Covered Entity Details

CH062242E SPRING BRANCH COMMUNITY HEALTH CENTER (Active) - information as of 5/7/2025 10:46:56 PM

Main Details

Name

SPRING BRANCH COMMUNITY HEALTH CENTER

Subdivision Name

Spring Branch Community Health Center - CyFair Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-019753

340B ID

CH062242E

Grant Number

H80CS06447

Additional Details

Current Program Status

Active

Registration Date

7/10/2017

Participating Start Date

9/21/2017

Participating Approval Date

7/13/2017

Last Recertification Date

3/4/2025

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

7777 Westgreen Blvd
Cypress, TX 77433

Billing Address

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

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	Last Updated On
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03691	20500 FM 529 RD	CYPRESS	TX	77433	01/10/2023	04/01/2023	04/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #21387	21820 KATY FWY STE 110	KATY	TX	77449	01/10/2023	04/01/2023	04/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/12/2023	01/01/2024	01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH0622420	Active	Admin/Service Delivery	SPRING BRANCH COMMUNITY HEALTH CENTER	SBCHC - Hillendahl Clinic	1615 Hillendahl Blvd.	Suite 100	Houston	TX
CH062242A	Active	BPS-H80-008909	Spring Branch Community Health Center	SBCHC - Pitner Clinic	8575 Pitner Road		Houston	TX
CH062242B	Active	BPS-H80-013245	SPRING BRANCH COMMUNITY HEALTH CENTER	Spring Branch Community Health Center West Houston Clinc	19333 Clay Rd		Katy	TX
CH062242C	Active	BPS-H80-015559	SPRING BRANCH COMMUNITY HEALTH CENTER	Spring Branch CHC - WholeLife Clinic	1905 JACQUELYN DR		HOUSTON	TX
CH062242D	Active	BPS-H80-018812	SPRING BRANCH COMMUNITY HEALTH CENTER	Spring Branch Community Health Center - Katy Clinic	5502 1st St		Katy	TX
CH062242E	Active	BPS-H80-019753	SPRING BRANCH COMMUNITY HEALTH CENTER	Spring Branch Community Health Center - CyFair Clinic	7777 Westgreen Blvd		Cypress	TX
CH062242F	Active	BPS-H80-034250	Spring Branch Community Health Center	Spring Branch CHC - Memorial Clinic	902 Frostwood Dr Ste 108		Houston	TX
CH062242G	Active	BPS-H80-033412	Spring Branch Community Health Center	Spring Branch CHC - NAM Clinic	15555 Kuykendahl Rd		Houston	TX

