Covered Entity Details

CHC26573-00 TRAVERSE HEALTH CLINIC AND COALITION (Active) - information as of 5/6/2025 12:01:25 AM

Main Details

Name

TRAVERSE HEALTH CLINIC AND COALITION

Subdivision Name

Traverse Health Clinic and Coalition

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017088

340B ID

CHC26573-00

Grant Number

H80CS26573

Additional Details

Current Program Status

Active

Registration Date

1/4/2017

Participating Start Date

4/1/2017

Participating Approval Date

2/17/2017

Last Recertification Date

2/24/2025

Contacts

Authorizing Official

Traverse Health Clinic
Casey Kandow, Chief Executive Officer
(231) 642-5813

Primary Contact

Traverse Health Clinic
Rebecca Jenema, Business and Finance Manager
(231) 642-5931

Addresses

Street Address

1719 S. Garfield Ave.
Traverse City, MI 49686

Billing Address
Same as Street Address

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

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
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	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	03/24/2017	04/01/2017	04/25/2018	07/17/2018
Contract Detail	MEIJER INC #33	3955 U.S. 31 SOUTH HWY		TRAVERSE CITY	MI	49684	03/24/2017	04/01/2017	04/25/2018	07/17/2018
Contract Detail	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	03/24/2017	04/01/2017	04/25/2018	07/17/2018
Contract Detail	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	03/24/2017	04/01/2017	04/25/2018	07/17/2018
Contract Detail	PDS-I MICHIGAN, INC.	RITE AID #4586	1104 E FRONT ST	TRAVERSE CITY	MI	49686	04/15/2024	07/01/2024	07/01/2024	07/22/2024
Contract Detail	RITE AID OF MICHIGAN, INC.	RITE AID #1010	13916 S.W. BAY SHORE DRIVE	TRAVERSE CITY	MI	49684	04/15/2024	07/01/2024	07/01/2024	07/22/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	03/24/2017	04/01/2017		03/24/2017
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/17/2018	10/01/2018		10/01/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07874	3900 N US 31 S	TRAVERSE CITY	MI	49684-4447	04/06/2018	07/01/2018		04/06/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10186	1029 M 37 S	TRAVERSE CITY	MI	49685	04/06/2018	07/01/2018		04/06/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07369	2350 US 31 NORTH	TRAVERSE CITY	MI	49686	04/06/2018	07/01/2018		04/06/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12894	975 W SOUTH AIRPORT ROAD	TRAVERSE CITY	MI	49686-4846	04/06/2018	07/01/2018		04/06/2018
Contract Detail	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	10/09/2023	01/01/2024		01/01/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/17/2023	04/01/2023		04/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/09/2023	01/01/2024		01/01/2024
Contract Detail	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 6843	626 WEST FRONT ST.	TRAVERSE CITY	MI	49684	07/11/2024	10/01/2024		10/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC26573-00	Active	BPS-H80-017088	TRAVERSE HEALTH CLINIC AND COALITION	Traverse Health Clinic and Coalition	1719 S. Garfield Ave.		Traverse City	MI
CHC26573-01	Active	BPS-H80-034738	Traverse Health Clinic and Coalition	Traverse Health Clinic and Coalition Mobile Medical Unit #1	1719 S Garfield Ave		Traverse City	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC26573-00	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	04/01/2017	04/25/2018
CHC26573-00	MEIJER INC #33	3955 U.S. 31 SOUTH HWY		TRAVERSE CITY	MI	49684	04/01/2017	04/25/2018
CHC26573-00	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	04/01/2017	04/25/2018
CHC26573-00	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	04/01/2017	04/25/2018
CHC26573-00	PDS-I MICHIGAN, INC.	RITE AID #4586	1104 E FRONT ST	TRAVERSE CITY	MI	49686	07/01/2024	07/01/2024
CHC26573-00	RITE AID OF MICHIGAN, INC.	RITE AID #1010	13916 S.W. BAY SHORE DRIVE	TRAVERSE CITY	MI	49684	07/01/2024	07/01/2024
CHC26573-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CHC26573-00	WAL-MART PHARMACY 10-2338	2640 CROSSING CIRCLE		TRAVERSE CITY	MI	49684	04/01/2017
CHC26573-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CHC26573-00	WALGREEN CO.	DBA: WALGREENS # 07874	3900 N US 31 S	TRAVERSE CITY	MI	49684-4447	07/01/2018
CHC26573-00	WALGREEN CO.	DBA: WALGREENS # 10186	1029 M 37 S	TRAVERSE CITY	MI	49685	07/01/2018
CHC26573-00	WALGREEN CO.	DBA: WALGREENS # 07369	2350 US 31 NORTH	TRAVERSE CITY	MI	49686	07/01/2018
CHC26573-00	WALGREEN CO.	DBA: WALGREENS #12894	975 W SOUTH AIRPORT ROAD	TRAVERSE CITY	MI	49686-4846	07/01/2018
CHC26573-01	WALGREEN CO.	DBA: WALGREENS # 10186	1029 M 37 S	TRAVERSE CITY	MI	49685	01/01/2025
