Covered Entity Details

CHC30718-04 SIGNATURE HEALTH, INC. (Active) - information as of 6/3/2025 12:03:43 PM

Main Details

Name

SIGNATURE HEALTH, INC.

Subdivision Name

Signature Health Ashtabula Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-019491

340B ID

CHC30718-04

Grant Number

H80CS30718

Additional Details

Current Program Status

Active

Registration Date

4/17/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/24/2017

Last Recertification Date

2/22/2025

Contacts

Authorizing Official

Signature Health Inc.
Jonathan Albert Lee, CEO
(440) 953-9999 Ext: 705133

Primary Contact

Signature Health, Inc
Shannon Majoras, Chief Compliance Officer
(440) 578-8200

Addresses

Street Address

4726 Main Ave.
Ashtabula, OH 44004

Billing Address

Signature Health
7232 Justin Way
Mentor, OH 44060

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?
Yes

State	Medicaid Number	NPI Number
OH	0251049,0438259,0250601,0085987,0480664,0215892,3042102,0101177	1073932588,1821695594,1841457025,1093138299,1285072603,1740938604,1740502335,1407879406,1336687482,1063950111

Shipping Addresses

Shipping Address 1

Signature Health, Inc.
4726 Main Ave.
Ashtabula, OH 44004

Shipping Address 2

Signature Health, Inc.
53 South Saint Clair
Painesville, OH 44077

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	07/16/2018	10/01/2018	01/14/2022	01/14/2022
Contract Detail	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	07/16/2018	10/01/2018	01/14/2022	01/14/2022
Contract Detail	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	10/16/2017	01/01/2018		10/16/2017
Contract Detail	GIANT EAGLE PHARMACY #0216	30320 LAKE SHORE BLVD		WILLOWICK	OH	44095	01/15/2019	04/01/2019		04/01/2019
Contract Detail	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	01/15/2019	04/01/2019	03/31/2023	04/15/2024
Contract Detail	GIANT EAGLE PHARMACY #1217	6079 ANDREWS RD		MENTOR ON THE LAKE	OH	44060	01/15/2019	04/01/2019		04/01/2019
Contract Detail	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	01/15/2019	04/01/2019		04/01/2019
Contract Detail	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	01/15/2019	04/01/2019	11/16/2023	11/17/2023
Contract Detail	GIANT EAGLE PHARMACY #1421	2390 PROSPECT AVENUE		ASHTABULA	OH	44004	01/15/2019	04/01/2019		04/01/2019
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	01/15/2019	04/01/2019		04/01/2019
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	01/15/2019	04/01/2019	11/16/2023	11/17/2023
Contract Detail	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	01/15/2019	04/01/2019	01/14/2022	01/14/2022
Contract Detail	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	01/15/2019	04/01/2019	04/14/2022	04/16/2023
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #3032	2148 LAKE AVENUE	ASHTABULA	OH	44004	01/15/2018	04/01/2018	01/14/2022	01/14/2022
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #4847	6655 NORTH RIDGE ROAD	MADISON	OH	44057	01/15/2018	04/01/2018	01/14/2022	01/14/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09833	318 W PROSPECT ROAD	ASHTABULA	OH	44004	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10518	6707 N RIDGE RD	MADISON	OH	44057-2656	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05821	132 RICHMOND STREET	PAINESVILLE	OH	44077	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	01/15/2019	04/01/2019	01/01/2025	03/19/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03314	5400 PEARL ROAD	PARMA	OH	44129	01/15/2019	04/01/2019		04/01/2019