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0622420	AVENUE 360 HEALTH AND WELLNESS	2150 W 18TH ST STE 300	SERVICE JOBS FOR PROGRESS	HOUSTON	TX	77008	10/01/2014	01/01/2023
CH0622420	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2023
CH0622420	WAL-MART PHARMACY 10-0768	1313 FRY RD		KATY	TX	77449	04/01/2023
CH062242D	WAL-MART PHARMACY 10-0768	1313 FRY RD		KATY	TX	77449	04/01/2023
CH062242B	WAL-MART PHARMACY 10-0768	1313 FRY RD		KATY	TX	77449	04/01/2023
CH0622420	WAL-MART PHARMACY 10-2257	13484 NORTHWEST FREEWAY		HOUSTON	TX	77040	04/01/2023
CH0622420	WAL-MART PHARMACY 10-3640	1118 SILBER ROAD		HOUSTON	TX	77055	04/01/2023
CH062242A	WAL-MART PHARMACY 10-3640	1118 SILBER ROAD		HOUSTON	TX	77055	04/01/2023
CH0622420	WAL-MART PHARMACY 10-4538	6060 NORTH FRY ROAD		KATY	TX	77449	04/01/2023
CH062242B	WAL-MART PHARMACY 10-4538	6060 NORTH FRY ROAD		KATY	TX	77449	04/01/2023
CH0622420	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2023
CH0622420	WALGREEN CO	DBA: WALGREENS #15515	18400 KATY FREEWAY SUITE 100	HOUSTON	TX	77094	04/01/2019	01/02/2023
CH0622420	WALGREEN CO.	DBA: WALGREENS # 03820	8590 LONG POINT RD	HOUSTON	TX	77055	10/01/2015
CH0622420	WALGREEN CO.	DBA: WALGREENS # 05536	2808 GESSNER RD	HOUSTON	TX	77080	10/01/2015
CH0622420	WALGREEN CO.	DBA: WALGREENS # 06668	9450 HAMMERLY BLVD	HOUSTON	TX	77080-5400	10/01/2015
CH0622420	WALGREEN CO.	DBA: WALGREENS # 07019	3120 N FRY RD	KATY	TX	77449-6239	10/01/2015
CH0622420	WALGREEN CO.	DBA: WALGREENS # 04078	5161 FRANZ ROAD	KATY	TX	77493	09/22/2017
CH0622420	WALGREEN CO.	DBA: WALGREENS # 06702	3403 MANGUM ROAD	HOUSTON	TX	77092-7415	09/22/2017
CH0622420	WALGREEN CO.	DBA: WALGREENS # 05423	1413 WIRT ROAD	HOUSTON	TX	77055	09/22/2017
CH0622420	WALGREEN CO.	DBA: WALGREENS #13062	25620 KINGSLAND BLVD.	KATY	TX	77494	09/22/2017
CH0622420	WALGREEN CO.	DBA: WALGREENS # 03441	1710 FRY ROAD	HOUSTON	TX	77084	04/01/2019
CH0622420	WALGREEN CO.	DBA: WALGREENS # 06909	4007 BARKER CYPRESS ROAD	HOUSTON	TX	77084-6802	04/01/2019
CH0622420	WALGREEN CO.	DBA: WALGREENS # 03691	20500 FM 529 RD	CYPRESS	TX	77433	04/01/2019
CH0622420	WALGREEN CO.	DBA: WALGREENS # 04513	1403 FM 1960 W	HOUSTON	TX	77090	01/01/2022
CH0622420	WALGREEN CO.	DBA: WALGREENS # 03160	6280 BARKER CYPRESS	HOUSTON	TX	77084	04/01/2023
CH0622420	WALGREEN CO.	DBA: WALGREENS # 03870	4995 HWY 6 NORTH	HOUSTON	TX	77084	04/01/2023
CH0622420	WALGREEN CO.	WALGREENS #21387	21820 KATY FWY STE 110	KATY	TX	77449	04/01/2023
CH0622420	WALGREEN CO.	WALGREENS #21388	9055 KATY FWY STE 101	HOUSTON	TX	77024	04/01/2023
CH0622420	WALGREEN CO.	DBA: WALGREENS # 02116	6107 HIGHWAY 6 N	HOUSTON	TX	77084	04/01/2023
CH062242A	WALGREEN CO.	DBA: WALGREENS # 05536	2808 GESSNER RD	HOUSTON	TX	77080	04/01/2023
CH062242A	WALGREEN CO.	DBA: WALGREENS # 06668	9450 HAMMERLY BLVD	HOUSTON	TX	77080-5400	04/01/2023
CH062242B	WALGREEN CO.	DBA: WALGREENS # 07019	3120 N FRY RD	KATY	TX	77449-6239	04/01/2023
CH062242C	WALGREEN CO.	DBA: WALGREENS # 03820	8590 LONG POINT RD	HOUSTON	TX	77055	04/01/2023
CH062242C	WALGREEN CO.	DBA: WALGREENS # 05423	1413 WIRT ROAD	HOUSTON	TX	77055	04/01/2023
CH062242D	WALGREEN CO.	DBA: WALGREENS # 04078	5161 FRANZ ROAD	KATY	TX	77493	04/01/2023
CH062242D	WALGREEN CO.	DBA: WALGREENS # 03441	1710 FRY ROAD	HOUSTON	TX	77084	04/01/2023
CH062242D	WALGREEN CO.	DBA: WALGREENS #13062	25620 KINGSLAND BLVD.	KATY	TX	77494	04/01/2023
CH062242D	WALGREEN CO.	WALGREENS #21387	21820 KATY FWY STE 110	KATY	TX	77449	04/01/2023
CH062242E	WALGREEN CO.	DBA: WALGREENS # 03691	20500 FM 529 RD	CYPRESS	TX	77433	04/01/2023
CH062242F	WALGREEN CO.	WALGREENS #21388	9055 KATY FWY STE 101	HOUSTON	TX	77024	04/01/2023
CH062242B	WALGREEN CO.	WALGREENS #21387	21820 KATY FWY STE 110	KATY	TX	77449	04/01/2023
CH062242E	WALGREEN CO.	WALGREENS #21387	21820 KATY FWY STE 110	KATY	TX	77449	04/01/2023
CH062242G	WALGREEN CO.	DBA: WALGREENS # 04513	1403 FM 1960 W	HOUSTON	TX	77090	04/01/2023
CH0622420	Walgreens #21373	Walgreens Central Fill #21373	4100 Dale Earnhardt Way STE 200	Northlake	TX	76262	01/01/2022
CH0622420	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH0622420	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH062242A	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH062242B	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH062242C	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH062242D	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH062242E	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH062242G	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	2/26/2024 4:14:10 PM	3/4/2025 2:56:56 PM	3/4/2025 2:56 PM
