Covered Entity Details

CHC12863-08 St. Thomas Community Health Center, Inc. (Active) - information as of 5/2/2025 10:41:00 PM

Main Details

Name

St. Thomas Community Health Center, Inc.

Subdivision Name

St. Thomas CHC Medical Mobile Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-019727

340B ID

CHC12863-08

Grant Number

H80CS12863

Additional Details

Current Program Status

Active

Registration Date

4/8/2021

Participating Start Date

7/1/2021

Participating Approval Date

4/8/2021

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

St. Thomas Community Health Center, Inc.
Donald Erwin, CEO
(504) 529-5558

Primary Contact

St Thomas Community Health Center
Claudia D Madrid, Quality and Compliance Coordinator
(504) 529-5558

Addresses

Street Address

1936 Magazine St
New Orleans, LA 70130

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
Participated starting 4/1/2018, terminated 4/1/2020. Reinstated 7/1/2021.	04/08/2021

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
LA	2178563,2206621,2210955,2211072	1003185125,1922584523,1538930490,1417786062

Shipping Addresses

Shipping Address 1

St Thomas Pharmacy
2010 Magazine St
New Orleans, LA 70130

Shipping Address 2

St Thomas Pharmacy Columbia Parc
3943 Saint Bernard Ave
New Orleans, LA 70122

Shipping Address 3

St Thomas Pharmacy General DeGaulle
3221 General DeGaulle Dr
New Orleans, LA 70114

