340B Drug Pricing Program Database


CHC00341-07 PRIMECARE COMMUNITY HEALTH INC (Active) - information as of 4/29/2025 1:40:14 AM

Main Details
PRIMECARE COMMUNITY HEALTH INC
PrimeCare West Town Dental
HRSA-Funded Health Center
BPS-H80-018120
CHC00341-07
H80CS00341


Additional Details
Active
10/13/2017
1/1/2018
11/6/2017
2/10/2025

Contacts

PrimeCare Community Health
Michael C Holtrop, Chief Financial Officer
(616) 482-9892

PRIMECARE COMMUNITY HEALTH INC
Kenzie Keisler, Interim 340B Compliance Analyst
(803) 465-2011

Addresses

1431 N Western Ave
Ste 401
Chicago, IL 60622

PrimeCare Community Health
2211 N. Elston Ave
Suite 301
Chicago, IL 60614


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

Yes
StateMedicaid NumberNPI Number
IL3638452530171205374964
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08740 2427 W CHICAGO AVE
CHICAGOIL6062210/12/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07359 3222 N. MILWAUKEE AVENUE
CHICAGOIL60618-510604/15/202407/01/2024  07/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09000 2001 N MILWAUKEE AVE
CHICAGOIL60647-400104/15/202407/01/2024  07/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC00341-00ActiveBPS-H80-002087PRIMECARE COMMUNITY HEALTH INCPRIMECARE WEST TOWN1431 N Western Ave ChicagoIL
CHC00341-01ActiveBPS-H80-001933PRIMECARE COMMUNITY HEALTH INCPRIMECARE FULLERTON3924 W Fullerton Ave ChicagoIL
CHC00341-02ActiveBPS-H80-027459PRIMECARE COMMUNITY HEALTH INCPrimeCare Belmont Cragin5635 West Belmont ChicagoIL
CHC00341-03ActiveBPS-H80-011484PRIMECARE COMMUNITY HEALTH INCPrimeCare Northwest1649 N Pulaski Rd ChicagoIL
CHC00341-04ActiveBPS-H80-012113PRIMECARE COMMUNITY HEALTH INCPrimeCare Hamlin1920 N Hamlin ChicagoIL
CHC00341-05ActiveBPS-H80-018009PRIMECARE COMMUNITY HEALTH INCPrimeCare Wicker Park1127 N. Oakley Blvd. ChicagoIL
CHC00341-06ActiveBPS-H80-018449PRIMECARE COMMUNITY HEALTH INCMichael Michelini Center for Health1431 N Western Ave ChicagoIL
CHC00341-07ActiveBPS-H80-018120PRIMECARE COMMUNITY HEALTH INCPrimeCare West Town Dental1431 N Western Ave ChicagoIL
CHC00341-08ActiveBPS-H80-036204PrimeCare Community Health, Inc.PrimeCare Young Family Health Center1431 N Western Ave ChicagoIL
CHC00341-09TerminatedBPS-H80-038466PRIMECARE COMMUNITY HEALTH INCElston1308 N Elston Ave ChicagoIL
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC00341-00ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2024  
CHC00341-00ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/01/2024  
CHC00341-00ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2024  
CHC00341-00ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/01/2024  
CHC00341-00ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/01/2024  
CHC00341-00ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/01/2024  
CHC00341-00ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280901/01/2020  
CHC00341-00AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271204/01/2020 01/01/2025
CHC00341-00AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291110/01/2019 01/01/2025
CHC00341-00AMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700310/01/2024  
CHC00341-00AMAZON PHARMACY #008408 TECHNOLOGY PARKWAY BUILDING B, STE 101
COLLEGE STATIONTX7784510/01/2024 01/01/2025
CHC00341-00AMAZON PHARMACY #0097469 KINGSPOINTE PKWY STE 400
ORLANDOFL3281910/01/2024 01/01/2025
CHC00341-00AMAZON PHARMACY #0101331 E 6TH ST
CORONACA9287910/01/2024 01/01/2025
CHC00341-00AMERICAN DRUG STORES LLCDBA OSCO DRUG 1403 7122 40TH ST
STICKNEYIL60402-419801/01/2025  
CHC00341-00AMERICAN DRUG STORES LLCDBA OSCO DRUG 3262 4660 W. IRVING PARK ROAD
CHICAGOIL6064101/01/2025  
CHC00341-00AMERICAN DRUG STORES LLCDBA OSCO DRUG 1241 1343 N. PAULINA ST.