Addresses	Billing Address	Update	Recertification	Spring Branch Community Health Center - CyFair Clinic 800 W Sam Houston Pkwy S 200 Houston, TX 77042	Spring Branch Community Health Center 1615 Hillendahl Blvd Suite 100 Houston, TX 77055	2/26/2024 4:14 PM
Details	Last Recertification Date	Update	Recertification	2/1/2023 10:47:36 AM	2/26/2024 4:14:10 PM	2/26/2024 4:14 PM
Details	Last Recertification Date	Update	Recertification	2/28/2022 10:26:11 PM	2/1/2023 10:47:36 AM	2/1/2023 10:47 AM
Details	Last Recertification Date	Update	Recertification	2/12/2021 4:36:29 PM	2/28/2022 10:26:11 PM	2/28/2022 10:26 PM
Details	Last Recertification Date	Update	Recertification	2/24/2020 8:30:19 AM	2/12/2021 4:36:29 PM	2/12/2021 4:36 PM
Contacts	Primary Contact	Update	Recertification	McEvoy, Mary Ellen Chief Compliance Officer Spring Branch Community Health Center 7134626565-165	Krusleski, David Chief Medical Officer Spring Branch CHC 7134626565-190	2/24/2020 8:30 AM
Details	Last Recertification Date	Update	Recertification	2/21/2019 8:27:12 PM	2/24/2020 8:30:19 AM	2/24/2020 8:30 AM
Details	Last Recertification Date	Update	Recertification	2/26/2018 4:21:26 PM	2/21/2019 8:27:12 PM	2/21/2019 8:27 PM
Addresses	Billing Address	Insert	Recertification		Spring Branch Community Health Center - CyFair Clinic 800 W Sam Houston Pkwy S 200 Houston, TX 77042	2/26/2018 4:21 PM
Details	Last Recertification Date	Update	Recertification		2/26/2018 4:21:26 PM	2/26/2018 4:21 PM
Contacts	Authorizing Official	Update		Trujillo, Marlen Chief Executive Officer 7134626565-118	Trujillo, Marlen Chief Executive Officer Spring Branch CHC 7134626565-118	2/26/2018 4:19 PM
Contacts	Signed By	Update		Trujillo, Marlen Chief Executive Officer 7134626565-118	Trujillo, Marlen Chief Executive Officer Spring Branch CHC 7134626565-118	2/26/2018 4:19 PM
Details	Is Authorizing Official EHB Data	Update	OPA Edit	False		9/21/2017 3:31 PM
Details	State	Update	OPA Edit	Approved	Active	9/21/2017 3:31 PM
Dates	Start Date	Update	OPA Edit	10/1/2017 12:00:00 AM	9/21/2017 12:00:00 AM	9/21/2017 3:31 PM
Contacts	Primary Contact	Update		McEvoy, Mary Ellen Chief Compliance Officer 7134626565-165	McEvoy, Mary Ellen Chief Compliance Officer Spring Branch Community Health Center 7134626565-165	9/19/2017 2:40 PM
Addresses	Main Address	Insert			7777 Westgreen Blvd Cypress, TX 77433	7/13/2017 4:33 PM
Contacts	Primary Contact	Insert			McEvoy, Mary Ellen Chief Compliance Officer 7134626565-165	7/13/2017 4:33 PM
Contacts	Authorizing Official	Insert			Trujillo, Marlen Chief Executive Officer 7134626565-118	7/13/2017 4:33 PM
Contacts	Signed By	Insert			Trujillo, Marlen Chief Executive Officer 7134626565-118	7/13/2017 4:33 PM
Dates	Participating Approval Date	Update			7/13/2017 12:00:00 AM	7/13/2017 4:33 PM
Details	State	Update		Pending	Approved	7/13/2017 4:33 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/13/2017 4:33 PM
Details	340B ID	Update		ONLINE_REG_78053	CH062242E	7/13/2017 1:46 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_78053	7/10/2017 11:42 AM
Details	Last Recertification Date	Insert				7/10/2017 11:42 AM
Details	Grant Number	Insert			H80CS06447	7/10/2017 11:42 AM
Details	340B ID	Insert			ONLINE_REG	7/10/2017 11:42 AM
Details	Is Authorizing Official EHB Data	Insert			False	7/10/2017 11:42 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/10/2017 11:42 AM
Details	Medicare Provider Number	Insert				7/10/2017 11:42 AM
Details	Entity Name	Insert			SPRING BRANCH COMMUNITY HEALTH CENTER	7/10/2017 11:42 AM
Details	Program Code	Insert			CH	7/10/2017 11:42 AM
Details	Entity Subname	Insert			Spring Branch Community Health Center - CyFair Clinic	7/10/2017 11:42 AM
Dates	Participating Approval Date	Insert				7/10/2017 11:42 AM
Details	State	Insert			Pending	7/10/2017 11:42 AM
Dates	Registration Date	Insert			7/10/2017 12:00:00 AM	7/10/2017 11:42 AM
Dates	Signed By Date	Insert			7/10/2017 12:00:00 AM	7/10/2017 11:42 AM
Dates	Start Date	Insert				7/10/2017 11:42 AM
Terminations	Termination Comments	Insert				7/10/2017 11:42 AM
Terminations	Termination Date	Insert				7/10/2017 11:42 AM
Terminations	Termination Effective Date	Insert				7/10/2017 11:42 AM
Terminations	Termination Reason	Insert				7/10/2017 11:42 AM

340B Drug Pricing Program Database