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC30718-00	Active	BPS-H80-022019	SIGNATURE HEALTH, INC.	Signature Health, Inc. Administration	7232 Justin Way	Mentor	OH
CHC30718-01	Active	BPS-H80-034082	SIGNATURE HEALTH, INC.	Signature Health, Inc. Painesville Clinic	54 S. State St	Painesville	OH
CHC30718-02	Terminated	BPS-H80-019105	SIGNATURE HEALTH, INC.	Signature Health, Inc. Willoughby Clinic	38882 Mentor Avenue	Willoughby	OH
CHC30718-03	Terminated	BPS-H80-019405	SIGNATURE HEALTH, INC.	Signature Health Garfield Heights Health Center	5410 Transportation Blvd.	Garfield Heights	OH
CHC30718-04	Active	BPS-H80-019491	SIGNATURE HEALTH, INC.	Signature Health Ashtabula Health Center	4726 Main Ave.	Ashtabula	OH
CHC30718-05	Active	BPS-H80-021191	Signature Health, Inc.	Signature Health, Inc. Connections Location	24200 Chagrin Blvd	Beachwood	OH
CHC30718-06	Active	BPS-H80-021470	Signature Health, Inc.	Signature Health Maple Heights Health Center	21100 Southgate Park Blvd	Maple Heights	OH
CHC30718-07	Active	BPS-H80-022276	Signature Health, Inc.	Signature Health Inc. Cleveland West	14701 Detroit Ave.	Lakewood	OH
CHC30718-08	Active	BPS-H80-035359	SIGNATURE HEALTH	Signature Health - Wickliffe	2255 Rockefeller Rd Ste E	Wickliffe	OH
CHC30718-09	Active	BPS-H80-037813	SIGNATURE HEALTH	Signature Health New Willoughby Clinic	38876 Mentor Ave	Willoughby	OH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC30718-06	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	10/01/2018	01/14/2022
CHC30718-04	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	10/01/2018	01/14/2022
CHC30718-02	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	10/01/2018	01/14/2022
CHC30718-00	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	10/01/2018	01/14/2022
CHC30718-01	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	10/01/2018	01/14/2022
CHC30718-07	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	10/01/2018	01/14/2022
CHC30718-07	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	10/01/2018	01/14/2022
CHC30718-05	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	10/01/2018	01/14/2022
CHC30718-02	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	10/01/2018	01/14/2022
CHC30718-01	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	10/01/2018	01/14/2022
CHC30718-06	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	10/01/2018	01/14/2022
CHC30718-04	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	10/01/2018	01/14/2022
CHC30718-00	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	10/01/2018	01/14/2022
CHC30718-07	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	10/01/2018	01/14/2022
CHC30718-05	ACARIAHEALTH PHARMACY #12, INC.	5 SKYLINE DR STE 240		HAWTHORNE	NY	10532-2166	10/01/2018	01/14/2022
CHC30718-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2019
CHC30718-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2019
CHC30718-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2019
CHC30718-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2019
CHC30718-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2019
CHC30718-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2019
CHC30718-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2019
CHC30718-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2019
CHC30718-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2019
CHC30718-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2019
CHC30718-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2019
CHC30718-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2019
CHC30718-05	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	01/01/2018
CHC30718-00	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	01/01/2018
CHC30718-01	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	01/01/2018
CHC30718-02	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	01/01/2018	04/01/2024
CHC30718-03	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	01/01/2018	04/01/2018
CHC30718-04	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	01/01/2018
CHC30718-05	GIANT EAGLE PHARMACY #0216	30320 LAKE SHORE BLVD		WILLOWICK	OH	44095	04/01/2019
CHC30718-07	GIANT EAGLE PHARMACY #0216	30320 LAKE SHORE BLVD		WILLOWICK	OH	44095	04/01/2019
CHC30718-01	GIANT EAGLE PHARMACY #0216	30320 LAKE SHORE BLVD		WILLOWICK	OH	44095	04/01/2019
CHC30718-04	GIANT EAGLE PHARMACY #0216	30320 LAKE SHORE BLVD		WILLOWICK	OH	44095	04/01/2019
CHC30718-02	GIANT EAGLE PHARMACY #0216	30320 LAKE SHORE BLVD		WILLOWICK	OH	44095	04/01/2019	04/01/2024
CHC30718-00	GIANT EAGLE PHARMACY #0216	30320 LAKE SHORE BLVD		WILLOWICK	OH	44095	04/01/2019