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	City	State
CHC12863-00	Active	BPS-H80-011095	St. Thomas Community Health Center, Inc.	St Thomas CHC at 1936-1938 Magazine Street	1936 Magazine St	New Orleans	LA
CHC12863-01	Active	BPS-H80-008402	ST. THOMAS COMMUNITY HEALTH CENTER, INC.	St. Thomas Community Health Center	1020 St. Andrew Street	New Orleans	LA
CHC12863-02	Terminated	BPS-H80-011093	ST. THOMAS COMMUNITY HEALTH CENTER, INC.	Mahalia Jackson Health Service Center	2405 Jackson Ave	New Orleans	LA
CHC12863-03	Active	BPS-H80-012978	ST. THOMAS COMMUNITY HEALTH CENTER, INC.	Columbia Parc CHC	3943 Saint Bernard Ave	New Orleans	LA
CHC12863-04	Terminated	BPS-H80-014750	ST. THOMAS COMMUNITY HEALTH CENTER, INC.	L. B. Landry Community Clinic	1200 L B LANDRY AVE	NEW ORLEANS	LA
CHC12863-05	Active	BPS-H80-020797	St. Thomas Community Health Center, Inc.	St. Thomas Community Health Center	2014 Magazine St	New Orleans	LA
CHC12863-06	Terminated	BPS-H80-018670	St. Thomas Community Health Center, Inc.	Herschel L. Abbott, Jr. Community Health Center	1024 Jackson Avenue	New Orleans	LA
CHC12863-07	Active	BPS-H80-008403	St. Thomas Community Health Center, Inc.	St. Thomas Community Wellness Center	2010 Magazine Street	New Orleans	LA
CHC12863-08	Active	BPS-H80-019727	St. Thomas Community Health Center, Inc.	St. Thomas CHC Medical Mobile Clinic	1936 Magazine St	New Orleans	LA
CHC12863-09	Active	BPS-H80-021286	St. Thomas Community Health Center, Inc.	St. Thomas Community Health Center - West Bank	3221 General Degaulle Dr	New Orleans	LA
CHC12863-10	Active	BPS-H80-021424	St. Thomas Community Health Center, Inc.	St. Thomas Community Health Center - West Bank	230 Ochsner Blvd	Gretna	LA
CHC12863-11	Active	BPS-H80-035267	St. Thomas Community Health Center, Inc.	St. Thomas Community Health Center - Holiday Drive	3500 Holiday Drive	New Orleans	LA
CHC12863-12	Active	BPS-H80-034100	St. Thomas Community Health Center, Inc.	St. Thomas Community Health Center	2000 Magazine St	New Orleans	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC12863-00	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2014
CHC12863-01	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2014	02/21/2020
CHC12863-02	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2014	02/21/2020
CHC12863-03	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	10/01/2014	02/21/2020
CHC12863-00	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2014
CHC12863-01	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2014	02/21/2020
CHC12863-02	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2014	02/21/2020
CHC12863-03	AVITA PHARMACY 1029	340B PARTNERS PHARMACY LLC D/B/A AVITA P	303 N FRIO ST SUITE 102	SAN ANTONIO	TX	78207-3034	10/01/2014	02/21/2020
CHC12863-00	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2014
CHC12863-01	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2014	02/21/2020
CHC12863-02	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2014	02/21/2020
CHC12863-03	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	10/01/2014	02/21/2020
CHC12863-00	AVITA PHARMACY 1038	AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM	3308 TULANE AVE STE 102	NEW ORLEANS	LA	70119-7170	10/01/2016
CHC12863-00	AVITA PHARMACY 1039	1631 ELYSIAN FIELDS AVE STE 200		NEW ORLEANS	LA	70117-8208	10/01/2019
CHC12863-00	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2014
CHC12863-01	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2014	02/21/2020
CHC12863-02	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2014	02/21/2020
CHC12863-03	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	10/01/2014	02/21/2020
CHC12863-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2023
CHC12863-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2023
CHC12863-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2023
CHC12863-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2023
CHC12863-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2023
CHC12863-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2023
CHC12863-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2023
CHC12863-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2023
CHC12863-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2023
CHC12863-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2023
CHC12863-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2023
CHC12863-00	ENCORE PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	05/04/2022	10/31/2022
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 167	4401 S CLAIBORNE AVE.	NEW ORLEANS	LA	70125	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #03730	3700 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05333	2242 WILLIAMS BLVD.,	KENNER	LA	70062	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05503	4901 PRYTANIA ST	NEW ORLEANS	LA	70115	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY #11427	2564 BARATARIA BLVD	MARRERO	LA	70072	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05387	3621 GENERAL DEGAULLE DR.	NEW ORLEANS	LA	70131	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5409	1950 BARATARIA BLVD.	MARRERO	LA	70072	07/01/2023	07/22/2024