CHICAGOIL6062201/01/2025  
CHC00341-00ARMITAGE PHARMACY, INC.3650 W ARMITAGE AVE
CHICAGOIL60647-361107/01/2025  
CHC00341-00AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503410/01/2019  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2020  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2020  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/01/2025  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620304/01/2025  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2025  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01495 4225 W. ARMITAGE
CHICAGOIL6063910/01/2014 08/11/2015
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02877 2440 W NORTH AVE
CHICAGOIL6064710/01/2014  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04147 1546 N. CENTRAL AVE.
CHICAGOIL60651-125910/01/2014  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04938 4748 W NORTH AVE
CHICAGOIL6063910/01/2014  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 11410 1627 N PULASKI RD
CHICAGOIL6063910/01/2014  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01310 3110 W ARMITAGE
CHICAGOIL6064707/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05121 5935 W ADDISON
CHICAGOIL6063407/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03833 2828 N HARLEM
ELMWOOD PARKIL6070710/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS #10771 6460 W. FULLERTON AVE
CHICAGOIL6070710/01/2015 06/27/2017
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01593 5230 N MILWAUKEE AVE
CHICAGOIL6063010/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04935 6809 W BELMONT AVE
CHICAGOIL6063410/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04936 4040 N. CICERO AVE.
CHICAGOIL6064110/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04986 4745 W BELMONT AVE
CHICAGOIL60641-441010/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04233 5600 W. FULLERTON
CHICAGOIL6063910/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04862 4343 N CENTRAL AVE
CHICAGOIL6063410/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05057 3153 W IRVING PARK RD
CHICAGOIL6061807/01/2016  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04542 5625 N. RIDGE AVE
CHICAGOIL60660-343401/01/2017  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01298 1372 N MILWAUKEE AVE
CHICAGOIL6062204/01/2017  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03961 2340 W MADISON ST
CHICAGOIL6061207/01/2019  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05235 6412 ROOSEVELT RD
OAK PARKIL60304-213507/01/2019  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01417 1931 W CERMAK RD
CHICAGOIL6060804/01/2020  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03395 3401 W ROOSEVELT RD
CHICAGOIL6062404/01/2020 11/12/2024
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA WALGREENS SPECIALTY PHARMACY #04505 4025 N. SHERIDAN RD.
CHICAGOIL6061304/01/2020  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02903 5222 WEST MADISON ST
CHICAGOIL6064404/01/2021  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05103 5932 W. CERMAK RD
CICEROIL6080401/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04978 111 S. HALSTED STREET
CHICAGOIL6066101/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05234 5435 S KEDZIE AVE
CHICAGOIL6063201/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05356 4710 S WESTERN AVE
CHICAGOIL6060901/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04826 9800 IRVING PARK ROAD
SCHILLER PARKIL6017601/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02586 2301 W. IRVING PARK
CHICAGOIL6061801/01/2022  
CHC00341-06BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02877 2440 W NORTH AVE
CHICAGOIL6064701/01/2024  
CHC00341-04BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04233 5600 W. FULLERTON
CHICAGOIL6063904/01/2024  
CHC00341-08BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04935 6809 W BELMONT AVE
CHICAGOIL6063407/01/2024  
CHC00341-03BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 11410 1627 N PULASKI RD
CHICAGOIL6063907/01/2024  
CHC00341-02BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04935 6809 W BELMONT AVE
CHICAGOIL6063407/01/2024  
CHC00341-03BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04233 5600 W. FULLERTON
CHICAGOIL6063907/01/2025  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03779 100 LAKE ST
MAYWOODIL6015307/01/2025  
CHC00341-00CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2020  