CHC30718-06	GIANT EAGLE PHARMACY #0216	30320 LAKE SHORE BLVD		WILLOWICK	OH	44095	04/01/2019
CHC30718-07	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	04/01/2019	03/31/2023
CHC30718-05	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	04/01/2019	03/31/2023
CHC30718-06	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	04/01/2019	03/31/2023
CHC30718-02	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	04/01/2019	04/01/2024
CHC30718-04	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	04/01/2019	03/31/2023
CHC30718-00	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	04/01/2019	03/31/2023
CHC30718-01	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	04/01/2019	10/02/2023
CHC30718-07	GIANT EAGLE PHARMACY #1217	6079 ANDREWS RD		MENTOR ON THE LAKE	OH	44060	04/01/2019
CHC30718-05	GIANT EAGLE PHARMACY #1217	6079 ANDREWS RD		MENTOR ON THE LAKE	OH	44060	04/01/2019
CHC30718-00	GIANT EAGLE PHARMACY #1217	6079 ANDREWS RD		MENTOR ON THE LAKE	OH	44060	04/01/2019
CHC30718-01	GIANT EAGLE PHARMACY #1217	6079 ANDREWS RD		MENTOR ON THE LAKE	OH	44060	04/01/2019
CHC30718-02	GIANT EAGLE PHARMACY #1217	6079 ANDREWS RD		MENTOR ON THE LAKE	OH	44060	04/01/2019	04/01/2024
CHC30718-04	GIANT EAGLE PHARMACY #1217	6079 ANDREWS RD		MENTOR ON THE LAKE	OH	44060	04/01/2019
CHC30718-06	GIANT EAGLE PHARMACY #1217	6079 ANDREWS RD		MENTOR ON THE LAKE	OH	44060	04/01/2019
CHC30718-05	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	04/01/2019
CHC30718-07	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	04/01/2019
CHC30718-00	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	04/01/2019
CHC30718-01	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	04/01/2019
CHC30718-04	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	04/01/2019
CHC30718-04	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	04/01/2019	11/16/2023
CHC30718-06	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	04/01/2019
CHC30718-02	GIANT EAGLE PHARMACY #1417	755 SOUTH BROADWAY AVE		GENEVA	OH	44041	04/01/2019	04/01/2024
CHC30718-07	GIANT EAGLE PHARMACY #1421	2390 PROSPECT AVENUE		ASHTABULA	OH	44004	04/01/2019
CHC30718-05	GIANT EAGLE PHARMACY #1421	2390 PROSPECT AVENUE		ASHTABULA	OH	44004	04/01/2019
CHC30718-00	GIANT EAGLE PHARMACY #1421	2390 PROSPECT AVENUE		ASHTABULA	OH	44004	04/01/2019
CHC30718-06	GIANT EAGLE PHARMACY #1421	2390 PROSPECT AVENUE		ASHTABULA	OH	44004	04/01/2019
CHC30718-02	GIANT EAGLE PHARMACY #1421	2390 PROSPECT AVENUE		ASHTABULA	OH	44004	04/01/2019	04/01/2024
CHC30718-01	GIANT EAGLE PHARMACY #1421	2390 PROSPECT AVENUE		ASHTABULA	OH	44004	04/01/2019
CHC30718-04	GIANT EAGLE PHARMACY #1421	2390 PROSPECT AVENUE		ASHTABULA	OH	44004	04/01/2019
CHC30718-00	GIANT EAGLE PHARMACY #4097	6556 NORTH RIDGE ROAD		NORTH MADISON	OH	44057	07/01/2023
CHC30718-00	GIANT EAGLE PHARMACY #6377	1201 MENTOR AVE		PAINESVILLE	OH	44077	07/01/2023
CHC30718-00	GIANT EAGLE PHARMACY #6381	36475 EUCLID AVE		WILLOUGHBY	OH	44094	07/01/2023
CHC30718-07	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	04/01/2019
CHC30718-05	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	04/01/2019
CHC30718-01	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	04/01/2019
CHC30718-00	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	04/01/2019
CHC30718-02	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	04/01/2019	04/01/2024
CHC30718-04	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	04/01/2019
CHC30718-06	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	04/01/2019
CHC30718-04	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	04/01/2019	11/16/2023
CHC30718-05	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	04/01/2019	01/14/2022
CHC30718-07	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	04/01/2019	01/14/2022
CHC30718-01	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	04/01/2019	01/14/2022
CHC30718-00	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	04/01/2019	01/14/2022
CHC30718-04	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	04/01/2019	01/14/2022
CHC30718-02	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	04/01/2019	01/14/2022
CHC30718-04	GREAT LAKES PHARMACY	9500 MENTOR AVE STE 110		MENTOR	OH	44060-8712	04/01/2019	04/14/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03301	28100 CHAGRIN BLVD.	WOODMERE	OH	44122	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03343	1491 SOM CENTER RD	MAYFIELD HEIGHTS	OH	44124	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04300	13777 PEARL RD.	STRONGSVILLE	OH	44136	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03333	3171 WEST BLVD.	CLEVELAND	OH	44111	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03032	4961 MONTICELLO BLVD,	RICHMOND HEIGHTS	OH	44143	10/01/2019	01/06/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04282	3728 PEARL RD	CLEVELAND	OH	44109	10/01/2019	09/25/2023
