		HORNELL	NY	14843	10/01/2022
FQHCLA344	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
FQHCLA344D	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
FQHCLA344C	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
FQHCLA344B	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
FQHCLA344A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
FQHCLA344E	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017	10/10/2017
FQHCLA344E	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2021
FQHCLA344F	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2022
FQHCLA344	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19760	12 PARK DR	HORNELL	NY	14843	03/02/2018
FQHCLA344	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17396	21 E STATE ST	MOUNT MORRIS	NY	14510	03/02/2018
FQHCLA344	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19766	9519 FOSTER WHEELER RD	DANSVILLE	NY	14437	03/02/2018
FQHCLA344	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19739	128 N CENTER ST	PERRY	NY	14530	03/02/2018
FQHCLA344A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19760	12 PARK DR	HORNELL	NY	14843	04/01/2018
FQHCLA344A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17396	21 E STATE ST	MOUNT MORRIS	NY	14510	04/01/2018
FQHCLA344A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19766	9519 FOSTER WHEELER RD	DANSVILLE	NY	14437	04/01/2018
FQHCLA344A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19739	128 N CENTER ST	PERRY	NY	14530	04/01/2018
FQHCLA344B	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19760	12 PARK DR	HORNELL	NY	14843	04/01/2018
FQHCLA344B	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17396	21 E STATE ST	MOUNT MORRIS	NY	14510	04/01/2018
FQHCLA344B	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19766	9519 FOSTER WHEELER RD	DANSVILLE	NY	14437	04/01/2018
FQHCLA344B	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19739	128 N CENTER ST	PERRY	NY	14530	04/01/2018
FQHCLA344C	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19760	12 PARK DR	HORNELL	NY	14843	04/01/2018
FQHCLA344C	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17396	21 E STATE ST	MOUNT MORRIS	NY	14510	04/01/2018
FQHCLA344C	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19766	9519 FOSTER WHEELER RD	DANSVILLE	NY	14437	04/01/2018
FQHCLA344C	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19739	128 N CENTER ST	PERRY	NY	14530	04/01/2018
FQHCLA344D	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19760	12 PARK DR	HORNELL	NY	14843	04/01/2018
FQHCLA344D	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17396	21 E STATE ST	MOUNT MORRIS	NY	14510	04/01/2018
FQHCLA344D	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19766	9519 FOSTER WHEELER RD	DANSVILLE	NY	14437	04/01/2018
FQHCLA344D	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19739	128 N CENTER ST	PERRY	NY	14530	04/01/2018
FQHCLA344E	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19760	12 PARK DR	HORNELL	NY	14843	04/01/2018
FQHCLA344E	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17396	21 E STATE ST	MOUNT MORRIS	NY	14510	04/01/2018
FQHCLA344E	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19766	9519 FOSTER WHEELER RD	DANSVILLE	NY	14437	04/01/2018
FQHCLA344E	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19739	128 N CENTER ST	PERRY	NY	14530	04/01/2018
FQHCLA344	WALGREEN EASTERN CO., INC.	WALGREENS #18364	135 W MAIN ST	HONEOYE FALLS	NY	14472	07/01/2019	12/31/2023
FQHCLA344A	WALGREEN EASTERN CO., INC.	WALGREENS #18364	135 W MAIN ST	HONEOYE FALLS	NY	14472	07/01/2019	12/31/2023
