Covered Entity Details

CHC26514-09 TRIAD ADULT AND PEDIATRIC MEDICINE, INC. (Active) - information as of 5/13/2025 1:42:13 AM

Main Details

Name

TRIAD ADULT AND PEDIATRIC MEDICINE, INC.

Subdivision Name

TAPM Family Medicine at Brentwood

Type

HRSA-Funded Health Center

Site ID

BPS-H80-019032

340B ID

CHC26514-09

Grant Number

H80CS26514

Additional Details

Current Program Status

Active

Registration Date

1/10/2017

Participating Start Date

4/1/2017

Participating Approval Date

1/11/2017

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Triad Adult and Pediatric Medicine
Danielle Cole, Finance Director
(336) 355-9728

Primary Contact

Triad Adult and Pediatric Medicine
Michelle Lewis, CEO
(336) 355-9715

Addresses

Street Address

2039 Brentwood St.
109B
High Point, NC 27263

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	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	GUILFORD CTY HLTH DEPT PHARM	501 E GREEN DR		HIGH POINT	NC	27260-6707	10/06/2017	01/01/2018			10/06/2017

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC26514-00	Active	BPS-H80-012922	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	TAPM Pediatrics at Wendover	1046 E Wendover Ave	Greensboro	NC
CHC26514-01	Active	BPS-H80-012943	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	TAPM Family Medicine at Eugene	1002 S Eugene St	Greensboro	NC
CHC26514-02	Terminated	BPS-H80-012936	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	Interactive Resource Center	407 E Washington St	Greensboro	NC
CHC26514-03	Terminated	BPS-H80-012935	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	TAPM Pediatrics at Meadowview	433 W Meadowview Rd	Greensboro	NC
CHC26514-04	Terminated	BPS-H80-012923	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	High Point Adult Medicine	624 Quaker Lane STE 100-C	High Point	NC
CHC26514-05	Terminated	BPS-H80-014073	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	TAPM-Clara F. Gunn	922 Third Avenue	Reidsville	NC
CHC26514-06	Terminated	BPS-H80-012920	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	TAPM Pediatrics at E. Commerce	400 E Commerce St	High Point	NC
CHC26514-07	Active	BPS-H80-019033	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	Family Medicine at Arlington	1205 Arlington St.	Greensboro	NC
CHC26514-08	Terminated	BPS-H80-015762	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	TAPM Family Medicine at East Market Street	1102 E MARKET ST	GREENSBORO	NC
CHC26514-09	Active	BPS-H80-019032	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	TAPM Family Medicine at Brentwood	2039 Brentwood St.	High Point	NC
CHC26514-10	Active	BPS-H80-034086	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	Family Medicine at Elm	606 N Elm St	High Point	NC
CHC26514-11	Active	BPS-H80-035562	TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	Family Medicine at Northwood	300 W Northwood St	Greensboro	NC