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04803	8000 EUCLID AVE.	CLEVELAND	OH	44103	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03338	22001 LAKESHORE BLVD	EUCLID	OH	44123	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04499	1443 RICHMOND RD.	LYNDHURST	OH	44124	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 07371	22909 EMERY ROAD	WARRENSVILLE HEIGHTS	OH	44128	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04351	6005 SOM CENTER RD.	WILLOUGHBY	OH	44094	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03329	11706 CLIFTON BOULEVARD	LAKEWOOD	OH	44107	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03362	1819 EAST PROSPECT ROAD	ASHTABULA	OH	44004	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03169	170 EAST MAIN ST	GENEVA	OH	44041	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04101	34 SHOPPING PLAZA DR	CHAGRIN FALLS	OH	44022	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04366	8519 MAYFIELD RD.	CHESTERLAND	OH	44026	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03322	2007 BROOKPARK ROAD	CLEVELAND	OH	44109	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04330	140 SOLON ROAD	BEDFORD	OH	44146	10/01/2019	01/01/2025
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03645	7710 CHIPPEWA RD	BRECKSVILLE	OH	44141	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04327	1506 MENTOR AVENUE	PAINESVILLE	OH	44077	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03314	4240 PEARL RD	CLEVELAND	OH	44109	10/01/2019	01/01/2025
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04331	380 STATE ST.	CONNEAUT	OH	44030	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 07686	7301 LAKESHORE BOULEVARD	MENTOR	OH	44060	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	CVS/PHARMACY #10893	5812 RIDGE ROAD	PARMA	OH	44129	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03634	2160 LEE RD	CLEVELAND HEIGHTS	OH	44118	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03359	33840 AURORA RD.	SOLON	OH	44139	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03337	3825 MONTICELLO BLVD	CLEVELAND HEIGHTS	OH	44121	10/01/2019	01/01/2025
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03035	212 WEST BAGLEY ROAD	BEREA	OH	44017	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04347	11223 GRANGER RD.	GARFIELD HEIGHTS	OH	44125	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04348	28700 CHARDON RD	WILLOUGHBY HILLS	OH	44092	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04305	840 EUCLID AVE	CLEVELAND	OH	44114	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03346	17120 CHAGRIN BLVD	SHAKER HEIGHTS	OH	44120	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03317	296 CENTER ST.	CHARDON	OH	44024	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 02503	13027 LORAIN AVE.,	CLEVELAND	OH	44111	10/01/2019	01/01/2025
CHC30718-00	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 17388	9669 MENTOR AVE	MENTOR	OH	44060	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04320	14025 PURITAS AVE	CLEVELAND	OH	44135	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03356	265 EAST ERIE STREET	PAINESVILLE	OH	44077	10/01/2019	01/01/2025
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04338	10022 MADISON AVENUE	CLEVELAND	OH	44102	10/01/2019	11/30/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04336	10380 NORTHFIELD ROAD	NORTHFIELD	OH	44067	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03326	9040 MENTOR AVE	MENTOR	OH	44060	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04316	6301 HARVARD AVENUE	CLEVELAND	OH	44105	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05941	1890 N RIDGE RD	PAINESVILLE	OH	44077	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05366	10825 KINSMAN RD.	CLEVELAND	OH	44104	10/01/2019	01/01/2025
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03817	7412 STATE ROAD	PARMA	OH	44134	10/01/2019	01/06/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04350	13215 SHAKER SQUARE	CLEVELAND	OH	44120	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 07370	4460 MAYFIELD RD.	SOUTH EUCLID	OH	44121	10/01/2019	01/01/2025
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03332	14000 RIDGE ROAD	NORTH ROYALTON	OH	44133	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04804	16801 CHILLICOTHE RD.	CHAGRIN FALLS	OH	44023	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04607	5901 MAYFIELD RD.	MAYFIELD HEIGHTS	OH	44124	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16484	36195 EUCLID AVE	WILLOUGHBY	OH	44094	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16927	14070 CEDAR RD	UNIVERSITY HEIGHTS	OH	44118	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04345	14440 CEDAR RD	CLEVELAND	OH	44121	10/01/2019