FQHCLA344B	WALGREEN EASTERN CO., INC.	WALGREENS #18364	135 W MAIN ST	HONEOYE FALLS	NY	14472	07/01/2019	12/31/2023
FQHCLA344C	WALGREEN EASTERN CO., INC.	WALGREENS #18364	135 W MAIN ST	HONEOYE FALLS	NY	14472	07/01/2019	12/31/2023
FQHCLA344D	WALGREEN EASTERN CO., INC.	WALGREENS #18364	135 W MAIN ST	HONEOYE FALLS	NY	14472	07/01/2019	12/31/2023
FQHCLA344E	WALGREEN EASTERN CO., INC.	WALGREENS #18364	135 W MAIN ST	HONEOYE FALLS	NY	14472	07/01/2019	12/31/2023
FQHCLA344F	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19760	12 PARK DR	HORNELL	NY	14843	10/01/2022
FQHCLA344F	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17396	21 E STATE ST	MOUNT MORRIS	NY	14510	10/01/2022
FQHCLA344F	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19766	9519 FOSTER WHEELER RD	DANSVILLE	NY	14437	10/01/2022
FQHCLA344F	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19739	128 N CENTER ST	PERRY	NY	14530	10/01/2022
FQHCLA344F	WALGREEN EASTERN CO., INC.	WALGREENS #18364	135 W MAIN ST	HONEOYE FALLS	NY	14472	10/01/2022	12/31/2023
FQHCLA344	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11716	321 W. WASHINGTON ST.	BATH	NY	14810-1017	01/01/2024
FQHCLA344A	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11716	321 W. WASHINGTON ST.	BATH	NY	14810-1017	01/01/2024
FQHCLA344B	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11716	321 W. WASHINGTON ST.	BATH	NY	14810-1017	01/01/2024
FQHCLA344C	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11716	321 W. WASHINGTON ST.	BATH	NY	14810-1017	01/01/2024
FQHCLA344D	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11716	321 W. WASHINGTON ST.	BATH	NY	14810-1017	01/01/2024
FQHCLA344E	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11716	321 W. WASHINGTON ST.	BATH	NY	14810-1017	01/01/2024
FQHCLA344F	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11716	321 W. WASHINGTON ST.	BATH	NY	14810-1017	01/01/2024
FQHCLA344	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	10/01/2017	10/10/2017
FQHCLA344D	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	10/01/2017	10/10/2017
FQHCLA344C	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	10/01/2017	10/10/2017
FQHCLA344B	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	10/01/2017	10/10/2017
FQHCLA344A	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	10/01/2017	10/10/2017
FQHCLA344E	WALMART PHARMACY 10-3585	2901 RILEY FUZZELL RD		SPRING	TX	77386	10/01/2017	10/01/2017
FQHCLA344	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
FQHCLA344A	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
FQHCLA344B	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
FQHCLA344C	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
FQHCLA344D	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
FQHCLA344E	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
FQHCLA344F	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
FQHCLA344	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
FQHCLA344A	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
FQHCLA344B	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
FQHCLA344C	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
FQHCLA344D	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
FQHCLA344E	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
FQHCLA344F	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
FQHCLA344	WEGMANS FOOD MARKETS, INC.	4287 GENESEE VALLEY PLAZA	ATTN: PHARMACY	GENESEO	NY	14454	01/01/2018
FQHCLA344A	WEGMANS FOOD MARKETS, INC.	4287 GENESEE VALLEY PLAZA	ATTN: PHARMACY	GENESEO	NY	14454	01/01/2018