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08921	2831 BELLE CHASE HWY.	TERRYTOWN	LA	70056	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10108	5902 READ BLVD.	NEW ORLEANS	LA	70127	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10594	500 N. CARROLLTON AVE.	NEW ORLEANS	LA	70119	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10058	1116 LOUISIANA AVE	NEW ORLEANS	LA	70115	07/01/2023
CHC12863-00	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10483	1600 ELYSIAN FIELDS AVE.	NEW ORLEANS	LA	70117	07/01/2023
CHC12863-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2023
CHC12863-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2023
CHC12863-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2023
CHC12863-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2023
CHC12863-00	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	10/01/2021	10/31/2022
CHC12863-00	SAM'S PHARMACY 10-8221	1527 MANHATTAN BLVD.		HARVEY	LA	70058	01/01/2020	10/31/2022
CHC12863-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-0909	8101 W. JUDGE PEREZ DR.		CHALMETTE	LA	70043	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-0911	4810 LAPALCO BLVD		MARRERO	LA	70072	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-0961	1616 W AIRLINE HWY		LAPLACE	LA	70068	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-0989	8912 VETERANS MEMORIAL BLVD		METAIRIE	LA	70003	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-1163	4001 BEHRMAN HWY		NEW ORLEANS	LA	70114	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-1342	300 WEST ESPLANADE		KENNER	LA	70065	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-1353	5110 JEFFERSON HWY		HARAHAN	LA	70123	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-2706	1501 MANHATTAN BLVD		HARVEY	LA	70058	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-3703	3520 WILLIAMS BLVD		KENNER	LA	70065	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-5022	1901 TCHOPITOULAS STREET		NEW ORLEANS	LA	70130	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-5722	3265 MANHATTAN BLVD.		HARVEY	LA	70058	01/01/2020	10/31/2022
CHC12863-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2020	10/31/2022
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05040	1801 SAINT CHARLES AVE	NEW ORLEANS	LA	70130	04/01/2013
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02640	3227 MAGAZINE ST	NEW ORLEANS	LA	70115	04/01/2013
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03139	1826 N BROAD ST	NEW ORLEANS	LA	70119	04/01/2013
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11414	3216 GENTILLY BLVD	NEW ORLEANS	LA	70122	04/01/2013
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04451	4400 S.CLAIBORNE AVE.	NEW ORLEANS	LA	70125	04/01/2013
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03889	4110 GENERAL DEGAULLE DR	NEW ORLEANS	LA	70131	07/01/2014
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #05866	2418 S. CARROLLTON AVE	NEW ORLEANS	LA	70118-3012	07/01/2014
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #04982	7401 READ BLVD	NEW ORLEANS	LA	70127	07/01/2014	01/29/2025
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 02262	1100 ELYSIAN FIELDS	NEW ORLEANS	LA	70117	07/01/2014
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03558	6201 ELYSIAN FIELDS AVE	NEW ORLEANS	LA	70122	07/01/2014
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15199	5518 MAGAZINE STREET	NEW ORLEANS	LA	70115-3152	07/01/2014
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #13777	1415 TULANE AVE STE 2CW07	NEW ORLEANS	LA	70112	10/01/2014
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #10316	4001 CANAL ST	NEW ORLEANS	LA	70119	04/01/2015
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03024	4200 CHEF MENTEUR HWY	NEW ORLEANS	LA	70126	04/01/2015	01/22/2025
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #16312	5702 CROWDER BLVD	NEW ORLEANS	LA	70127	04/01/2015
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12557	4550 GENERAL MEYER AVE	NEW ORLEANS	LA	70131	01/01/2016	05/15/2017
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06506	89 WESTBANK EXPRESSWAY	GRETNA	LA	70053-3662	01/01/2016
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04304	145 ELK PLACE	NEW ORLEANS	LA	70112	07/01/2016	02/03/2017
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04305	900 CANAL	NEW ORLEANS	LA	70112	07/01/2016	01/02/2025
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05358	11297 LAKE FOREST BLVD.	NEW ORLEANS	LA	70128	07/01/2016
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #16309	1401 FOUCHER ST STE C-309	NEW ORLEANS	LA	70115	07/01/2016
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS SPECIALTY PHARMACY #15198	1111 MEDICAL CENTER BLVD STE 116N	MARRERO	LA	70072	04/01/2017
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16395	2000 CANAL ST STE G1-1200	NEW ORLEANS	LA	70112	04/01/2017
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15200	2001 CAROL SUE AVE	GRETNA	LA	70056-4445	01/01/2018
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04450	718 S. CARROLLTON AVE.	NEW ORLEANS	LA	70118	01/01/2018
CHC12863-05	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15571	4501 AIRLINE DR.	METAIRIE	LA	70001	07/01/2018	02/21/2020
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07261	457 LAPALCO BLVD	GRETNA	LA	70056-7366	10/01/2018
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03156	1556 LAPALCO BLVD.	HARVEY	LA	70058	10/01/2018