CHC00341-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2020  
CHC00341-00CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2020  
CHC00341-00CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2020  
CHC00341-00CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2020  
CHC00341-00CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2020  
CHC00341-00CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2020  
CHC00341-00CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813301/01/2020  
CHC00341-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237401/01/2020  
CHC00341-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/01/2021  
CHC00341-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/01/2021  
CHC00341-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/01/2021  
CHC00341-00CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/01/2021  
CHC00341-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/21/2021  
CHC00341-00DOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K
GREENVILLESC29607-654004/01/2020  
CHC00341-00EAM GROUP, LLC.ANVIRX PHARMACY 13925 YALE AVE STE 145
IRVINECA9262010/01/2022 12/27/2024
CHC00341-00ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/01/2024  
CHC00341-00EXACT CARE PHARMACYDDCRX, LLC 2701 HIGHPOINT OAKS DR STE 100
LEWISVILLETX75067-389610/01/2022 12/27/2024
CHC00341-00EXACT CARE PHARMACY, LLC8333 ROCKSIDE RD
CLEVELANDOH4412510/01/2022 12/27/2024
CHC00341-00EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/01/2024  
CHC00341-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/01/2024  
CHC00341-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/01/2024  
CHC00341-00GENOA HEALTHCARE LLCN171 W21840 CAYMUS CT
JACKSONWI5303704/01/2024  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 00788 344 WEST HUBBARD
CHICAGOIL6065410/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 01054 101 N. CLINTON ST.
CHICAGOIL6066110/01/2019 07/14/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 01493 5205 N. BROADWAY ST.
CHICAGOIL6064010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02809 2815 N. WESTERN AVE.
CHICAGOIL6061810/01/2019 01/19/2023
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02862 3944 N. WESTERN AVE.
CHICAGOIL6061810/01/2019 10/11/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02934 208 W. WASHINGTON ST.
CHICAGOIL6060610/01/2019 10/11/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02942 401 W. ARMITAGE AVE.
CHICAGOIL6061410/01/2019 01/31/2024
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02981 1201 N. STATE ST.
CHICAGOIL6061010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 03742 121 W KINZIE ST
CHICAGOIL6065410/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 04781 205 N. MICHIGAN AVE.
CHICAGOIL6060110/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 04793 1211 W. ROOSEVELT RD.
CHICAGOIL6060810/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05001 3033 N. BROADWAY ST.
CHICAGOIL6065710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA CVS/PHARMACY # 5394 1200 N. ASHLAND, UNIT C-1
CHICAGOIL6062210/01/2019 03/07/2023
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05482 3615 N. CENTRAL AVE
CHICAGOIL6063410/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05681 3311 N. PULASKI RD.
CHICAGOIL6064110/01/2019 11/14/2024
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05768 130 S. CANAL ST.
CHICAGOIL6060610/01/2019 04/14/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05770 4777 N. MILWAUKEE AVE.
CHICAGOIL6063010/01/2019 10/11/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05836 1228 E. 53RD ST.
CHICAGOIL6061510/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05987 4800 NORTH DAMEN
CHICAGOIL6062510/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 06785 3343 W. MONTROSE AVE.
CHICAGOIL6061810/01/2019 06/15/2023
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08519 11055 S. WESTERN AVENUE
CHICAGOIL6064310/01/2019 05/16/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08695 3101 N. CLARK
CHICAGOIL6065710/01/2019 04/13/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08698 1165 N. CLARK
CHICAGOIL6061010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08731 400 W MADISON ST
CHICAGOIL6060610/01/2019 08/08/2024
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08735 3940 WEST FULLERTON
CHICAGOIL6064710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08737 2414 N. LINCOLN AVE.