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC26514-00	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	07/01/2017	03/02/2020
CHC26514-00	FRIENDLY PHARMACY	3712 LAWNDALE DR STE G		GREENSBORO	NC	27455-3066	07/01/2016	03/02/2020
CHC26514-01	FRIENDLY PHARMACY	3712 LAWNDALE DR STE G		GREENSBORO	NC	27455-3066	07/01/2016	04/15/2020
CHC26514-06	GUILFORD CO HLTH DEPT PHCY	1100 E WENDOVER AVE		GREENSBORO	NC	27405-6713	01/01/2016	04/01/2022
CHC26514-01	GUILFORD CO HLTH DEPT PHCY	1100 E WENDOVER AVE		GREENSBORO	NC	27405-6713	07/01/2020
CHC26514-07	GUILFORD CO HLTH DEPT PHCY	1100 E WENDOVER AVE		GREENSBORO	NC	27405-6713	07/01/2020
CHC26514-00	GUILFORD CO HLTH DEPT PHCY	1100 E WENDOVER AVE		GREENSBORO	NC	27405-6713	07/01/2020
CHC26514-11	GUILFORD CO HLTH DEPT PHCY	1100 E WENDOVER AVE		GREENSBORO	NC	27405-6713	01/01/2023
CHC26514-06	GUILFORD CTY HLTH DEPT PHARM	501 E GREEN DR		HIGH POINT	NC	27260-6707	01/01/2016	04/01/2022
CHC26514-09	GUILFORD CTY HLTH DEPT PHARM	501 E GREEN DR		HIGH POINT	NC	27260-6707	01/01/2018
CHC26514-10	GUILFORD CTY HLTH DEPT PHARM	501 E GREEN DR		HIGH POINT	NC	27260-6707	01/01/2023
CHC26514-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CHC26514-00	WAL-MART PHARMACY 10-1613	2628 S. MAIN STREET		HIGH POINT	NC	27263	07/01/2017
CHC26514-00	WAL-MART PHARMACY 10-3304	1624 NC #14 HWY		REIDSVILLE	NC	27320	07/01/2017	06/30/2018
CHC26514-00	WAL-MART PHARMACY 10-3658	2107 PYRAMID VILLAGE BLVD.		GREENSBORO (NE)	NC	27405	07/01/2017
CHC26514-00	WAL-MART PHARMACY 10-4477	2710 NORTH MAIN ST.		HIGH POINT	NC	27265	07/01/2017	02/07/2019
CHC26514-00	WAL-MART PHARMACY 10-5014	3605 GATE CITY BLVD		GREENSBORO	NC	27407	07/01/2017	02/07/2019
CHC26514-00	WAL-MART PHARMACY 10-5320	121 W. ELMSLEY ST.		GREENSBORO	NC	27406	07/01/2017
CHC26514-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CHC26514-00	WALGREEN CO.	DBA: WALGREENS # 06315	2019 N MAIN STREET	HIGH POINT	NC	27262-2133	01/01/2015
CHC26514-00	WALGREEN CO.	DBA: WALGREENS # 09527	904 N MAIN	HIGH POINT	NC	27262-3924	01/01/2015
CHC26514-00	WALGREEN CO.	DBA: WALGREENS #12047	2758 S. MAIN ST.	HIGH POINT	NC	27263	01/01/2015
CHC26514-00	WALGREEN CO.	WALGREENS #21352	2913 E MARKET ST	GREENSBORO	NC	27405	10/01/2018
CHC26514-00	WALGREEN CO.	DBA: WALGREENS # 06812	3701 W GATE CITY BLVD	GREENSBORO	NC	27407	01/01/2022
CHC26514-00	WALGREEN CO.	DBA: WALGREENS # 06813	4701 W MARKET STREET	GREENSBORO	NC	27407-1233	01/01/2022
CHC26514-00	WALGREEN CO.	DBA: WALGREENS # 07280	1015 RANDOLPH STREET	THOMASVILLE	NC	27360-5726	01/01/2022
CHC26514-00	WALGREEN CO.	DBA: WALGREENS #15070	3880 BRIAN JORDAN PLACE	HIGH POINT	NC	27265	01/01/2022
CHC26514-00	WALGREEN CO.	WALGREENS #16129	407 W MAIN ST	JAMESTOWN	NC	27282	01/01/2022
CHC26514-00	WALGREEN CO.	WALGREENS #17372	3501 GROOMETOWN RD	GREENSBORO	NC	27407	01/01/2022
CHC26514-00	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	10/01/2023
CHC26514-00	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	01/01/2015	08/17/2015
CHC26514-00	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2015	08/17/2015
CHC26514-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CHC26514-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/12/2024 10:03:55 AM	2/11/2025 12:51:08 PM	2/11/2025 12:51 PM
Details	Last Recertification Date	Update	Recertification	2/16/2023 12:14:12 PM	2/12/2024 10:03:55 AM	2/12/2024 10:03 AM
Details	Last Recertification Date	Update	Recertification	2/2/2022 8:12:50 AM	2/16/2023 12:14:12 PM	2/16/2023 12:14 PM
