340B Drug Pricing Program Database


CH062242C SPRING BRANCH COMMUNITY HEALTH CENTER (Active) - information as of 6/5/2025 2:41:45 PM

Main Details
SPRING BRANCH COMMUNITY HEALTH CENTER
Spring Branch CHC - WholeLife Clinic
HRSA-Funded Health Center
BPS-H80-015559
CH062242C
H80CS06447


Additional Details
Active
4/5/2017
7/1/2017
4/24/2017
3/4/2025

Contacts

Spring Branch CHC
Marlen Trujillo, Chief Executive Officer
(713) 462-6565 Ext: 118

Spring Branch CHC
David Krusleski, Chief Medical Officer
(713) 462-6565 Ext: 190

Addresses

1905 JACQUELYN DR
101
HOUSTON, TX 77055-2520

Spring Branch Community Health Center
1615 Hillendahl Blvd
Suite 100
Houston, TX 77055


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailWALGREEN CO.DBA: WALGREENS # 03820 8590 LONG POINT RD
HOUSTONTX7705501/10/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 05423 1413 WIRT ROAD
HOUSTONTX7705501/10/202304/01/2023  04/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/12/202301/01/2024  01/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH0622420ActiveAdmin/Service DeliverySPRING BRANCH COMMUNITY HEALTH CENTERSBCHC - Hillendahl Clinic1615 Hillendahl Blvd.Suite 100HoustonTX
CH062242AActiveBPS-H80-008909Spring Branch Community Health CenterSBCHC - Pitner Clinic8575 Pitner Road HoustonTX
CH062242BActiveBPS-H80-013245SPRING BRANCH COMMUNITY HEALTH CENTERSpring Branch Community Health Center West Houston Clinc19333 Clay Rd KatyTX
CH062242CActiveBPS-H80-015559SPRING BRANCH COMMUNITY HEALTH CENTERSpring Branch CHC - WholeLife Clinic1905 JACQUELYN DR HOUSTONTX
CH062242DActiveBPS-H80-018812SPRING BRANCH COMMUNITY HEALTH CENTERSpring Branch Community Health Center - Katy Clinic5502 1st St KatyTX
CH062242EActiveBPS-H80-019753SPRING BRANCH COMMUNITY HEALTH CENTERSpring Branch Community Health Center - CyFair Clinic7777 Westgreen Blvd CypressTX
CH062242FActiveBPS-H80-034250Spring Branch Community Health CenterSpring Branch CHC - Memorial Clinic902 Frostwood Dr Ste 108 HoustonTX
CH062242GActiveBPS-H80-033412Spring Branch Community Health CenterSpring Branch CHC - NAM Clinic15555 Kuykendahl Rd HoustonTX
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH0622420AVENUE 360 HEALTH AND WELLNESS2150 W 18TH ST STE 300 SERVICE JOBS FOR PROGRESS
HOUSTONTX7700810/01/2014 01/01/2023
CH0622420WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2023  
CH0622420WAL-MART PHARMACY 10-07681313 FRY RD
KATYTX7744904/01/2023  
CH062242DWAL-MART PHARMACY 10-07681313 FRY RD
KATYTX7744904/01/2023  
CH062242BWAL-MART PHARMACY 10-07681313 FRY RD
KATYTX7744904/01/2023  
CH0622420WAL-MART PHARMACY 10-225713484 NORTHWEST FREEWAY
HOUSTONTX7704004/01/2023  
CH0622420WAL-MART PHARMACY 10-36401118 SILBER ROAD
HOUSTONTX7705504/01/2023  
CH062242AWAL-MART PHARMACY 10-36401118 SILBER ROAD
HOUSTONTX7705504/01/2023  
CH0622420WAL-MART PHARMACY 10-45386060 NORTH FRY ROAD
KATYTX7744904/01/2023  
CH062242BWAL-MART PHARMACY 10-45386060 NORTH FRY ROAD
KATYTX7744904/01/2023  
CH0622420WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2023  
CH0622420WALGREEN CODBA: WALGREENS #15515 18400 KATY FREEWAY
SUITE 100 		HOUSTONTX7709404/01/2019 01/02/2023
CH0622420WALGREEN CO.DBA: WALGREENS # 03820 8590 LONG POINT RD
HOUSTONTX7705510/01/2015  
CH0622420WALGREEN CO.DBA: WALGREENS # 05536 2808 GESSNER RD
HOUSTONTX7708010/01/2015  
CH0622420WALGREEN CO.DBA: WALGREENS # 06668 9450 HAMMERLY BLVD
HOUSTONTX77080-540010/01/2015  
CH0622420WALGREEN CO.DBA: WALGREENS # 07019 3120 N FRY RD
KATYTX77449-623910/01/2015  
