Covered Entity Details

CH02848Q DAMIAN FAMILY CARE CENTERS, INC. (Active) - information as of 6/12/2025 6:06:55 AM

Main Details

Name

DAMIAN FAMILY CARE CENTERS, INC.

Subdivision Name

Ronkonkoma Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-021524

340B ID

CH02848Q

Grant Number

H80CS01765

Additional Details

Current Program Status

Active

Registration Date

1/8/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/25/2018

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Damian Family Care Centers, Inc.
Peter Grisafi, CEO
(718) 657-1100 Ext: 1225

Primary Contact

Damian Family Care Centers, Inc.
Juan P Garcia, Director of Pharmacy Services
(718) 657-1100 Ext: 4124

Addresses

Street Address

161 Lake Shore Road
Ronkonkoma, NY 11779-3182

Billing Address

Damian Family Care Centers, Inc.
89-56 162nd Street
3rd Floor
Jamaica, NY 11432

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	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	01/15/2025	04/01/2025	04/01/2025
Contract Detail	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	01/15/2019	04/01/2019	04/01/2019
Contract Detail	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	01/15/2019	04/01/2019	04/01/2019
Contract Detail	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	02/03/2022	04/01/2022	04/01/2022

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH028480	Active	BPS-H80-000276	DAMIAN FAMILY CARE CENTERS, INC.	DBA PROJECT SAMARITAN HEALTH SERVICES	13750 Jamaica Ave	Jamaica	NY
CH02848A	Terminated	BPS-H80-009998	DAMIAN FAMILY CARE CENTERS, INC.	Starhill Clinic	1600 Macombs Rd.	Bronx	NY
CH02848B	Terminated	BPS-H80-010001	DAMIAN FAMILY CARE CENTERS, INC.	Highbridge Clinic	1381 University Ave	Bronx	NY
CH02848C	Active	BPS-H80-011902	DAMIAN FAMILY CARE CENTERS, INC.	Fire House Health Center	8956 162nd St	Jamaica	NY
CH02848D	Active	BPS-H80-013446	DAMIAN FAMILY CARE CENTERS, INC.	Ellenville Health Center	751 BRIGGS HWY	ELLENVILLE	NY
CH02848E	Active	BPS-H80-017510	DAMIAN FAMILY CARE CENTERS, INC.	Third Avenue Family Health Center	2604 Third Avenue	Bronx	NY
CH02848F	Active	BPS-H80-017512	DAMIAN FAMILY CARE CENTERS, INC.	Richmond Hill Health Center	13020 89TH RD	RICHMOND HILL	NY
CH02848G	Active	BPS-H80-017513	DAMIAN FAMILY CARE CENTERS, INC.	Fox Run Health Center (Rhinebeck)	216 FOX HOLLOW RD	RHINEBECK	NY
CH02848H	Terminated	BPS-H80-017511	DAMIAN FAMILY CARE CENTERS, INC.	35th Street Health Center	500 8TH AVE	NEW YORK	NY
CH02848J	Active	BPS-H80-018582	DAMIAN FAMILY CARE CENTERS, INC.	53rd Street Health Center	225 E. 53rd Street	New York	NY
CH02848K	Active	BPS-H80-018080	DAMIAN FAMILY CARE CENTERS, INC.	121st Street Family Health Center	219 E. 121st Street	New York	NY
CH02848L	Active	BPS-H80-018515	DAMIAN FAMILY CARE CENTERS, INC.	Ralph Avenue Health Center	599 Ralph Avenue	Brooklyn	NY
CH02848M	Active	BPS-H80-019438	DAMIAN FAMILY CARE CENTERS, INC.	Long Island City Health Center	34-11 Vernon Blvd.	Long Island City	NY
CH02848N	Active	BPS-H80-018792	DAMIAN FAMILY CARE CENTERS, INC.	Myrtle Avenue Family Health Center	117-11 Myrtle Ave	Richmond Hill	NY
CH02848P	Active	BPS-H80-020985	DAMIAN FAMILY CARE CENTERS, INC.	Wards Island Family Health Center	13 Hell Gate Circle	New York	NY
CH02848Q	Active	BPS-H80-021524	DAMIAN FAMILY CARE CENTERS, INC.	Ronkonkoma Health Center	161 Lake Shore Road	Ronkonkoma	NY
CH02848R	Active	BPS-H80-038805	DAMIAN FAMILY CARE CENTERS INC	Mott Haven Family Health Center	427 Grand Concourse BLDG	Bronx	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH028480	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/01/2023
CH028480	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2023
CH028480	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/01/2023
CH028480	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/01/2023
CH028480	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2023
CH028480	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/01/2023
CH028480	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/01/2023
CH02848N	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848D	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848L	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848G	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848P	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848J	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848E	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848K	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848R	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848C	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH028480	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848M	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848F	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH02848Q	BOAN DRUGS, INC.	DBA - EMBASSY PHARMACY	1842 AMSTERDAM AVE	NEW YORK	NY	10031	04/01/2025
CH028480	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2014
CH02848A	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2014	04/01/2021
CH02848B	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2014	04/01/2024