CHICAGOIL6061410/01/2019 04/14/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08739 1819 N. HARLEM AVENUE
CHICAGOIL6070710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08740 2427 W CHICAGO AVE
CHICAGOIL6062210/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08745 771 N OGDEN AVE
CHICAGOIL6064210/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08747 6150 N BROADWAY
CHICAGOIL6066010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08750 4801 N CENTRAL
CHICAGOIL6063010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08751 4051 N LINCOLN
CHICAGOIL6061810/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08753 3637 N SOUTHPORT
CHICAGOIL6061310/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08756 6200 W HIGGINS
CHICAGOIL6063010/01/2019 05/16/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08910 205 N COLUMBUS DR
CHICAGOIL6060110/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08980 6510 NORTH SHERIDAN RD.
CHICAGOIL6062610/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 16361 2656 N ELSTON AVE
CHICAGOIL6064710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 16771 2939 W ADDISON ST
CHICAGOIL6061810/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17042 6525 W DIVERSEY AVE
CHICAGOIL6070710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17167 2112 W PETERSON AVE
CHICAGOIL6065910/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17437 4466 N BROADWAY ST
CHICAGOIL6064010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17591 1200 N LARRABEE ST
CHICAGOIL6061010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17634 1101 W JACKSON BLVD
CHICAGOIL6060710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 17683 2650 N CLARK ST
CHICAGOIL6061410/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 17686 1346 E 53RD ST
CHICAGOIL6061510/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 17698 3204 NORTH CLARK ST.
CHICAGOIL6065710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 03163 345 MADISON ST.
OAK PARKIL6030204/01/2020  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08502 6315 S PULASKI RD STE 1
CHICAGOIL6062904/01/2020  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08742 5524 W CERMAK RD, STE 1
CICEROIL6080404/01/2020  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02844 6748 ROOSEVELT RD.
OAK PARKIL6030401/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05769 470 S. TORRENCE AVE.
CALUMET CITYIL6040901/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05978 3434 DEMPSTER ST.
SKOKIEIL6007601/01/2021 10/11/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 07142 16760 W. DIVISION ST.
LOCKPORTIL6044101/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08741 2634 S PULASKI
CHICAGOIL6062301/01/2021 07/14/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08757 4001 MAIN ST.
SKOKIEIL6007601/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02846 8639 S. CICERO AVE.
CHICAGOIL6065210/01/2021 01/14/2024
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 16999 4433 S PULASKI RD
CHICAGOIL6063210/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 10942 310 SOUTH MICHIGAN AVE
CHICAGOIL6060407/01/2022  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17536 130 S MANNHEIM RD
HILLSIDEIL6016210/01/2022  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02663 225 WEST COURT ST
KANKAKEEIL6090110/01/2022  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17008 4050 N HARLEM AVE
NORRIDGEIL6070601/01/2023  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02827 600 NORTH MANNHEIM RD.
HILLSIDEIL6016201/01/2023  
CHC00341-04HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17042 6525 W DIVERSEY AVE
CHICAGOIL6070701/01/2024  
CHC00341-07HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08740 2427 W CHICAGO AVE
CHICAGOIL6062201/01/2024  
CHC00341-01HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08735 3940 WEST FULLERTON
CHICAGOIL6064701/01/2024  
CHC00341-08HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05482 3615 N. CENTRAL AVE
CHICAGOIL6063401/01/2024  
CHC00341-05HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 16361 2656 N ELSTON AVE
CHICAGOIL6064701/01/2024  
CHC00341-03HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05681 3311 N. PULASKI RD.
CHICAGOIL6064101/01/2024 11/13/2024
CHC00341-00IC PHARMACY LLCAMAZON PHARMACY #004 34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYNNY1123210/01/2024 01/01/2025
CHC00341-00M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312610/01/2019 01/01/2025
CHC00341-00OPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/01/2024  
CHC00341-00OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520404/01/2024  
CHC00341-00OPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302504/01/2024  
CHC00341-00OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/01/2024  
CHC00341-00PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310110/01/2019  
CHC00341-00PILLPACK LLCAMAZON PHARMACY #005 20416 72ND AVE S
KENTWA98032-231910/01/2024 01/01/2025
CHC00341-00PRESENCE NAZARETH FAMILY CENTERPHARMACY 1127 N. OAKLEY BLVD
CHICAGOIL6062204/01/2023 10/30/2023
CHC00341-00PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999201/21/2021 10/01/2022
CHC00341-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/01/2020  
CHC00341-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/01/2020  
CHC00341-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681301/01/2020  
CHC00341-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/01/2021  
CHC00341-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255004/01/2020  
CHC00341-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2020 12/27/2024
CHC00341-00SHEFFIELD AVENUE CVS, L.L.C.DBA: CVS/PHARMACY # 03690 1714 N. SHEFFIELD AVE.