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03347	13956 CEDAR RD.	UNIVERSITY HEIGHTS	OH	44118	01/01/2020
CHC30718-00	OHIO CVS STORES, L.L.C.	CVS PHARMACY # 16245	6850 RIDGE RD	PARMA	OH	44129	04/01/2020	03/31/2023
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 07687	20641 FAIRMOUNT BLVD.	SHAKER HEIGHTS	OH	44118	04/01/2020	03/31/2023
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04811	27120 BAGLEY ROAD	OLMSTED TWP	OH	44138	04/01/2020	03/31/2023
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA CVS/PHARMACY #10209	3761 MASSILLON RD	UNIONTOWN	OH	44685-7730	04/01/2020	03/31/2023
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03393	118 W. GARFIELD RD.	AURORA	OH	44202	04/01/2020	03/31/2023
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03028	14372 SNOW RD	BROOK PARK	OH	44142	04/01/2020	03/31/2023
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03697	19950 DETROIT RD	ROCKY RIVER	OH	44116	04/01/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 02469	625 DOVER CENTER ROAD	BAY VILLAGE	OH	44140	04/01/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03340	15501 DETROIT AVENUE	LAKEWOOD	OH	44107	04/01/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04437	10085 DARROW ROAD	TWINSBURG	OH	44087	04/01/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04304	30791 DETROIT RD	WESTLAKE	OH	44145	04/01/2022
CHC30718-00	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 04349	15925 W. HIGH ST	MIDDLEFIELD	OH	44062	04/01/2022
CHC30718-00	OMNICARE OF NORTHWEST OHIO	WESTHAVEN SERVICES CO, LLC	7643 PONDEROSA RD	PERRYSBURG	OH	43551	04/01/2022
CHC30718-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2019
CHC30718-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2019
CHC30718-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2019
CHC30718-06	RITE AID OF OHIO, INC.	RITE AID #4296	1403 WOOSTER ROAD WEST	BARBERTON	OH	44203	04/01/2018	01/14/2022
CHC30718-06	RITE AID OF OHIO, INC.	RITE AID #4847	6655 NORTH RIDGE ROAD	MADISON	OH	44057	04/01/2018	01/14/2022
CHC30718-06	RITE AID OF OHIO, INC.	RITE AID #3032	2148 LAKE AVENUE	ASHTABULA	OH	44004	04/01/2018	01/14/2022
CHC30718-06	RITE AID OF OHIO, INC.	RITE AID #3195	180 NORTH STATE STREET	PAINESVILLE	OH	44077	04/01/2018	01/14/2022
CHC30718-06	RITE AID OF OHIO, INC.	RITE AID #3486	11702 LORAIN AVENUE	CLEVELAND	OH	44111	04/01/2018	01/14/2022
CHC30718-01	RITE AID OF OHIO, INC.	RITE AID #3195	180 NORTH STATE STREET	PAINESVILLE	OH	44077	04/01/2018	01/14/2022
CHC30718-01	RITE AID OF OHIO, INC.	RITE AID #4847	6655 NORTH RIDGE ROAD	MADISON	OH	44057	04/01/2018	01/14/2022
CHC30718-02	RITE AID OF OHIO, INC.	RITE AID #3195	180 NORTH STATE STREET	PAINESVILLE	OH	44077	04/01/2018	01/14/2022
CHC30718-02	RITE AID OF OHIO, INC.	RITE AID #4847	6655 NORTH RIDGE ROAD	MADISON	OH	44057	04/01/2018	01/14/2022
CHC30718-04	RITE AID OF OHIO, INC.	RITE AID #3032	2148 LAKE AVENUE	ASHTABULA	OH	44004	04/01/2018	01/14/2022
CHC30718-04	RITE AID OF OHIO, INC.	RITE AID #4847	6655 NORTH RIDGE ROAD	MADISON	OH	44057	04/01/2018	01/14/2022
CHC30718-05	RITE AID OF OHIO, INC.	RITE AID #3486	11702 LORAIN AVENUE	CLEVELAND	OH	44111	04/01/2018	01/14/2022
CHC30718-05	RITE AID OF OHIO, INC.	RITE AID #3195	180 NORTH STATE STREET	PAINESVILLE	OH	44077	04/01/2018	01/14/2022
CHC30718-05	RITE AID OF OHIO, INC.	RITE AID #4847	6655 NORTH RIDGE ROAD	MADISON	OH	44057	04/01/2018	01/14/2022
CHC30718-05	RITE AID OF OHIO, INC.	RITE AID #3032	2148 LAKE AVENUE	ASHTABULA	OH	44004	04/01/2018	01/14/2022
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 09833	318 W PROSPECT ROAD	ASHTABULA	OH	44004	04/01/2018
CHC30718-04	WALGREEN CO.	DBA: WALGREENS # 09833	318 W PROSPECT ROAD	ASHTABULA	OH	44004	04/01/2018
CHC30718-04	WALGREEN CO.	DBA: WALGREENS # 10518	6707 N RIDGE RD	MADISON	OH	44057-2656	04/01/2018
CHC30718-04	WALGREEN CO.	DBA: WALGREENS # 05821	132 RICHMOND STREET	PAINESVILLE	OH	44077	04/01/2018
CHC30718-01	WALGREEN CO.	DBA: WALGREENS # 10518	6707 N RIDGE RD	MADISON	OH	44057-2656	04/01/2018