CH02848C	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2014
CH02848D	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2014
CH02848F	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2016
CH02848G	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2016
CH02848H	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2016	04/01/2018
CH02848K	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	01/01/2017
CH02848J	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	01/01/2017
CH02848L	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2017
CH02848M	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	07/01/2017
CH02848Q	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	04/01/2019
CH02848N	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	04/01/2019
CH02848P	CHEM RX PHARMACY SERVICES LLC	TRADE NAME: PHARMERICA	51 CHARLES LINDBERGH BLVD	UNIONDALE	NY	11553-3658	04/01/2019
CH02848L	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848Q	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848A	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019	04/01/2021
CH028480	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848F	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848M	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848E	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848G	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848N	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848J	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848D	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848K	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848B	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019	04/01/2024
CH02848C	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH02848P	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	04/01/2019
CH028480	COORDINATED CARE NETWORK PHARMACY	268 MARTIN LUTHER KING JR. BLVD.		NEWARK	NJ	07102	07/01/2019
CH028480	CUSTOM RX, INC	90-09 37TH AVE		JACKSON HEIGHTS	NY	11372	04/01/2023	01/13/2025
CH02848C	CUSTOM RX, INC	90-09 37TH AVE		JACKSON HEIGHTS	NY	11372	04/01/2023	05/01/2023
CH028480	DULARI CORP.	QUEENS DRUGS & SURGICAL	146-14 JAMAICA AVE ATTN: SUPERVISING PHARMACIST	JAMAICA	NY	11435-3628	04/01/2014
CH02848A	DULARI CORP.	QUEENS DRUGS & SURGICAL	146-14 JAMAICA AVE ATTN: SUPERVISING PHARMACIST	JAMAICA	NY	11435-3628	04/01/2014	04/01/2021
CH02848B	DULARI CORP.	QUEENS DRUGS & SURGICAL	146-14 JAMAICA AVE ATTN: SUPERVISING PHARMACIST	JAMAICA	NY	11435-3628	07/01/2014	04/01/2024
CH02848C	DULARI CORP.	QUEENS DRUGS & SURGICAL	146-14 JAMAICA AVE ATTN: SUPERVISING PHARMACIST	JAMAICA	NY	11435-3628	07/01/2014
CH02848D	DULARI CORP.	QUEENS DRUGS & SURGICAL	146-14 JAMAICA AVE ATTN: SUPERVISING PHARMACIST	JAMAICA	NY	11435-3628	07/01/2014
CH028480	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	01/01/2023
CH028480	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/01/2023
CH028480	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/01/2023
CH028480	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/01/2023
CH028480	GREAT NECK CHEMISTS INC OF NY	69 ALLEN BLVD		FARMINGDALE	NY	11735-5614	10/01/2021
CH02848D	MATTHEWS PHARMACY	101 CANAL ST		ELLENVILLE	NY	12428	07/01/2014
CH028480	MEDLY PHARMACY INC.	DBA MEDLY PHARMACY	31 DEBEVOISE ST	BROOKLYN	NY	11206-4196	01/01/2021	01/13/2025
CH02848J	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848E	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848D	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848C	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022	11/14/2022
CH02848L	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848K	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848P	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848G	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848Q	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848B	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022	04/01/2024
CH02848N	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848F	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH028480	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	02/03/2022
CH02848M	MEDLY QUEENS INC.	DBA: MEDLY PHARMACY	89-56 162ND ST	JAMAICA	NY	11432	04/01/2022
CH02848E	MERK PHARMA INC.	D/B/A 5 STAR PHARMACY & SURGICAL SUPPLIE	2604 3RD AVE D B A 5 STAR PHARMACY & SURGICAL SUPPLIE	BRONX	NY	10454	07/01/2016
CH028480	OZ PHARMA INC	DBA-OZ PHARMACY	322 E 149TH ST	BRONX	NY	10451	07/01/2022
CH028480	PSK RX INC	D/B/A THIRD AVE PHARMACY	2700 3RD AVE	BRONX	NY	10454	07/01/2022
CH028480	SMARTPILLS PHARMACY INC.	8956 162ND ST		JAMAICA	NY	11432	07/01/2025
CH02848C	SMARTPILLS PHARMACY INC.	8956 162ND ST		JAMAICA	NY	11432	07/01/2025
CH028480	WATSONS PHARMACY LLC	192-21 STATION RD		FLUSHING	NY	11358-2956	07/01/2014
CH02848A	WATSONS PHARMACY LLC	192-21 STATION RD		FLUSHING	NY	11358-2956	07/01/2014	04/01/2021
CH02848B	WATSONS PHARMACY LLC	192-21 STATION RD		FLUSHING	NY	11358-2956	07/01/2014	04/01/2024
CH02848C	WATSONS PHARMACY LLC	192-21 STATION RD		FLUSHING	NY	11358-2956	04/01/2014
CH02848D	WATSONS PHARMACY LLC	192-21 STATION RD		FLUSHING	NY	11358-2956	07/01/2014