CHICAGOIL6061410/01/2019  
CHC00341-00SOUTH WABASH CVS, L.L.C.DBA: CVS/PHARMACY # 03674 105 S. WABASH AVE.
CHICAGOIL6060310/01/2019 04/14/2022
CHC00341-00TRUEPILL3121 DIABLO AVE
HAYWARDCA9454510/23/2020 12/31/2024
CHC00341-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/01/2019  
CHC00341-00WAL-MART PHARMACY 10-54024650 WEST NORTH AVE
CHICAGOIL6063907/01/2019  
CHC00341-00WAL-MART PHARMACY 10-56174626 W DIVERSEY AVE.
CHICAGOIL6063907/01/2019  
CHC00341-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/01/2019  
CHC00341-00WALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200
TOLLESONAZ8535307/01/2022  
CHC00341-00WALGREEN CODBA: WALGREENS #15525 201 E. HURON STREET, SUITE 01-210
CHICAGOIL6061107/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 03948 5140 W DIVERSEY AVE
CHICAGOIL6063910/01/2014  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 07359 3222 N. MILWAUKEE AVENUE
CHICAGOIL60618-510610/01/2014  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09470 4817 W FULLERTON AVE
CHICAGOIL60639-250310/01/2014  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 10424 3934 W DIVERSEY AVE
CHICAGOIL6064710/01/2014 06/18/2015
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00118 5650 W BELMONT AVE
CHICAGOIL6063407/01/2015 11/19/2020
CHC00341-00WALGREEN CO.DBA: WALGREENS # 07687 3320 W FULLERTON AVE
CHICAGOIL60647-251407/01/2015  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09000 2001 N MILWAUKEE AVE
CHICAGOIL60647-400107/01/2015  
CHC00341-00WALGREEN CO.DBA: WALGREENS #11332 4101 N HARLEM AVE
NORRIDGEIL6070610/01/2015  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 05962 4820 N CUMBERLAND AVE
NORRIDGEIL6070610/01/2015  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00829 8361 BELMONT AVE
RIVER GROVEIL6017107/01/2016  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 10649 3424 W BELMONT AVE
CHICAGOIL6061807/01/2016  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09709 4010 W LAWRENCE AVE
CHICAGOIL6063007/01/2016  
CHC00341-00WALGREEN CO.DBA: WALGREENS #12304 2744 N. CALIFORNIA AVE
CHICAGOIL6064707/01/2016  
CHC00341-00WALGREEN CO.DBA: WALGREENS #15065 1601 N. MILWAUKEE AVE.
CHICAGOIL60647-541101/01/2017 01/31/2023
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00258 1650 W CHICAGO AVE
CHICAGOIL6062207/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 01249 4800 W CERMAK RD
CICEROIL6080407/01/2019 11/06/2024
CHC00341-00WALGREEN CO.DBA: WALGREENS # 03950 4343 N KEDZIE AVE
CHICAGOIL6061807/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 06641 1614 W 47TH STREET
CHICAGOIL60609-324507/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 06727 4720 N MARINE DRIVE
CHICAGOIL60640-512007/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09038 4001 W IRVING PARK RD
CHICAGOIL60641-292607/01/2019  
CHC00341-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #09399 2835 N SHEFFIELD AVE STE 505
CHICAGOIL6065707/01/2019  
CHC00341-00WALGREEN CO.WALGREENS SPECIALTY PHARMACY #15305 912 W BELMONT AVE
CHICAGOIL6065707/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS #15507 3800 W MADISON STREET SUITE 101
CHICAGOIL6062407/01/2019  
CHC00341-00WALGREEN CO.WALGREENS SPECIALTY PHARMACY #16498 2351 E 71ST ST
SUITE A
CHICAGOIL6064907/01/2019  
CHC00341-00WALGREEN CO.WALGREENS SPECIALTY PHARMACY #13832 4339 DIPAOLO CENTER
GLENVIEWIL6002504/01/2020  
CHC00341-00WALGREEN CO.DBA: WALGREENS #13975 711 W NORTH AVE STE #204
CHICAGOIL6061010/01/2020 09/18/2023
CHC00341-00WALGREEN CO.DBA: WALGREENS #15493 1333 W. BELMONT AVENUE
CHICAGOIL6065710/01/2020  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 07515 7155 W FOSTER PLACE
CHICAGOIL60656-361404/01/2021  
CHC00341-00WALGREEN CO.DBA: WALGREENS #21447 3513 N HALSTED ST
CHICAGOIL6065710/01/2021  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00194 4801 N LINCOLN AVE
CHICAGOIL6062501/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 13826 7200 W. NORTH AVE.