FQHCLA344B	WEGMANS FOOD MARKETS, INC.	4287 GENESEE VALLEY PLAZA	ATTN: PHARMACY	GENESEO	NY	14454	01/01/2018
FQHCLA344C	WEGMANS FOOD MARKETS, INC.	4287 GENESEE VALLEY PLAZA	ATTN: PHARMACY	GENESEO	NY	14454	01/01/2018
FQHCLA344D	WEGMANS FOOD MARKETS, INC.	4287 GENESEE VALLEY PLAZA	ATTN: PHARMACY	GENESEO	NY	14454	01/01/2018
FQHCLA344E	WEGMANS FOOD MARKETS, INC.	4287 GENESEE VALLEY PLAZA	ATTN: PHARMACY	GENESEO	NY	14454	01/01/2018
FQHCLA344	WEGMANS FOOD MARKETS, INC.	2851 BROADWAY	ATTN: PHARMACY	CHEEKTOWAGA	NY	14227	07/01/2019	04/01/2021
FQHCLA344A	WEGMANS FOOD MARKETS, INC.	2851 BROADWAY	ATTN: PHARMACY	CHEEKTOWAGA	NY	14227	07/01/2019	04/01/2021
FQHCLA344B	WEGMANS FOOD MARKETS, INC.	2851 BROADWAY	ATTN: PHARMACY	CHEEKTOWAGA	NY	14227	07/01/2019	04/01/2021
FQHCLA344C	WEGMANS FOOD MARKETS, INC.	2851 BROADWAY	ATTN: PHARMACY	CHEEKTOWAGA	NY	14227	07/01/2019	04/01/2021
FQHCLA344D	WEGMANS FOOD MARKETS, INC.	2851 BROADWAY	ATTN: PHARMACY	CHEEKTOWAGA	NY	14227	07/01/2019	04/01/2021
FQHCLA344E	WEGMANS FOOD MARKETS, INC.	2851 BROADWAY	ATTN: PHARMACY	CHEEKTOWAGA	NY	14227	07/01/2019	04/01/2021
FQHCLA344	WEGMANS FOOD MARKETS, INC.	1000 HIGHWAY 36 NORTH	ATTN: PHARMACY	HORNELL	NY	14843	07/01/2019
FQHCLA344A	WEGMANS FOOD MARKETS, INC.	1000 HIGHWAY 36 NORTH	ATTN: PHARMACY	HORNELL	NY	14843	07/01/2019
FQHCLA344B	WEGMANS FOOD MARKETS, INC.	1000 HIGHWAY 36 NORTH	ATTN: PHARMACY	HORNELL	NY	14843	07/01/2019
FQHCLA344C	WEGMANS FOOD MARKETS, INC.	1000 HIGHWAY 36 NORTH	ATTN: PHARMACY	HORNELL	NY	14843	07/01/2019
FQHCLA344D	WEGMANS FOOD MARKETS, INC.	1000 HIGHWAY 36 NORTH	ATTN: PHARMACY	HORNELL	NY	14843	07/01/2019
FQHCLA344E	WEGMANS FOOD MARKETS, INC.	1000 HIGHWAY 36 NORTH	ATTN: PHARMACY	HORNELL	NY	14843	07/01/2019
FQHCLA344	WEGMANS FOOD MARKETS, INC.	745 CALKINS ROAD	ATTN: PHARMACY	ROCHESTER	NY	14623	07/01/2019
FQHCLA344A	WEGMANS FOOD MARKETS, INC.	745 CALKINS ROAD	ATTN: PHARMACY	ROCHESTER	NY	14623	07/01/2019
FQHCLA344B	WEGMANS FOOD MARKETS, INC.	745 CALKINS ROAD	ATTN: PHARMACY	ROCHESTER	NY	14623	07/01/2019
FQHCLA344C	WEGMANS FOOD MARKETS, INC.	745 CALKINS ROAD	ATTN: PHARMACY	ROCHESTER	NY	14623	07/01/2019
FQHCLA344D	WEGMANS FOOD MARKETS, INC.	745 CALKINS ROAD	ATTN: PHARMACY	ROCHESTER	NY	14623	07/01/2019
FQHCLA344E	WEGMANS FOOD MARKETS, INC.	745 CALKINS ROAD	ATTN: PHARMACY	ROCHESTER	NY	14623	07/01/2019
FQHCLA344	WEGMANS FOOD MARKETS, INC.	2873 BROADWAY ST	SUITE 100	CHEEKTOWAGA	NY	14227-1036	02/11/2021	10/02/2023
FQHCLA344A	WEGMANS FOOD MARKETS, INC.	2873 BROADWAY ST	SUITE 100	CHEEKTOWAGA	NY	14227-1036	02/11/2021	10/02/2023
FQHCLA344B	WEGMANS FOOD MARKETS, INC.	2873 BROADWAY ST	SUITE 100	CHEEKTOWAGA	NY	14227-1036	02/11/2021	10/02/2023
FQHCLA344C	WEGMANS FOOD MARKETS, INC.	2873 BROADWAY ST	SUITE 100	CHEEKTOWAGA	NY	14227-1036	02/11/2021	10/02/2023
FQHCLA344D	WEGMANS FOOD MARKETS, INC.	2873 BROADWAY ST	SUITE 100	CHEEKTOWAGA	NY	14227-1036	02/11/2021	10/02/2023
FQHCLA344E	WEGMANS FOOD MARKETS, INC.	2873 BROADWAY ST	SUITE 100	CHEEKTOWAGA	NY	14227-1036	02/11/2021	10/02/2023
FQHCLA344F	WEGMANS FOOD MARKETS, INC.	1000 HIGHWAY 36 NORTH	ATTN: PHARMACY	HORNELL	NY	14843	10/01/2022
FQHCLA344F	WEGMANS FOOD MARKETS, INC.	745 CALKINS ROAD	ATTN: PHARMACY	ROCHESTER	NY	14623	10/01/2022
FQHCLA344F	WEGMANS FOOD MARKETS, INC.	4287 GENESEE VALLEY PLAZA	ATTN: PHARMACY	GENESEO	NY	14454	10/01/2022
FQHCLA344F	WEGMANS FOOD MARKETS, INC.	2873 BROADWAY ST	SUITE 100	CHEEKTOWAGA	NY	14227-1036	10/01/2022	10/02/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Wright, Laurie 340B and Special Projects Coordinator Tri-County Family Medicine Program, Inc. 5852040964	Wright, Laurie 340B and Administrative Manager Tri-County Family Medicine Program, Inc. 5852040964	4/24/2025 2:20 PM