CHC26573-00	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CHC26573-01	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CHC26573-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CHC26573-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CHC26573-00	WOODWARD DETROIT CVS, L.L.C.	DBA CVS/PHARMACY # 6843	626 WEST FRONT ST.	TRAVERSE CITY	MI	49684	10/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/5/2024 10:41:02 AM	2/24/2025 11:02:52 AM	2/24/2025 11:02 AM
Contacts	Authorizing Official	Update	Change Request	Tharp, Krista Corporate Compliance and Risk Officer Traverse Health Clinic 2319350799-5936	Kandow, Casey Chief Executive Officer Traverse Health Clinic 2316425813	1/28/2025 1:08 PM
Contacts	Primary Contact	Update	Change Request	Campbell, Tricia Director of Finance Traverse Health Clinic 2319350799-5931	Jenema, Rebecca Business and Finance Manager Traverse Health Clinic 2316425931	1/15/2025 8:18 AM
Details	Last Recertification Date	Update	Recertification	2/7/2023 6:29:45 PM	2/5/2024 10:41:02 AM	2/5/2024 10:41 AM
Contacts	Authorizing Official	Update	Change Request	Brennan, Arlene CEO Traverse Health Clinic 2316425935	Tharp, Krista Corporate Compliance and Risk Officer Traverse Health Clinic 2319350799-5936	10/5/2023 3:06 PM
Details	Last Recertification Date	Update	Recertification	2/23/2022 3:44:58 PM	2/7/2023 6:29:45 PM	2/7/2023 6:29 PM
Contacts	Primary Contact	Update	Change Request	Sailors, Amanda CFO Traverse Health Clinic 2316425931	Campbell, Tricia Director of Finance Traverse Health Clinic 2319350799-5931	1/23/2023 1:40 PM
Details	Last Recertification Date	Update	Recertification	2/20/2021 1:03:23 PM	2/23/2022 3:44:58 PM	2/23/2022 3:44 PM
Contacts	Primary Contact	Update	Profile Change Request	Sailors, Amanda Finance Manager Traverse Health Clinic 2316425931	Sailors, Amanda CFO Traverse Health Clinic 2316425931	2/3/2022 11:02 AM
Details	Last Recertification Date	Update	Recertification	2/9/2020 2:22:44 PM	2/20/2021 1:03:23 PM	2/20/2021 1:03 PM
Details	Last Recertification Date	Update	Recertification	2/20/2019 5:58:06 PM	2/9/2020 2:22:44 PM	2/9/2020 2:22 PM
Details	Last Recertification Date	Update	Recertification	2/9/2018 1:39:11 PM	2/20/2019 5:58:06 PM	2/20/2019 5:58 PM
Contacts	Primary Contact	Update	Recertification	Brennan, Arlene CEO Traverse Health Clinic 2316425935	Sailors, Amanda Finance Manager Traverse Health Clinic 2316425931	2/9/2018 1:39 PM
Details	Last Recertification Date	Update	Recertification		2/9/2018 1:39:11 PM	2/9/2018 1:39 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/9/2018 1:39 PM
Contacts	Authorizing Official	Update		Brennan, Arlene CEO 2316425935	Brennan, Arlene CEO Traverse Health Clinic 2316425935	2/9/2018 1:29 PM
Contacts	Primary Contact	Update		Brennan, Arlene CEO 2316425935	Brennan, Arlene CEO Traverse Health Clinic 2316425935	2/9/2018 1:29 PM
Contacts	Signed By	Update		Brennan, Arlene CEO 2316425935	Brennan, Arlene CEO Traverse Health Clinic 2316425935	2/9/2018 1:29 PM
Contacts	Authorizing Official	Insert			Brennan, Arlene CEO 2316425935	3/24/2017 12:17 PM
Contacts	Primary Contact	Insert			Brennan, Arlene CEO 2316425935	3/24/2017 12:17 PM
Contacts	Signed By	Insert			Brennan, Arlene CEO 2316425935	3/24/2017 12:17 PM
Addresses	Main Address	Insert			1719 S. Garfield Ave. Traverse City, MI 49686	2/17/2017 3:57 PM
Dates	Participating Approval Date	Update			2/17/2017 12:00:00 AM	2/17/2017 3:57 PM
Details	State	Update		Pending	Active	2/17/2017 3:57 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	2/17/2017 3:57 PM
Details	340B ID	Update		ONLINE_REG_73703	CHC26573-00	2/14/2017 4:18 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_73703	1/4/2017 10:08 AM
Details	Last Recertification Date	Insert				1/4/2017 10:08 AM
Details	Grant Number	Insert			H80CS26573	1/4/2017 10:08 AM
Details	340B ID	Insert			ONLINE_REG	1/4/2017 10:08 AM
Details	Is Authorizing Official EHB Data	Insert			False	1/4/2017 10:08 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/4/2017 10:08 AM
Details	Medicare Provider Number	Insert				1/4/2017 10:08 AM
Details	Entity Name	Insert			TRAVERSE HEALTH CLINIC AND COALITION	1/4/2017 10:08 AM
Details	Program Code	Insert			CH	1/4/2017 10:08 AM
Details	Entity Subname	Insert			Traverse Health Clinic and Coalition	1/4/2017 10:08 AM
Dates	Participating Approval Date	Insert				1/4/2017 10:08 AM
Details	State	Insert			Pending	1/4/2017 10:08 AM
Dates	Registration Date	Insert			1/4/2017 12:00:00 AM	1/4/2017 10:08 AM
Dates	Signed By Date	Insert			1/4/2017 12:00:00 AM	1/4/2017 10:08 AM
Dates	Start Date	Insert				1/4/2017 10:08 AM
Terminations	Termination Comments	Insert				1/4/2017 10:08 AM
Terminations	Termination Date	Insert				1/4/2017 10:08 AM
Terminations	Termination Effective Date	Insert				1/4/2017 10:08 AM
Terminations	Termination Reason	Insert				1/4/2017 10:08 AM

340B Drug Pricing Program Database