Details	Last Recertification Date	Update	Recertification	2/22/2021 3:46:57 PM	2/2/2022 8:12:50 AM	2/2/2022 8:12 AM
Details	Last Recertification Date	Update	Recertification	1/29/2020 8:02:55 AM	2/22/2021 3:46:57 PM	2/22/2021 3:46 PM
Addresses	Main Address	Update	Recertification	2039 Brentwood St. High Point, NC 27263	2039 Brentwood St. 109B High Point, NC 27263	1/29/2020 8:02 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 10:53:08 AM	1/29/2020 8:02:55 AM	1/29/2020 8:02 AM
Details	Last Recertification Date	Update	Recertification	2/7/2018 4:37:59 PM	1/29/2019 10:53:08 AM	1/29/2019 10:53 AM
Contacts	Primary Contact	Update	Recertification	Cole, Danielle Finance Director Triad Adult and Pediatric Medicine 3363559728	Lewis, Michelle CEO Triad Adult and Pediatric Medicine 3363559715	2/7/2018 4:37 PM
Details	Last Recertification Date	Update	Recertification		2/7/2018 4:37:59 PM	2/7/2018 4:37 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/7/2018 4:37 PM
Contacts	Authorizing Official	Update		Cole, Danielle Finance Director 3363559728	Cole, Danielle Finance Director Triad Adult and Pediatric Medicine 3363559728	10/6/2017 8:36 AM
Contacts	Primary Contact	Update		Cole, Danielle Finance Director 3363559728	Cole, Danielle Finance Director Triad Adult and Pediatric Medicine 3363559728	10/6/2017 8:36 AM
Contacts	Signed By	Update		Cole, Danielle Finance Director 3363559728	Cole, Danielle Finance Director Triad Adult and Pediatric Medicine 3363559728	10/6/2017 8:36 AM
Contacts	Authorizing Official	Insert			Cole, Danielle Finance Director 3363559728	4/21/2017 2:00 PM
Contacts	Primary Contact	Insert			Cole, Danielle Finance Director 3363559728	4/21/2017 2:00 PM
Contacts	Signed By	Insert			Cole, Danielle Finance Director 3363559728	4/21/2017 2:00 PM
Addresses	Main Address	Insert			2039 Brentwood St. High Point, NC 27263	3/16/2017 3:28 PM
Dates	Participating Approval Date	Update			1/11/2017 12:00:00 AM	1/11/2017 10:12 AM
Details	State	Update		Pending	Active	1/11/2017 10:12 AM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	1/11/2017 10:12 AM
Details	340B ID	Update		ONLINE_REG_74349	CHC26514-09	1/11/2017 8:51 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_74349	1/10/2017 2:05 PM
Details	Last Recertification Date	Insert				1/10/2017 2:05 PM
Details	Grant Number	Insert			H80CS26514	1/10/2017 2:05 PM
Details	340B ID	Insert			ONLINE_REG	1/10/2017 2:05 PM
Details	Is Authorizing Official EHB Data	Insert			False	1/10/2017 2:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/10/2017 2:05 PM
Details	Medicare Provider Number	Insert				1/10/2017 2:05 PM
Details	Entity Name	Insert			TRIAD ADULT AND PEDIATRIC MEDICINE, INC.	1/10/2017 2:05 PM
Details	Program Code	Insert			CH	1/10/2017 2:05 PM
Details	Entity Subname	Insert			TAPM Family Medicine at Brentwood	1/10/2017 2:05 PM
Dates	Participating Approval Date	Insert				1/10/2017 2:05 PM
Details	State	Insert			Pending	1/10/2017 2:05 PM
Dates	Registration Date	Insert			1/10/2017 12:00:00 AM	1/10/2017 2:05 PM
Dates	Signed By Date	Insert			1/10/2017 12:00:00 AM	1/10/2017 2:05 PM
Dates	Start Date	Insert				1/10/2017 2:05 PM
Terminations	Termination Comments	Insert				1/10/2017 2:05 PM
Terminations	Termination Date	Insert				1/10/2017 2:05 PM
Terminations	Termination Effective Date	Insert				1/10/2017 2:05 PM
Terminations	Termination Reason	Insert				1/10/2017 2:05 PM

340B Drug Pricing Program Database