CH0622420WALGREEN CO.DBA: WALGREENS # 04078 5161 FRANZ ROAD
KATYTX7749309/22/2017  
CH0622420WALGREEN CO.DBA: WALGREENS # 06702 3403 MANGUM ROAD
HOUSTONTX77092-741509/22/2017  
CH0622420WALGREEN CO.DBA: WALGREENS # 05423 1413 WIRT ROAD
HOUSTONTX7705509/22/2017  
CH0622420WALGREEN CO.DBA: WALGREENS #13062 25620 KINGSLAND BLVD.
KATYTX7749409/22/2017  
CH0622420WALGREEN CO.DBA: WALGREENS # 03441 1710 FRY ROAD
HOUSTONTX7708404/01/2019  
CH0622420WALGREEN CO.DBA: WALGREENS # 06909 4007 BARKER CYPRESS ROAD
HOUSTONTX77084-680204/01/2019  
CH0622420WALGREEN CO.DBA: WALGREENS # 03691 20500 FM 529 RD
CYPRESSTX7743304/01/2019  
CH0622420WALGREEN CO.DBA: WALGREENS # 04513 1403 FM 1960 W
HOUSTONTX7709001/01/2022  
CH0622420WALGREEN CO.DBA: WALGREENS # 03160 6280 BARKER CYPRESS
HOUSTONTX7708404/01/2023  
CH0622420WALGREEN CO.DBA: WALGREENS # 03870 4995 HWY 6 NORTH
HOUSTONTX7708404/01/2023  
CH0622420WALGREEN CO.WALGREENS #21387 21820 KATY FWY STE 110
KATYTX7744904/01/2023  
CH0622420WALGREEN CO.WALGREENS #21388 9055 KATY FWY STE 101
HOUSTONTX7702404/01/2023  
CH0622420WALGREEN CO.DBA: WALGREENS # 02116 6107 HIGHWAY 6 N
HOUSTONTX7708404/01/2023  
CH062242AWALGREEN CO.DBA: WALGREENS # 05536 2808 GESSNER RD
HOUSTONTX7708004/01/2023  
CH062242AWALGREEN CO.DBA: WALGREENS # 06668 9450 HAMMERLY BLVD
HOUSTONTX77080-540004/01/2023  
CH062242BWALGREEN CO.DBA: WALGREENS # 07019 3120 N FRY RD
KATYTX77449-623904/01/2023  
CH062242CWALGREEN CO.DBA: WALGREENS # 03820 8590 LONG POINT RD
HOUSTONTX7705504/01/2023  
CH062242CWALGREEN CO.DBA: WALGREENS # 05423 1413 WIRT ROAD
HOUSTONTX7705504/01/2023  
CH062242DWALGREEN CO.DBA: WALGREENS # 04078 5161 FRANZ ROAD
KATYTX7749304/01/2023  
CH062242DWALGREEN CO.DBA: WALGREENS # 03441 1710 FRY ROAD
HOUSTONTX7708404/01/2023  
CH062242DWALGREEN CO.DBA: WALGREENS #13062 25620 KINGSLAND BLVD.
KATYTX7749404/01/2023  
CH062242DWALGREEN CO.WALGREENS #21387 21820 KATY FWY STE 110
KATYTX7744904/01/2023  
CH062242EWALGREEN CO.DBA: WALGREENS # 03691 20500 FM 529 RD
CYPRESSTX7743304/01/2023  
CH062242FWALGREEN CO.WALGREENS #21388 9055 KATY FWY STE 101
HOUSTONTX7702404/01/2023  
CH062242BWALGREEN CO.WALGREENS #21387 21820 KATY FWY STE 110
KATYTX7744904/01/2023  
CH062242EWALGREEN CO.WALGREENS #21387 21820 KATY FWY STE 110
KATYTX7744904/01/2023  
CH062242GWALGREEN CO.DBA: WALGREENS # 04513 1403 FM 1960 W
HOUSTONTX7709004/01/2023  
CH0622420Walgreens #21373Walgreens Central Fill #21373 4100 Dale Earnhardt Way
STE 200 		NorthlakeTX7626201/01/2022  
CH0622420WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/01/2023  
CH0622420Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH062242AWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH062242BWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH062242CWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH062242DWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH062242EWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH062242GWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/26/2024 4:15:36 PM3/4/2025 3:00:22 PM3/4/2025 3:00 PM
AddressesBilling AddressUpdateRecertificationSpring Branch CHC - WholeLife Clinic 800 W Sam Houston Pkwy S 200 Houston, TX 77042Spring Branch Community Health Center 1615 Hillendahl Blvd Suite 100 Houston, TX 770552/26/2024 4:15 PM
DetailsLast Recertification DateUpdateRecertification2/1/2023 10:48:37 AM2/26/2024 4:15:36 PM2/26/2024 4:15 PM
DetailsLast Recertification DateUpdateRecertification2/28/2022 10:27:31 PM2/1/2023 10:48:37 AM2/1/2023 10:48 AM