ELMWOOD PARKIL6070701/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00259 3358 N WESTERN
CHICAGOIL6061801/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 05926 4385 S ARCHER AVE
CHICAGOIL6063201/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 06462 9595 GRAND AVE
FRANKLIN PARKIL6013101/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09600 1445 W NORTH AVE
MELROSE PARKIL6016001/01/2022  
CHC00341-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY#16501 6500 N CLARK ST
SUITE 101
CHICAGOIL6062601/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS #15506 3303 W. 26TH STREET
SUITE 101
CHICAGOIL6062301/01/2022  
CHC00341-00WALGREEN CO.DBA WALGREENS #16093 3040 S. CICERO AVE.
SUITE A
CICEROIL6080401/01/2022  
CHC00341-00WALGREEN CO.DBA WALGREENS #15971 259 E. ERIE STREET
SUITE 250
CHICAGOIL6061110/01/2022  
CHC00341-02WALGREEN CO.DBA: WALGREENS # 09000 2001 N MILWAUKEE AVE
CHICAGOIL60647-400101/01/2024  
CHC00341-07WALGREEN CO.DBA: WALGREENS # 07359 3222 N. MILWAUKEE AVENUE
CHICAGOIL60618-510607/01/2024  
CHC00341-03WALGREEN CO.DBA: WALGREENS # 09470 4817 W FULLERTON AVE
CHICAGOIL60639-250307/01/2024  
CHC00341-05WALGREEN CO.DBA: WALGREENS # 03948 5140 W DIVERSEY AVE
CHICAGOIL6063907/01/2024  
CHC00341-08WALGREEN CO.DBA: WALGREENS # 03948 5140 W DIVERSEY AVE
CHICAGOIL6063907/01/2024  
CHC00341-07WALGREEN CO.DBA: WALGREENS # 09000 2001 N MILWAUKEE AVE
CHICAGOIL60647-400107/01/2024  
CHC00341-05WALGREEN CO.DBA: WALGREENS # 09470 4817 W FULLERTON AVE
CHICAGOIL60639-250307/01/2024  
CHC00341-06WALGREEN CO.DBA: WALGREENS # 07359 3222 N. MILWAUKEE AVENUE
CHICAGOIL60618-510607/01/2024  
CHC00341-00WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904910/01/2014 07/02/2015
CHC00341-00WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528410/01/2014 07/02/2015
CHC00341-00WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700801/21/2021 10/01/2021
CHC00341-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/21/2021  
CHC00341-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/21/2021  
CHC00341-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/21/2021  
CHC00341-00WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/01/2023  
CHC00341-00Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616807/01/2024  
CHC00341-00WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E
SAN DIEGOCA9210210/01/2019 10/17/2022
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/13/2024 11:33:58 AM2/10/2025 5:20:38 PM2/10/2025 5:20 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/4/2024 2:56 PM
Medicaid BillingMedicaid: NumberInsertChange Request 36384525301712/4/2024 2:56 PM
Medicaid BillingMedicaid: StateInsertChange Request IL12/4/2024 2:56 PM
Medicaid BillingNPI: NumberInsertChange Request 120537496412/4/2024 2:56 PM
Medicaid BillingNPI: StateInsertChange Request IL12/4/2024 2:56 PM
ContactsPrimary ContactUpdatePC Change RequestDahbur, Alaina Finance & 340B Compliance Analyst PrimeCare Community Health, Inc. 7739888766Keisler, Kenzie Interim 340B Compliance Analyst PRIMECARE COMMUNITY HEALTH INC 80346520119/23/2024 7:45 AM
DetailsLast Recertification DateUpdateRecertification2/3/2023 10:25:25 AM2/13/2024 11:33:58 AM2/13/2024 11:33 AM
DetailsLast Recertification DateUpdateRecertification2/11/2022 3:20:51 PM2/3/2023 10:25:25 AM2/3/2023 10:25 AM
ContactsPrimary ContactUpdateGroup Change RequestJanecek, Jerron E Controller PrimeCare Community Health, Inc. 2178361148Dahbur, Alaina Finance & 340B Compliance Analyst PrimeCare Community Health, Inc. 77398887665/13/2022 12:14 PM
AddressesMain AddressUpdateRecertification 1431 N Western Ave, Suite 401 Chicago, IL 60622 1431 N Western Ave Ste 401 Chicago, IL 606222/11/2022 3:20 PM
DetailsLast Recertification DateUpdateRecertification2/3/2021 10:24:24 AM2/11/2022 3:20:51 PM2/11/2022 3:20 PM