CHC30718-01	WALGREEN CO.	DBA: WALGREENS # 05821	132 RICHMOND STREET	PAINESVILLE	OH	44077	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 04684	12777 ROCKSIDE ROAD	GARFIELD HEIGHTS	OH	44125	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 13058	35279 VINE ST	WILLOWICK	OH	44095	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 05820	6101 ANDREWS ROAD	MENTOR ON THE LAKE	OH	44060	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 03312	22401 LAKE SHORE BLVD	EUCLID	OH	44123	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 02226	5090 TURNEY ROAD	GARFIELD HEIGHTS	OH	44125	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 10220	520 BROADWAY AVE	BEDFORD	OH	44146-2724	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 10710	20485 EUCLID AVE	EUCLID	OH	44117	04/01/2018
CHC30718-06	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #16400	10001 CHESTER AVE SUITE B	CLEVELAND	OH	44106	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 10518	6707 N RIDGE RD	MADISON	OH	44057-2656	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 05821	132 RICHMOND STREET	PAINESVILLE	OH	44077	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 03310	16803 LORAIN AVE	CLEVELAND	OH	44111	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 04294	5881 SOM CENTER RD.	WILLOUGHBY	OH	44094	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 04317	9400 MENTOR AVE.	MENTOR	OH	44060	04/01/2018
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 07474	751 RICHMOND RD	RICHMOND HEIGHTS	OH	44143-2917	04/01/2018
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 05821	132 RICHMOND STREET	PAINESVILLE	OH	44077	04/01/2018	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 13058	35279 VINE ST	WILLOWICK	OH	44095	04/01/2018	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 04294	5881 SOM CENTER RD.	WILLOUGHBY	OH	44094	04/01/2018	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 03312	22401 LAKE SHORE BLVD	EUCLID	OH	44123	04/01/2018	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 05820	6101 ANDREWS ROAD	MENTOR ON THE LAKE	OH	44060	04/01/2018	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 10518	6707 N RIDGE RD	MADISON	OH	44057-2656	04/01/2018	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 04317	9400 MENTOR AVE.	MENTOR	OH	44060	04/01/2018	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 10710	20485 EUCLID AVE	EUCLID	OH	44117	04/01/2018	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 07474	751 RICHMOND RD	RICHMOND HEIGHTS	OH	44143-2917	04/01/2018	04/01/2024
CHC30718-03	WALGREEN CO.	DBA: WALGREENS # 02226	5090 TURNEY ROAD	GARFIELD HEIGHTS	OH	44125	04/01/2018	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 10220	520 BROADWAY AVE	BEDFORD	OH	44146-2724	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 07474	751 RICHMOND RD	RICHMOND HEIGHTS	OH	44143-2917	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 04684	12777 ROCKSIDE ROAD	GARFIELD HEIGHTS	OH	44125	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 02226	5090 TURNEY ROAD	GARFIELD HEIGHTS	OH	44125	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 03312	22401 LAKE SHORE BLVD	EUCLID	OH	44123	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 10710	20485 EUCLID AVE	EUCLID	OH	44117	04/01/2018
CHC30718-05	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #16400	10001 CHESTER AVE SUITE B	CLEVELAND	OH	44106	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 03310	16803 LORAIN AVE	CLEVELAND	OH	44111	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 10518	6707 N RIDGE RD	MADISON	OH	44057-2656	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 04294	5881 SOM CENTER RD.	WILLOUGHBY	OH	44094	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 04317	9400 MENTOR AVE.	MENTOR	OH	44060	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 09833	318 W PROSPECT ROAD	ASHTABULA	OH	44004	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 05820	6101 ANDREWS ROAD	MENTOR ON THE LAKE	OH	44060	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 05821	132 RICHMOND STREET	PAINESVILLE	OH	44077	04/01/2018
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 13058	35279 VINE ST	WILLOWICK	OH	44095	04/01/2018
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	04/01/2019	01/01/2025
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 03314	5400 PEARL ROAD	PARMA	OH	44129	04/01/2019
CHC30718-04	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	04/01/2019	01/01/2025
CHC30718-01	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	04/01/2019	01/01/2025
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	04/01/2019	01/01/2025
CHC30718-06	WALGREEN CO.	DBA: WALGREENS # 03314	5400 PEARL ROAD	PARMA	OH	44129	04/01/2019
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 03314	5400 PEARL ROAD	PARMA	OH	44129	04/01/2019	04/01/2024
CHC30718-02	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	04/01/2019	04/01/2024
CHC30718-04	WALGREEN CO.	DBA: WALGREENS # 03314	5400 PEARL ROAD	PARMA	OH	44129	04/01/2019