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/13/2024 12:59:08 PM	2/12/2025 9:24:52 AM	2/12/2025 9:24 AM
Details	Last Recertification Date	Update	Recertification	1/30/2023 2:46:02 PM	2/13/2024 12:59:08 PM	2/13/2024 12:59 PM
Contacts	Primary Contact	Update	Group Change Request	Choudhury, Sadia Tasnim Chief Corporate Compliance & Quality Assurance Officer Damian Family Care Centers Inc. 7186571100-5613	Garcia, Juan P Director of Pharmacy Services Damian Family Care Centers, Inc. 7186571100-4124	8/2/2023 4:51 PM
Details	Last Recertification Date	Update	Recertification	2/3/2022 10:29:43 AM	1/30/2023 2:46:02 PM	1/30/2023 2:46 PM
Contacts	Primary Contact	Update	PC Change Request	Withus, Michael Chief Compliance Officer Damian Family Care Centers, Inc. 7186571100-4124	Choudhury, Sadia Tasnim Chief Corporate Compliance & Quality Assurance Officer Damian Family Care Centers Inc. 7186571100-5613	10/18/2022 7:22 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 9:28:13 AM	2/3/2022 10:29:43 AM	2/3/2022 10:29 AM
Details	Last Recertification Date	Update	Recertification	1/29/2020 5:18:56 PM	2/4/2021 9:28:13 AM	2/4/2021 9:28 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1265970834 ( )		7/22/2020 5:17 PM
Details	Last Recertification Date	Update	Recertification	2/1/2019 9:43:40 AM	1/29/2020 5:18:56 PM	1/29/2020 5:18 PM
Addresses	Billing Address	Update	Change Request	Damian Family Care Centers, Inc. 138-02 Queens Blvd 2nd Floor Briarwood, NY 11435	Damian Family Care Centers, Inc. 89-56 162nd Street 3rd Floor Jamaica, NY 11432	10/11/2019 4:16 PM
Details	Last Recertification Date	Update	Recertification		2/1/2019 9:43:40 AM	2/1/2019 9:43 AM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Grisafi, Peter CEO Damian Family Care Centers, Inc. 7186571100-1225	1/25/2018 8:09 AM
Details	340B ID	Update	New Registration		CH02848Q	1/25/2018 8:09 AM
Dates	Participating Approval Date	Update	New Registration		1/25/2018 8:09:11 AM	1/25/2018 8:09 AM
Details	State	Update	New Registration	Pending	Approved	1/25/2018 8:09 AM
Dates	Signed By Date	Update	New Registration		1/9/2018 1:48:10 PM	1/25/2018 8:09 AM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/25/2018 8:09 AM
Addresses	Main Address	Insert	New Registration		161 Lake Shore Road Ronkonkoma, NY 11779-3182	1/8/2018 9:47 AM
Addresses	Billing Address	Insert	New Registration		Damian Family Care Centers, Inc. 138-02 Queens Blvd 2nd Floor Briarwood, NY 11435	1/8/2018 9:47 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1265970834	1/8/2018 9:47 AM
Contacts	Authorizing Official	Insert	New Registration		Grisafi, Peter CEO Damian Family Care Centers, Inc. 7186571100-1225	1/8/2018 9:47 AM
Contacts	Primary Contact	Insert	New Registration		Withus, Michael Chief Compliance Officer Damian Family Care Centers, Inc. 7186571100-4124	1/8/2018 9:47 AM
Details	Last Recertification Date	Insert	New Registration			1/8/2018 9:47 AM
Details	Grant Number	Insert	New Registration		H80CS01765	1/8/2018 9:47 AM
Details	340B ID	Insert	New Registration			1/8/2018 9:47 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/8/2018 9:47 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/8/2018 9:47 AM
Details	Medicare Provider Number	Insert	New Registration			1/8/2018 9:47 AM
Details	Entity Name	Insert	New Registration		DAMIAN FAMILY CARE CENTERS, INC.	1/8/2018 9:47 AM
Details	Program Code	Insert	New Registration		CH	1/8/2018 9:47 AM
Details	Entity Subname	Insert	New Registration		Ronkonkoma Health Center	1/8/2018 9:47 AM
Dates	Participating Approval Date	Insert	New Registration			1/8/2018 9:47 AM
Details	State	Insert	New Registration		Pending	1/8/2018 9:47 AM
Dates	Registration Date	Insert	New Registration		1/8/2018 9:47:24 AM	1/8/2018 9:47 AM
Dates	Signed By Date	Insert	New Registration			1/8/2018 9:47 AM
Dates	Start Date	Insert	New Registration			1/8/2018 9:47 AM
Terminations	Termination Comments	Insert	New Registration			1/8/2018 9:47 AM
Terminations	Termination Date	Insert	New Registration			1/8/2018 9:47 AM
Terminations	Termination Effective Date	Insert	New Registration			1/8/2018 9:47 AM
Terminations	Termination Reason	Insert	New Registration			1/8/2018 9:47 AM

340B Drug Pricing Program Database