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 06637	1544 MANHATTAN BLVD	HARVEY	LA	70058	10/01/2018	11/04/2019
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15571	4501 AIRLINE DR.	METAIRIE	LA	70001	01/01/2019
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #21176	925 COMMON ST STE A	NEW ORLEANS	LA	70112	04/01/2019
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 03199	1891 BARATARIA BLVD.	MARRERO	LA	70072	04/01/2019
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15109	4327 JEFFERSON HWY.	JEFFERSON	LA	70121	01/01/2020
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #11496	101 ALLEN TOUSSAINT BLVD	NEW ORLEANS	LA	70124	01/01/2020
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13586	4141 E JUDGE PEREZ DR	MERAUX	LA	70075	01/01/2020
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04285	4142 PONTCHARTRAIN DR	SLIDELL	LA	70458-5138	01/01/2022
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05516	4600 WESTBANK EXPRESSWAY	MARRERO	LA	70072-3065	01/01/2022
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05633	2570 BARATARIA BLVD	MARRERO	LA	70072	01/01/2022
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07415	100 W JUDGE PEREZ DRIVE	CHALMETTE	LA	70043-5002	01/01/2022
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #12924	4100 WILLIAMS BLVD	KENNER	LA	70065	01/01/2022
CHC12863-00	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #13679	1717 VETERANS MEMORIAL BLVD	METAIRIE	LA	70005-2635	01/01/2022
CHC12863-00	WALGREEN LOUISIANA CO., INC.	WALGREENS #17089	760 HARRISON AVE	NEW ORLEANS	LA	70124-3156	01/01/2022
CHC12863-00	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2022
CHC12863-00	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2014	08/31/2015
CHC12863-00	WALMART PHARMACY 10-0912	6000 BULLARD AVE		NEW ORLEANS	LA	70128-2813	01/01/2020	10/31/2022
CHC12863-00	WALMART PHARMACY 10-3167	4301 CHEF MENTEUR HWY		NEW ORLEANS	LA	70126	01/01/2020	10/31/2022
CHC12863-00	WALMART PHARMACY 10-5081	2500 ARCHBISHOP HANNAN BLVD		MERAUX	LA	70075	04/01/2022	10/31/2022
CHC12863-00	WALMART PHARMACY 10-5102	99 WESTBANK EXPY		GRETNA	LA	70053	01/01/2020	10/31/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 4:56:15 PM	2/10/2025 11:25:36 AM	2/10/2025 11:25 AM
Addresses	Shipping Address	Insert	Change Request		St Thomas Pharmacy 2010 Magazine St New Orleans, LA 70130	11/12/2024 8:49 AM
Addresses	Shipping Address	Insert	Change Request		St Thomas Pharmacy Columbia Parc 3943 Saint Bernard Ave New Orleans, LA 70122	11/12/2024 8:49 AM
Addresses	Shipping Address	Insert	Change Request		St Thomas Pharmacy General DeGaulle 3221 General DeGaulle Dr New Orleans, LA 70114	11/12/2024 8:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/12/2024 8:49 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2211072	11/12/2024 8:49 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	11/12/2024 8:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1417786062	9/13/2024 10:09 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	9/13/2024 10:09 AM
Addresses	Main Address	Update	Change Request	1936 Magazine St New Orleans, LA 70130-5016	1936 Magazine St New Orleans, LA 70130	8/12/2024 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/12/2024 4:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2210955	8/12/2024 4:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	8/12/2024 4:35 PM
Details	Last Recertification Date	Update	Recertification	2/7/2023 11:31:37 AM	1/29/2024 4:56:15 PM	1/29/2024 4:56 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1538930490	1/16/2024 4:15 PM
Medicaid Billing	NPI: State	Insert	Change Request		LA	1/16/2024 4:15 PM
Details	Last Recertification Date	Update	Recertification	2/17/2022 11:06:57 AM	2/7/2023 11:31:37 AM	2/7/2023 11:31 AM
Contacts	Primary Contact	Update	Group Change Request	Higdon, April Director of Clinical Pharmacy St.Thomas Community Health Center 5045295558	Madrid, Claudia D Quality and Compliance Coordinator St Thomas Community Health Center 5045295558	8/30/2022 6:08 AM
Contacts	Primary Contact	Update	Profile Change Request	Higdon, April Director of Clinical Pharmacy St.Thomas Community Health Center 5045295558-448	Higdon, April Director of Clinical Pharmacy St.Thomas Community Health Center 5045295558	2/17/2022 11:08 AM
Details	Last Recertification Date	Update	Recertification		2/17/2022 11:06:57 AM	2/17/2022 11:06 AM
Contacts	Primary Contact	Update	Group Change Request	Darrow, Robert CFO St Thomas Community Health Center 5045295558	Higdon, April Director of Clinical Pharmacy St.Thomas Community Health Center 5045295558-448	10/5/2021 10:19 AM
Details	State	Update		Approved	Active	7/1/2021 12:01 AM
Addresses	Main Address	Update	Reinstatement	1936 Magazine Street New Orleans, LA 70130	1936 Magazine St New Orleans, LA 70130-5016	4/8/2021 3:59 PM
Medicaid Billing	Medicaid: Number	Delete	Reinstatement	2435990 (LA)		4/8/2021 3:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	4/8/2021 3:59 PM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		2206621	4/8/2021 3:59 PM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		LA	4/8/2021 3:59 PM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1003185125	4/8/2021 3:59 PM
Medicaid Billing	NPI: State	Insert	Reinstatement		LA	4/8/2021 3:59 PM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1922584523	4/8/2021 3:59 PM
