Covered Entity Details

CHC12845-01 NATIVE HEALTH (Active) - information as of 4/23/2025 10:51:15 PM

Main Details

Name

NATIVE HEALTH

Subdivision Name

NATIVE HEALTH Central

Type

HRSA-Funded Health Center

Site ID

BPS-H80-010845

340B ID

CHC12845-01

Grant Number

H80CS12845

Additional Details

Current Program Status

Active

Registration Date

7/19/2017

Participating Start Date

10/1/2017

Participating Approval Date

7/25/2017

Last Recertification Date

2/19/2025

Contacts

Authorizing Official

Native Health
Walter Murillo, Chief Executive Officer
(602) 279-5262

Primary Contact

NATIVE HEALTH
Mitchell Terry, Chief Compliance Officer
(602) 279-5262 Ext: 11028

Addresses

Street Address

4041 N Central Ave BLDG C
Phoenix, AZ 85012-3313

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?
Yes

State	Medicaid Number	NPI Number
AZ	936906,394932,479794,936933	1982830410,1700904075

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC12845-00	Active	BPS-H80-038614	NATIVE HEALTH	NATIVE HEALTH West 8800	8800 N 22nd Ave		Phoenix	AZ
CHC12845-01	Active	BPS-H80-010845	NATIVE HEALTH	NATIVE HEALTH Central	4041 N Central Ave BLDG C		Phoenix	AZ