CHC30718-01	WALGREEN CO.	DBA: WALGREENS # 03314	5400 PEARL ROAD	PARMA	OH	44129	04/01/2019
CHC30718-07	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	04/01/2019	01/01/2025
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 21252	16100 LAKE SHORE BLVD	CLEVELAND	OH	44110-1001	04/01/2019	01/01/2025
CHC30718-07	WALGREEN CO.	DBA: WALGREENS # 03314	5400 PEARL ROAD	PARMA	OH	44129	04/01/2019
CHC30718-05	WALGREEN CO.	DBA: WALGREENS # 03314	5400 PEARL ROAD	PARMA	OH	44129	04/01/2019
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 12444	3415 CLARK AVENUE	CLEVELAND	OH	44109	04/01/2020
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 05206	11701 DETROIT AVE	LAKEWOOD	OH	44107	04/01/2020
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 06889	6270 SOM CENTER ROAD	SOLON	OH	44139-2913	04/01/2020
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 03308	4265 STATE RD.	CLEVELAND	OH	44109	07/01/2020
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 06659	4071 LEE RD BLDG A-1	CLEVELAND	OH	44128	07/01/2020
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 03310	16803 LORAIN AVE	CLEVELAND	OH	44111	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 04317	9400 MENTOR AVE.	MENTOR	OH	44060	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 07474	751 RICHMOND RD	RICHMOND HEIGHTS	OH	44143-2917	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 13058	35279 VINE ST	WILLOWICK	OH	44095	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 02226	5090 TURNEY ROAD	GARFIELD HEIGHTS	OH	44125	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 05821	132 RICHMOND STREET	PAINESVILLE	OH	44077	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 09833	318 W PROSPECT ROAD	ASHTABULA	OH	44004	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 05820	6101 ANDREWS ROAD	MENTOR ON THE LAKE	OH	44060	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 10518	6707 N RIDGE RD	MADISON	OH	44057-2656	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 10220	520 BROADWAY AVE	BEDFORD	OH	44146-2724	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 04684	12777 ROCKSIDE ROAD	GARFIELD HEIGHTS	OH	44125	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 10710	20485 EUCLID AVE	EUCLID	OH	44117	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 03312	22401 LAKE SHORE BLVD	EUCLID	OH	44123	07/01/2024
CHC30718-00	WALGREEN CO.	DBA: WALGREENS # 04294	5881 SOM CENTER RD.	WILLOUGHBY	OH	44094	07/01/2024
CHC30718-00	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #16400	10001 CHESTER AVE SUITE B	CLEVELAND	OH	44106	07/01/2024
CHC30718-00	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/4/2024 9:56:32 AM	2/22/2025 8:10:08 AM	2/22/2025 8:10 AM
Details	Last Recertification Date	Update	Recertification	2/11/2023 8:43:18 AM	2/4/2024 9:56:32 AM	2/4/2024 9:56 AM
Addresses	Shipping Address	Update	Change Request	Signature Health, Inc. 53 South Saint Claire Painesville, OH 44077	Signature Health, Inc. 53 South Saint Clair Painesville, OH 44077	1/2/2024 1:16 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	304102 (OH)		1/2/2024 1:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/2/2024 1:16 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3042102	1/2/2024 1:16 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	1/2/2024 1:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0251049	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0438259	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0250601	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0085987	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0480664	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		304102	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0215892	11/17/2023 5:54 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1841457025	11/17/2023 5:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1093138299	11/17/2023 5:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1285072603	11/17/2023 5:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1740938604	11/17/2023 5:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1740502335	11/17/2023 5:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1407879406	11/17/2023 5:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1336687482	11/17/2023 5:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1063950111	11/17/2023 5:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		OH	11/17/2023 5:54 AM
Details	Last Recertification Date	Update	Recertification	1/31/2022 9:32:07 PM	2/11/2023 8:43:18 AM	2/11/2023 8:43 AM
Details	Last Recertification Date	Update	Recertification	2/3/2021 5:08:54 AM	1/31/2022 9:32:07 PM	1/31/2022 9:32 PM