Details	Last Recertification Date	Update	Recertification	1/31/2024 1:49:54 PM	2/11/2025 3:58:20 PM	2/11/2025 3:58 PM
Contacts	Authorizing Official	Update	Change Request	Apostoleris, Nicholas H CSIO Tri-County Family Medicine Program, Inc. 5854322300	Stone, Karen Chief Executive Officer Tri-County Family Medicine Program, Inc. 5854322301	12/10/2024 10:34 AM
Contacts	Primary Contact	Update	Change Request	Stone, Karen Chief Executive Officer Tri-County Family Medicine Program, Inc. 5854322301	Wright, Laurie 340B and Special Projects Coordinator Tri-County Family Medicine Program, Inc. 5852040964	12/10/2024 10:34 AM
Addresses	Shipping Address	Insert	Change Request		Tri-County Family Medicine Program, Inc. / Tri-County Pharmacy 60 Red Jacket Street Suite 8 Dansville, NY 14437-1758	8/2/2024 1:48 PM
Contacts	Primary Contact	Update	Profile Change Request	Stone, Karen Executive Director Tri-County Family Medicine Program, Inc. 5854322301	Stone, Karen Chief Executive Officer Tri-County Family Medicine Program, Inc. 5854322301	5/30/2024 11:28 AM
Contacts	Authorizing Official	Update	Profile Change Request	Apostoleris, Nicholas H CSIO Tri-County Family Medicine Program, Inc. 5853353416	Apostoleris, Nicholas H CSIO Tri-County Family Medicine Program, Inc. 5854322300	5/30/2024 9:54 AM
Details	Last Recertification Date	Update	Recertification	2/16/2023 11:23:50 AM	1/31/2024 1:49:54 PM	1/31/2024 1:49 PM
Addresses	Billing Address	Update	Recertification	Tri County Family Medicine Program PO Box 601 Dansville, NY 14437	Tri-County Family Medicine Program, Inc. PO Box 601 Dansville, NY 14437	2/16/2023 11:23 AM
Contacts	Primary Contact	Update	Recertification	Kuhn, Kiera Director of Compliance Tri-County Family Medicine 5854322307	Stone, Karen Executive Director Tri-County Family Medicine Program, Inc. 5854322301	2/16/2023 11:23 AM
Details	Last Recertification Date	Update	Recertification	2/17/2022 3:30:18 PM	2/16/2023 11:23:50 AM	2/16/2023 11:23 AM
Details	Entity Name	Update	Recertification	TRI COUNTY FAMILY MEDICINE PROGRAM	Tri-County Family Medicine Program, Inc.	2/16/2023 11:23 AM
Contacts	Authorizing Official	Update	Profile Change Request	Apostoleris, Nicholas H CEO Tri-County Family Medicine Program 5853353416	Apostoleris, Nicholas H CSIO Tri-County Family Medicine Program, Inc. 5853353416	1/17/2023 8:49 AM
Addresses	Main Address	Update	Change Request	60 Red Jacket Street - Suite 1 Dansville, NY 14437-1758	60 Red Jacket St Ste 1 Dansville, NY 14437-1758	5/6/2022 12:10 PM
Addresses	Billing Address	Update	Change Request	Tri-County Family Medicine Program PO Box 601 Dansville, NY 14437	Tri County Family Medicine Program PO Box 601 Dansville, NY 14437	5/6/2022 12:10 PM
Details	Last Recertification Date	Update	Recertification	2/5/2021 12:37:51 PM	2/17/2022 3:30:18 PM	2/17/2022 3:30 PM
Details	Last Recertification Date	Update	Recertification	2/4/2020 9:58:15 AM	2/5/2021 12:37:51 PM	2/5/2021 12:37 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	00355257 (NY)		10/14/2020 9:39 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1588649503 ( )		10/14/2020 9:39 AM
Contacts	Primary Contact	Update	Recertification	Steinmetz, Teresa Accountant Tri-County Family Medicine Program 5853353100	Kuhn, Kiera Director of Compliance Tri-County Family Medicine 5854322307	2/4/2020 9:58 AM
Details	Last Recertification Date	Update	Recertification	2/14/2019 1:14:19 PM	2/4/2020 9:58:15 AM	2/4/2020 9:58 AM