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC12845-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2024
CHC12845-00	ALBERTSON'S LLC	OSCO DRUG #2952	8035 NORTH 19TH AVE	PHOENIX	AZ	85021	10/01/2021	07/24/2023
CHC12845-00	ARIZONA CVS STORES, L.L.C.	DBA CVS/PHARMACY # 8983	5125 W. OLIVE AVE	GLENDALE	AZ	85302	07/01/2023
CHC12845-00	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03383	7550 SOUTH 19TH AVE.	PHOENIX	AZ	85041	07/01/2023
CHC12845-00	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09256	3560 WEST PEORIA AVENUE	PHOENIX	AZ	85029	07/01/2023
CHC12845-00	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09225	2406 EAST THOMAS RD.	PHOENIX	AZ	85016	07/01/2023
CHC12845-00	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09218	1137 S. DOBSON RD #10	MESA	AZ	85202	07/01/2023
CHC12845-00	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09314	3440 WEST GLENDALE AVE	PHOENIX	AZ	85051	07/01/2023
CHC12845-00	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09347	1525 NORTH CENTRAL AVENUE	PHOENIX	AZ	85004	07/01/2023
CHC12845-00	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09297	6002 NORTH 7TH STREET	PHOENIX	AZ	85014	01/01/2024
CHC12845-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2024
CHC12845-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2024
CHC12845-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2024
CHC12845-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2024
CHC12845-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2024
CHC12845-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2024
CHC12845-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2024
CHC12845-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2024
CHC12845-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2024
CHC12845-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2024
CHC12845-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2024
CHC12845-00	GENOA HEALTHCARE LLC	1201 S 7TH AVE, SUITE 150-P		PHOENIX	AZ	85007	07/01/2024
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 05892	5050 W. BASELINE RD.	LAVEEN	AZ	85339	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16765	1230 S LONGMORE AVE	MESA	AZ	85202	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 06862	1850 W. DUNLAP AVE.	PHOENIX	AZ	85021	07/01/2023	11/15/2022
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 08366	1610 E CAMELBACK RD	PHOENIX	AZ	85016	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 00033	1750 E BROADWAY RD	TEMPE	AZ	85282	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 07872	7499 W. BETHANY HOME RD.	GLENDALE	AZ	85303	07/01/2023	06/20/2024
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 01759	10 E DUNLAP AVE	PHOENIX	AZ	85020	07/01/2023	10/26/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 07116	1855 W. THUNDERBIRD RD.	PHOENIX	AZ	85023	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 17418	5715 N 19TH AVE	PHOENIX	AZ	85015	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 17406	10404 N 43RD AVE	GLENDALE	AZ	85302	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 00040	1424 W BASELINE RD	TEMPE	AZ	85283	07/01/2023	06/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	CVS/PHARMACY # 2963	711 E. INDIAN SCHOOL RD.	PHOENIX	AZ	85014	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 05778	4040 N. 19TH AVE.	PHOENIX	AZ	85015	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 09222	4275 W. THOMAS RD.	PHOENIX	AZ	85019	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 00017	18591 N 59TH AVE	GLENDALE	AZ	85308	07/01/2023
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 05950	855 E. ELLIOT ROAD	TEMPE	AZ	85284	04/01/2024
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16335	4734 E RAY RD	PHOENIX	AZ	85044	10/01/2024
CHC12845-00	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 06718	5835 W. INDIAN SCHOOL RD.	PHOENIX	AZ	85031	10/01/2024
CHC12845-00	MELROSE PHARMACY	706 W. MONTECITO AVE		PHOENIX	AZ	85013	10/01/2021
CHC12845-00	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/01/2024
CHC12845-00	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	07/01/2024
CHC12845-00	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2024
CHC12845-00	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/01/2024
CHC12845-00	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/01/2024
CHC12845-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2024
CHC12845-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2024
CHC12845-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2024
CHC12845-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-1532	5845 WEST BELL ROAD		GLENDALE	AZ	85308	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-1549	2020 N 75TH AVE SUITE 1		PHOENIX	AZ	85035	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-1598	4617 E BELL ROAD		PHOENIX	AZ	85032	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-1746	1380 WEST ELLIOTT ROAD		TEMPE	AZ	85284	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-2113	1607 WEST BETHANY HOME RD		PHOENIX	AZ	85015	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-2512	1825 W BELL ROAD		PHOENIX (NORTH)	AZ	85023	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-2632	115 E DUNLAP AVE		PHOENIX	AZ	85020	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-5124	5605 W NORTHERN AVE		GLENDALE (MANISTEE)	AZ	85301	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-5189	5250 WEST INDIAN SCHOOL RD		PHOENIX (MARYVALE)	AZ	85031	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-5330	6145 NORTH 35TH AVENUE		PHOENIX	AZ	85017	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2024
CHC12845-00	WAL-MART PHARMACY 10-6477	9600 N. METRO PARKWAY W		PHOENIX	AZ	85051	07/01/2024