DetailsLast Recertification DateUpdateRecertification2/12/2021 4:35:37 PM2/28/2022 10:27:31 PM2/28/2022 10:27 PM
DetailsLast Recertification DateUpdateRecertification2/24/2020 8:30:35 AM2/12/2021 4:35:37 PM2/12/2021 4:35 PM
ContactsPrimary ContactUpdateRecertificationMcEvoy, Mary Ellen Chief Compliance Officer Spring Branch Community Health Center 7134626565-165Krusleski, David Chief Medical Officer Spring Branch CHC 7134626565-1902/24/2020 8:30 AM
DetailsLast Recertification DateUpdateRecertification2/21/2019 8:30:45 PM2/24/2020 8:30:35 AM2/24/2020 8:30 AM
DetailsLast Recertification DateUpdateRecertification2/26/2018 4:23:04 PM2/21/2019 8:30:45 PM2/21/2019 8:30 PM
AddressesMain AddressUpdateChange Request 1839 JACQUELYN DR HOUSTON, TX 77055-2520 1905 JACQUELYN DR 101 HOUSTON, TX 77055-25207/12/2018 7:58 AM
AddressesBilling AddressInsertRecertification Spring Branch CHC - WholeLife Clinic 800 W Sam Houston Pkwy S 200 Houston, TX 770422/26/2018 4:23 PM
DetailsLast Recertification DateUpdateRecertification 2/26/2018 4:23:04 PM2/26/2018 4:23 PM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 2/26/2018 4:23 PM
ContactsAuthorizing OfficialUpdate Trujillo, Marlen Chief Executive Officer 7134626565-118Trujillo, Marlen Chief Executive Officer Spring Branch CHC 7134626565-1182/26/2018 4:19 PM
ContactsSigned ByUpdate Trujillo, Marlen Chief Executive Officer 7134626565-118Trujillo, Marlen Chief Executive Officer Spring Branch CHC 7134626565-1182/26/2018 4:19 PM
ContactsPrimary ContactUpdate McEvoy, Mary Ellen Chief Compliance Officer 7134626565-165McEvoy, Mary Ellen Chief Compliance Officer Spring Branch Community Health Center 7134626565-1659/19/2017 2:40 PM
ContactsPrimary ContactInsert  McEvoy, Mary Ellen Chief Compliance Officer 7134626565-1657/13/2017 4:33 PM
ContactsAuthorizing OfficialInsert  Trujillo, Marlen Chief Executive Officer 7134626565-1187/13/2017 4:33 PM
ContactsSigned ByInsert  Trujillo, Marlen Chief Executive Officer 7134626565-1187/13/2017 4:33 PM
AddressesMain AddressInsert   1839 JACQUELYN DR HOUSTON, TX 77055-25205/15/2017 5:52 PM
DatesParticipating Approval DateUpdate  4/24/2017 12:00:00 AM4/24/2017 1:28 PM
DetailsStateUpdate PendingActive4/24/2017 1:28 PM
DatesStart DateUpdate  7/1/2017 12:00:00 AM4/24/2017 1:28 PM
Details340B IDUpdate ONLINE_REG_75982CH062242C4/5/2017 1:42 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_759824/5/2017 1:19 PM
DetailsLast Recertification DateInsert   4/5/2017 1:19 PM
DetailsGrant NumberInsert  H80CS064474/5/2017 1:19 PM
Details340B IDInsert  ONLINE_REG4/5/2017 1:19 PM
DetailsIs Authorizing Official EHB DataInsert  False4/5/2017 1:19 PM
DatesLast Date That 340B Drugs PurchasedInsert   4/5/2017 1:19 PM
DetailsMedicare Provider NumberInsert   4/5/2017 1:19 PM
DetailsEntity NameInsert  SPRING BRANCH COMMUNITY HEALTH CENTER4/5/2017 1:19 PM
DetailsProgram CodeInsert  CH4/5/2017 1:19 PM
DetailsEntity SubnameInsert  Spring Branch CHC - WholeLife Clinic4/5/2017 1:19 PM
DatesParticipating Approval DateInsert   4/5/2017 1:19 PM
DetailsStateInsert  Pending4/5/2017 1:19 PM
DatesRegistration DateInsert  4/5/2017 12:00:00 AM4/5/2017 1:19 PM
DatesSigned By DateInsert  4/5/2017 12:00:00 AM4/5/2017 1:19 PM
DatesStart DateInsert   4/5/2017 1:19 PM
TerminationsTermination CommentsInsert   4/5/2017 1:19 PM
TerminationsTermination DateInsert   4/5/2017 1:19 PM
TerminationsTermination Effective DateInsert   4/5/2017 1:19 PM
TerminationsTermination ReasonInsert   4/5/2017 1:19 PM