ContactsAuthorizing OfficialUpdateAO Change RequestHopkins, Lynn CEO PrimeCare Community Health, Inc. 7732695511Holtrop, Michael C Chief Financial Officer PrimeCare Community Health 61648298922/1/2022 7:47 AM
ContactsPrimary ContactUpdateGroup Change RequestBuecking, Mindy Grants Manager PrimeCare Community Health, Inc. 3126335841-301Janecek, Jerron E Controller PrimeCare Community Health, Inc. 21783611481/31/2022 6:52 AM
ContactsAuthorizing OfficialUpdateGroup Change RequestVan Gilder, Robert CFO PrimeCare Community Health, Inc. 3148006161Hopkins, Lynn CEO PrimeCare Community Health, Inc. 773269551110/7/2021 8:29 AM
ContactsPrimary ContactUpdateGroup Change RequestHopkins, Lynn CEO PrimeCare Community Health, Inc. 7732695511Buecking, Mindy Grants Manager PrimeCare Community Health, Inc. 3126335841-30110/7/2021 8:29 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036091640 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification393632020001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036135177 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036128885 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125071155 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125066639 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036127338 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification154767356001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification123702823001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036083665 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036137979 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036136863 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification097688475001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036128879 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125071142 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125067787 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036080977 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification3634803389001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036132417 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036138845 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125066694 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036107113 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification153883530001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036103428 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification589986807001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036143294 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125070078 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification330842517001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036138831 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036139952 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification678118508001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125066491 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification321541588001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification335860422001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125067686 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036118907 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification125069640 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification593780193001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036077386 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification094913955001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification370139276001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036138907 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification019028069 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification337885204001 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification036085595 (IL) 2/3/2021 10:24 AM
Medicaid BillingMedicaid: NumberDeleteRecertification349801035001 (IL) 2/3/2021 10:24 AM