Contacts	Primary Contact	Update	Change Request	Shae, Ryan Pharmacist Signature Health 4405788200	Majoras, Shannon Chief Compliance Officer Signature Health, Inc 4405788200	5/17/2021 5:04 PM
Addresses	Shipping Address	Delete	Change Request	Signature Health, Inc. 54 South Saint Claire Painesville, OH 44077		3/22/2021 11:11 AM
Addresses	Shipping Address	Insert	Change Request		Signature Health, Inc. 53 South Saint Claire Painesville, OH 44077	3/22/2021 11:11 AM
Contacts	Primary Contact	Update	Change Request	Wood, Ryan Lee Director of Pharmacy and Lab Operations Signature Health Inc 4408133341	Shae, Ryan Pharmacist Signature Health 4405788200	3/22/2021 11:11 AM
Details	Last Recertification Date	Update	Recertification	1/27/2020 4:37:06 PM	2/3/2021 5:08:54 AM	2/3/2021 5:08 AM
Addresses	Shipping Address	Insert	Change Request		Signature Health, Inc. 4726 Main Ave. Ashtabula, OH 44004	10/28/2020 2:36 PM
Addresses	Shipping Address	Insert	Change Request		Signature Health, Inc. 54 South Saint Claire Painesville, OH 44077	10/28/2020 2:36 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1821695594	10/28/2020 2:36 PM
Medicaid Billing	NPI: State	Insert	Change Request		OH	10/28/2020 2:36 PM
Medicaid Billing	NPI: State	Update	Change Request		OH	10/28/2020 2:36 PM
Addresses	Billing Address	Update	Recertification	Signature Health 38882 Mentor Avenue Willoughby, OH 44094	Signature Health 7232 Justin Way Mentor, OH 44060	1/27/2020 4:37 PM
Details	Last Recertification Date	Update	Recertification	1/29/2019 8:03:43 AM	1/27/2020 4:37:06 PM	1/27/2020 4:37 PM
Details	Last Recertification Date	Update	Recertification	2/7/2018 12:15:31 PM	1/29/2019 8:03:43 AM	1/29/2019 8:03 AM
Contacts	Primary Contact	Update	Recertification	Sullivan, Kelley Pharmacy Manager 4409543333-111	Wood, Ryan Lee Director of Pharmacy and Lab Operations Signature Health Inc 4408133341	2/7/2018 12:15 PM
Details	Last Recertification Date	Update	Recertification		2/7/2018 12:15:31 PM	2/7/2018 12:15 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/7/2018 12:15 PM
Contacts	Authorizing Official	Update		Lee, Jonathan CEO 4409539999-705133	Lee, Jonathan Albert CEO Signature Health Inc. 4409539999-705133	10/16/2017 4:43 PM
Contacts	Signed By	Update		Lee, Jonathan CEO 4409539999-705133	Lee, Jonathan Albert CEO Signature Health Inc. 4409539999-705133	10/16/2017 4:43 PM
Addresses	Main Address	Insert			4726 Main Ave. Ashtabula, OH 44004	5/16/2017 10:18 AM
Contacts	Authorizing Official	Insert			Lee, Jonathan CEO 4409539999-705133	5/16/2017 10:18 AM
Contacts	Signed By	Insert			Lee, Jonathan CEO 4409539999-705133	5/16/2017 10:18 AM
Contacts	Primary Contact	Insert			Sullivan, Kelley Pharmacy Manager 4409543333-111	5/16/2017 10:18 AM
Addresses	Billing Address	Insert			Signature Health 38882 Mentor Avenue Willoughby, OH 44094	4/24/2017 1:54 PM
Dates	Participating Approval Date	Update			4/24/2017 12:00:00 AM	4/24/2017 1:53 PM
Details	State	Update		Pending	Active	4/24/2017 1:53 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/24/2017 1:53 PM
Details	340B ID	Update		ONLINE_REG_77399	CHC30718-04	4/18/2017 9:04 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_77399	4/17/2017 5:42 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/17/2017 5:42 PM
Medicaid Billing	Medicaid: Number	Insert			0101177	4/17/2017 5:42 PM
Medicaid Billing	Medicaid: State	Insert			OH	4/17/2017 5:42 PM
Medicaid Billing	NPI: Number	Insert			1073932588	4/17/2017 5:42 PM
Details	Last Recertification Date	Insert				4/17/2017 5:42 PM
Details	Grant Number	Insert			H80CS30718	4/17/2017 5:42 PM
Details	340B ID	Insert			ONLINE_REG	4/17/2017 5:42 PM
Details	Is Authorizing Official EHB Data	Insert			False	4/17/2017 5:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/17/2017 5:42 PM
Details	Medicare Provider Number	Insert				4/17/2017 5:42 PM
Details	Entity Name	Insert			SIGNATURE HEALTH, INC.	4/17/2017 5:42 PM
Details	Program Code	Insert			CH	4/17/2017 5:42 PM
Details	Entity Subname	Insert			Signature Health Ashtabula Health Center	4/17/2017 5:42 PM
Dates	Participating Approval Date	Insert				4/17/2017 5:42 PM
Details	State	Insert			Pending	4/17/2017 5:42 PM
Dates	Registration Date	Insert			4/17/2017 12:00:00 AM	4/17/2017 5:42 PM
Dates	Signed By Date	Insert			4/17/2017 12:00:00 AM	4/17/2017 5:42 PM
Dates	Start Date	Insert				4/17/2017 5:42 PM
Terminations	Termination Comments	Insert				4/17/2017 5:42 PM
Terminations	Termination Date	Insert				4/17/2017 5:42 PM
Terminations	Termination Effective Date	Insert				4/17/2017 5:42 PM
Terminations	Termination Reason	Insert				4/17/2017 5:42 PM

340B Drug Pricing Program Database