CHC12845-00	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 04139	3450 W. DUNLAP AVE	PHOENIX	AZ	85051	04/01/2017
CHC12845-00	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 06400	8030 N 19TH AVE	PHOENIX	AZ	85021-5101	04/01/2017
CHC12845-00	WALGREEN ARIZONA DRUG CO.	WALGREENS SPECIALTY PHARMACY #16431	2302 N. CENTRAL AVE. SUITE 7	PHOENIX	AZ	85004	04/01/2017
CHC12845-00	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 03464	3402 N CENTRAL AVE	PHOENIX	AZ	85012	04/01/2020
CHC12845-00	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	10/01/2021
CHC12845-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2025
CHC12845-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2024
CHC12845-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/21/2024 10:50:16 AM	2/19/2025 1:01:05 PM	2/19/2025 1:01 PM
Contacts	Primary Contact	Update	Profile Change Request	Terry, Mitchell Compliance Officer NATIVE HEALTH 6022795262-11028	Terry, Mitchell Chief Compliance Officer NATIVE HEALTH 6022795262-11028	2/11/2025 1:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		936906	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		394932	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		479794	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		936933	7/22/2024 9:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	7/22/2024 9:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1982830410	7/22/2024 9:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	7/22/2024 9:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1700904075	7/22/2024 9:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	7/22/2024 9:47 AM
Details	Last Recertification Date	Update	Recertification	2/16/2023 10:29:16 AM	2/21/2024 10:50:16 AM	2/21/2024 10:50 AM
Details	Entity Name	Update	Change Request	NATIVE AMERICAN COMMUNITY HEALTH CENTER, INC.	NATIVE HEALTH	9/28/2023 10:48 AM
Contacts	Primary Contact	Update	PC Change Request	SANGSTER, DEANNA Chief Operating Officer NATIVE HEALTH 6022795262	Terry, Mitchell Compliance Officer NATIVE HEALTH 6022795262-11028	3/17/2023 4:51 PM
Contacts	Primary Contact	Update	Profile Change Request	SANGSTER, DEANNA HEALTH SERVICES ADMINISTRATOR NATIVE HEALTH 6022795262	SANGSTER, DEANNA Chief Operating Officer NATIVE HEALTH 6022795262	2/19/2023 2:18 PM
Details	Last Recertification Date	Update	Recertification	2/7/2022 1:58:37 PM	2/16/2023 10:29:16 AM	2/16/2023 10:29 AM
Details	Last Recertification Date	Update	Recertification	2/10/2021 8:13:18 PM	2/7/2022 1:58:37 PM	2/7/2022 1:58 PM
Details	Last Recertification Date	Update	Recertification	2/20/2020 5:44:30 PM	2/10/2021 8:13:18 PM	2/10/2021 8:13 PM
Details	Last Recertification Date	Update	Recertification	2/6/2019 4:36:19 PM	2/20/2020 5:44:30 PM	2/20/2020 5:44 PM
Details	Last Recertification Date	Update	Recertification	2/10/2018 8:38:51 PM	2/6/2019 4:36:19 PM	2/6/2019 4:36 PM
Contacts	Authorizing Official	Update	AO Change Request	Patron, Patricia COO Native Health 6022795262-3134	Murillo, Walter Chief Executive Officer Native Health 6022795262	2/6/2019 6:49 AM
Contacts	Primary Contact	Update	Recertification	Patron, Patricia COO Native Health 6022795262-3134	SANGSTER, DEANNA HEALTH SERVICES ADMINISTRATOR NATIVE HEALTH 6022795262	2/10/2018 8:38 PM
Details	Last Recertification Date	Update	Recertification		2/10/2018 8:38:51 PM	2/10/2018 8:38 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/10/2018 8:38 PM
Contacts	Authorizing Official	Update		Patron, Patricia COO 6022795262-3134	Patron, Patricia COO Native Health 6022795262-3134	10/19/2017 7:23 PM
Contacts	Primary Contact	Update		Patron, Patricia COO 6022795262-3134	Patron, Patricia COO Native Health 6022795262-3134	10/19/2017 7:23 PM
Contacts	Signed By	Update		Patron, Patricia COO 6022795262-3134	Patron, Patricia COO Native Health 6022795262-3134	10/19/2017 7:23 PM
Addresses	Main Address	Insert			4041 N Central Ave BLDG C Phoenix, AZ 85012-3313	7/25/2017 10:32 AM
Contacts	Authorizing Official	Insert			Patron, Patricia COO 6022795262-3134	7/25/2017 10:32 AM
Contacts	Primary Contact	Insert			Patron, Patricia COO 6022795262-3134	7/25/2017 10:32 AM
Contacts	Signed By	Insert			Patron, Patricia COO 6022795262-3134	7/25/2017 10:32 AM
Details	State	Update		Approved	Active	7/25/2017 10:32 AM
Dates	Participating Approval Date	Update			7/25/2017 12:00:00 AM	7/25/2017 10:31 AM
Details	State	Update		Pending	Approved	7/25/2017 10:31 AM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/25/2017 10:31 AM
Details	340B ID	Update		ONLINE_REG_79311	CHC12845-01	7/24/2017 9:15 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_79311	7/19/2017 5:03 PM
Details	Last Recertification Date	Insert				7/19/2017 5:03 PM
Details	Grant Number	Insert			H80CS12845	7/19/2017 5:03 PM
Details	340B ID	Insert			ONLINE_REG	7/19/2017 5:03 PM
Details	Is Authorizing Official EHB Data	Insert			False	7/19/2017 5:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/19/2017 5:03 PM
Details	Medicare Provider Number	Insert				7/19/2017 5:03 PM
Details	Entity Name	Insert			NATIVE AMERICAN COMMUNITY HEALTH CENTER, INC.	7/19/2017 5:03 PM
Details	Program Code	Insert			CH	7/19/2017 5:03 PM
Details	Entity Subname	Insert			NATIVE HEALTH Central	7/19/2017 5:03 PM
Dates	Participating Approval Date	Insert				7/19/2017 5:03 PM
Details	State	Insert			Pending	7/19/2017 5:03 PM
Dates	Registration Date	Insert			7/19/2017 12:00:00 AM	7/19/2017 5:03 PM
Dates	Signed By Date	Insert			7/19/2017 12:00:00 AM	7/19/2017 5:03 PM
Dates	Start Date	Insert				7/19/2017 5:03 PM
Terminations	Termination Comments	Insert				7/19/2017 5:03 PM
Terminations	Termination Date	Insert				7/19/2017 5:03 PM
Terminations	Termination Effective Date	Insert				7/19/2017 5:03 PM
Terminations	Termination Reason	Insert				7/19/2017 5:03 PM

340B Drug Pricing Program Database