Contacts	Primary Contact	Update	Recertification	Myers, Susan Admin Asst Tri-County Family Medicine Program 5853353416	Steinmetz, Teresa Accountant Tri-County Family Medicine Program 5853353100	2/14/2019 1:14 PM
Details	Last Recertification Date	Update	Recertification	2/14/2018 2:29:40 PM	2/14/2019 1:14:19 PM	2/14/2019 1:14 PM
Details	Last Recertification Date	Update	Recertification	1/30/2017 12:00:00 AM	2/14/2018 2:29:40 PM	2/14/2018 2:29 PM
Details	Grant Number	Update	Recertification	LAL000181	LALCS00181	2/14/2018 2:29 PM
Contacts	Authorizing Official	Update	Change Request	Wheaton, Joyce CEO Tri-County Family Medicine Program 5853353416	Apostoleris, Nicholas H CEO Tri-County Family Medicine Program 5853353416	1/3/2018 1:42 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		1/3/2018 1:42 PM
Contacts	Primary Contact	Update	Change Request	Myers, Susan Admin Asst 5853353416	Myers, Susan Admin Asst Tri-County Family Medicine Program 5853353416	1/3/2018 9:21 AM
Contacts	Authorizing Official	Update		Wheaton, Joyce CEO 5853353416	Wheaton, Joyce CEO Tri-County Family Medicine Program 5853353416	10/9/2017 1:36 PM
Contacts	Signed By	Update		Wheaton, Joyce CEO 5853353416	Wheaton, Joyce CEO Tri-County Family Medicine Program 5853353416	10/9/2017 1:36 PM
Contacts	Authorizing Official	Insert			Wheaton, Joyce CEO 5853353416	7/14/2017 4:27 PM
Contacts	Signed By	Insert			Wheaton, Joyce CEO 5853353416	7/14/2017 4:27 PM
Contacts	Primary Contact	Insert			Myers, Susan Admin Asst 5853353416	1/31/2017 11:34 AM
Addresses	Main Address	Insert			60 Red Jacket Street - Suite 1 Dansville, NY 14437-1758	1/30/2017 11:25 AM
Details	Last Recertification Date	Update			1/30/2017 12:00:00 AM	1/30/2017 11:25 AM
Addresses	Billing Address	Insert			Tri-County Family Medicine Program PO Box 601 Dansville, NY 14437	11/25/2016 5:44 PM
Dates	Participating Approval Date	Update			11/25/2016 12:00:00 AM	11/25/2016 5:44 PM
Details	State	Update		Pending	Active	11/25/2016 5:44 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	11/25/2016 5:44 PM
Details	340B ID	Update		ONLINE_REG_72263	FQHCLA344C	10/17/2016 8:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/3/2016 3:46 PM
Medicaid Billing	Medicaid: Number	Insert			00355257	10/3/2016 3:46 PM
Medicaid Billing	Medicaid: State	Insert			NY	10/3/2016 3:46 PM
Medicaid Billing	NPI: Number	Insert			1588649503	10/3/2016 3:46 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_72263	10/3/2016 3:46 PM
Details	Last Recertification Date	Insert				10/3/2016 3:46 PM
Details	Grant Number	Insert			LAL000181	10/3/2016 3:46 PM
Details	340B ID	Insert			ONLINE_REG	10/3/2016 3:46 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/3/2016 3:46 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/3/2016 3:46 PM
Details	Medicare Provider Number	Insert				10/3/2016 3:46 PM
Details	Entity Name	Insert			TRI COUNTY FAMILY MEDICINE PROGRAM	10/3/2016 3:46 PM
Details	Program Code	Insert			FQHCLA	10/3/2016 3:46 PM
Details	Entity Subname	Insert			TCFM Dansville	10/3/2016 3:46 PM
Dates	Participating Approval Date	Insert				10/3/2016 3:46 PM
Details	State	Insert			Pending	10/3/2016 3:46 PM
Dates	Registration Date	Insert			10/3/2016 12:00:00 AM	10/3/2016 3:46 PM
Dates	Signed By Date	Insert			10/3/2016 12:00:00 AM	10/3/2016 3:46 PM
Dates	Start Date	Insert				10/3/2016 3:46 PM
Terminations	Termination Comments	Insert				10/3/2016 3:46 PM
Terminations	Termination Date	Insert				10/3/2016 3:46 PM
Terminations	Termination Effective Date	Insert				10/3/2016 3:46 PM
Terminations	Termination Reason	Insert				10/3/2016 3:46 PM

340B Drug Pricing Program Database