Medicaid Billing	NPI: State	Insert	Reinstatement		LA	4/8/2021 3:59 PM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1003185125 ( )		4/8/2021 3:59 PM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1922584523 ( )		4/8/2021 3:59 PM
Contacts	Primary Contact	Update	Reinstatement	Tran, Phuong Associate CEO St. Thomas Community Health Center, Inc. 5045295558	Darrow, Robert CFO St Thomas Community Health Center 5045295558	4/8/2021 3:59 PM
Details	Last Recertification Date	Update	Reinstatement	2/22/2019 9:10:19 AM		4/8/2021 3:59 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	6/1/2019 12:00:00 AM		4/8/2021 3:59 PM
Dates	Participating Approval Date	Update	Reinstatement	1/11/2018 1:49:43 PM	4/8/2021 3:59:12 PM	4/8/2021 3:59 PM
Details	State	Update	Reinstatement	Terminated	Approved	4/8/2021 3:59 PM
Dates	Registration Date	Update	Reinstatement	1/11/2018 12:04:46 PM	4/8/2021 11:04:32 AM	4/8/2021 3:59 PM
Dates	Signed By Date	Update	Reinstatement	1/11/2018 12:04:48 PM	4/8/2021 11:04:35 AM	4/8/2021 3:59 PM
Dates	Start Date	Update	Reinstatement	4/1/2018 12:00:00 AM	7/1/2021 12:00:00 AM	4/8/2021 3:59 PM
Terminations	Termination Comments	Update	Reinstatement	The mobile unit was returned to March of Dimes		4/8/2021 3:59 PM
Terminations	Termination Date	Update	Reinstatement	4/1/2020 12:00:00 AM		4/8/2021 3:59 PM
Terminations	Termination Effective Date	Update	Reinstatement	6/1/2019 12:00:00 AM		4/8/2021 3:59 PM
Terminations	Termination Reason	Update	Reinstatement	Other		4/8/2021 3:59 PM
Details	Comments Public	Insert	Reinstatement		Participated starting 4/1/2018, terminated 4/1/2020. Reinstated 7/1/2021.	4/8/2021 1:13 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		6/1/2019 12:00:00 AM	2/20/2020 11:19 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/20/2020 11:19 AM
Terminations	Termination Comments	Update	Recertification		The mobile unit was returned to March of Dimes	2/20/2020 11:19 AM
Terminations	Termination Date	Update	Recertification		4/1/2020 12:00:00 AM	2/20/2020 11:19 AM
Terminations	Termination Effective Date	Update	Recertification		6/1/2019 12:00:00 AM	2/20/2020 11:19 AM
Terminations	Termination Reason	Update	Recertification		Other	2/20/2020 11:19 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/28/2019 12:12 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2178563	2/28/2019 12:12 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	2/28/2019 12:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	2/28/2019 12:12 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2435990	2/28/2019 12:12 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	2/28/2019 12:12 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1003185125	2/28/2019 12:12 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1922584523	2/28/2019 12:12 PM
Details	Last Recertification Date	Update	Recertification		2/22/2019 9:10:19 AM	2/22/2019 9:10 AM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Erwin, Donald CEO St. Thomas Community Health Center, Inc. 5045295558	1/11/2018 1:49 PM
Details	340B ID	Update	New Registration		CHC12863-08	1/11/2018 1:49 PM
Dates	Participating Approval Date	Update	New Registration		1/11/2018 1:49:43 PM	1/11/2018 1:49 PM
Details	State	Update	New Registration	Pending	Approved	1/11/2018 1:49 PM
Dates	Signed By Date	Update	New Registration		1/11/2018 12:04:48 PM	1/11/2018 1:49 PM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/11/2018 1:49 PM
Addresses	Main Address	Insert	New Registration		1936 Magazine Street New Orleans, LA 70130	1/11/2018 12:04 PM
Contacts	Primary Contact	Insert	New Registration		Tran, Phuong Associate CEO St. Thomas Community Health Center, Inc. 5045295558	1/11/2018 12:04 PM
Contacts	Authorizing Official	Insert	New Registration		Erwin, Donald CEO St. Thomas Community Health Center, Inc. 5045295558	1/11/2018 12:04 PM
Details	Last Recertification Date	Insert	New Registration			1/11/2018 12:04 PM
Details	Grant Number	Insert	New Registration		H80CS12863	1/11/2018 12:04 PM
Details	340B ID	Insert	New Registration			1/11/2018 12:04 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2018 12:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2018 12:04 PM
Details	Medicare Provider Number	Insert	New Registration			1/11/2018 12:04 PM
Details	Entity Name	Insert	New Registration		St. Thomas Community Health Center, Inc.	1/11/2018 12:04 PM
Details	Program Code	Insert	New Registration		CH	1/11/2018 12:04 PM
Details	Entity Subname	Insert	New Registration		St. Thomas CHC Medical Mobile Clinic	1/11/2018 12:04 PM
Dates	Participating Approval Date	Insert	New Registration			1/11/2018 12:04 PM
Details	State	Insert	New Registration		Pending	1/11/2018 12:04 PM
Dates	Registration Date	Insert	New Registration		1/11/2018 12:04:46 PM	1/11/2018 12:04 PM
Dates	Signed By Date	Insert	New Registration			1/11/2018 12:04 PM
Dates	Start Date	Insert	New Registration			1/11/2018 12:04 PM
Terminations	Termination Comments	Insert	New Registration			1/11/2018 12:04 PM
Terminations	Termination Date	Insert	New Registration			1/11/2018 12:04 PM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2018 12:04 PM
Terminations	Termination Reason	Insert	New Registration			1/11/2018 12:04 PM

340B Drug Pricing Program Database