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DetailsLast Recertification DateUpdateRecertification1/28/2020 3:10:00 PM2/3/2021 10:24:24 AM2/3/2021 10:24 AM
AddressesBilling AddressUpdateRecertificationPrimeCare Community Health 2232 N Clybourn Ave, 3rd Floor Chicago, IL 60614PrimeCare Community Health 2211 N. Elston Ave Suite 301 Chicago, IL 606141/28/2020 3:10 PM
ContactsPrimary ContactInsertRecertification Hopkins, Lynn CEO PrimeCare Community Health, Inc. 77326955111/28/2020 3:10 PM
DetailsLast Recertification DateUpdateRecertification1/31/2019 3:42:04 PM1/28/2020 3:10:00 PM1/28/2020 3:10 PM
DetailsLast Recertification DateUpdateRecertification3/5/2018 10:48:09 PM1/31/2019 3:42:04 PM1/31/2019 3:42 PM
ContactsAuthorizing OfficialUpdateAO Change RequestMoldovan, Joseph Chief Operating Officer/Chief Financial Officer PrimeCare Community Health, Inc. 3124915034Van Gilder, Robert CFO PrimeCare Community Health, Inc. 31480061611/31/2019 9:54 AM
AddressesBilling AddressInsertChange Request PrimeCare Community Health 2232 N Clybourn Ave, 3rd Floor Chicago, IL 606148/20/2018 3:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False3/5/2018 10:48 PM
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Medicaid BillingNPI: NumberInsertRecertification 19820815433/5/2018 10:48 PM
Medicaid BillingNPI: NumberInsertRecertification 15587736633/5/2018 10:48 PM
Medicaid BillingNPI: NumberInsertRecertification 12053749643/5/2018 10:48 PM
DetailsLast Recertification DateUpdateRecertification 3/5/2018 10:48:09 PM3/5/2018 10:48 PM
DetailsStateUpdate ApprovedActive1/1/2018 12:00 AM
ContactsSigned ByInsertNew Registration Moldovan, Joseph Chief Operating Officer/Chief Financial Officer PrimeCare Community Health, Inc. 312491503411/6/2017 3:03 PM
Details340B IDUpdateNew Registration CHC00341-0711/6/2017 3:03 PM
DatesParticipating Approval DateUpdateNew Registration 11/6/2017 3:03:06 PM11/6/2017 3:03 PM
DetailsStateUpdateNew RegistrationPendingApproved11/6/2017 3:03 PM
DatesSigned By DateUpdateNew Registration 10/13/2017 10:28:43 AM11/6/2017 3:03 PM
DatesStart DateUpdateNew Registration 1/1/2018 12:00:00 AM11/6/2017 3:03 PM
AddressesMain AddressInsertNew Registration  1431 N Western Ave, Suite 401 Chicago, IL 6062210/13/2017 10:28 AM
Medicaid BillingNPI: NumberInsertNew Registration 185152072010/13/2017 10:28 AM
ContactsAuthorizing OfficialInsertNew Registration Moldovan, Joseph Chief Operating Officer/Chief Financial Officer PrimeCare Community Health, Inc. 312491503410/13/2017 10:28 AM
DetailsLast Recertification DateInsertNew Registration  10/13/2017 10:28 AM
DetailsGrant NumberInsertNew Registration H80CS0034110/13/2017 10:28 AM
Details340B IDInsertNew Registration  10/13/2017 10:28 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/13/2017 10:28 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/13/2017 10:28 AM
DetailsMedicare Provider NumberInsertNew Registration  10/13/2017 10:28 AM
DetailsEntity NameInsertNew Registration PRIMECARE COMMUNITY HEALTH INC10/13/2017 10:28 AM
DetailsProgram CodeInsertNew Registration CH10/13/2017 10:28 AM
DetailsEntity SubnameInsertNew Registration PrimeCare West Town Dental10/13/2017 10:28 AM
DatesParticipating Approval DateInsertNew Registration  10/13/2017 10:28 AM
DetailsStateInsertNew Registration Pending10/13/2017 10:28 AM
DatesRegistration DateInsertNew Registration 10/13/2017 10:28:41 AM10/13/2017 10:28 AM
DatesSigned By DateInsertNew Registration  10/13/2017 10:28 AM
DatesStart DateInsertNew Registration  10/13/2017 10:28 AM
TerminationsTermination CommentsInsertNew Registration  10/13/2017 10:28 AM
TerminationsTermination DateInsertNew Registration  10/13/2017 10:28 AM
TerminationsTermination Effective DateInsertNew Registration  10/13/2017 10:28 AM
TerminationsTermination ReasonInsertNew Registration  10/13/2017 10:28 AM