Covered Entity Details

CH10248H Cowlitz Family Health Center (Active) - information as of 5/20/2025 12:51:57 AM

Main Details

Name

Cowlitz Family Health Center

Subdivision Name

14th Avenue Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-018606

340B ID

CH10248H

Grant Number

H80CS00542

Additional Details

Current Program Status

Active

Registration Date

1/12/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/16/2018

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Cowlitz Family Health Center
JIm Coffee, CEO
(360) 636-3892

Primary Contact

Cowlitz Family Health Center
Jim Merrill, CFO
(360) 636-3892

Addresses

Street Address

784 14th Avenue
Longview, WA 98632

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?
No

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	City	State
CH102480	Active	BPS-H80-004562	COWLITZ FAMILY HEALTH CENTER	COWLITZ FAMILY HEALTH CENTER	1057 12th Ave	Longview	WA
CH10248A	Active	BPS-H80-004168	COWLITZ FAMILY HEALTH CENTER	FAMILY HLTH CTR NO. BEACH CLINIC	21610 PACIFIC HIGHWAY	OCEAN PARK	WA
CH10248D	Active	BPS-H80-004409	COWLITZ FAMILY HEALTH CENTER	WOODLAND CLINIC	1251 Lewis River Rd STE D	Woodland	WA
CH10248E	Active	BPS-H80-009178	COWLITZ FAMILY HEALTH CENTER	Wahkiakum Clinic	335 Una Avenue	Cathlamet	WA
CH10248F	Active	BPS-H80-012656	COWLITZ FAMILY HEALTH CENTER	FHC Kelso Clinic	300 Oak Street STE B	Kelso	WA
CH10248G	Active	BPS-H80-017364	Cowlitz Family Health Center	Castle Rock Clinic	139 1st Avenue	Castle Rock	WA
CH10248H	Active	BPS-H80-018606	Cowlitz Family Health Center	14th Avenue Clinic	784 14th Avenue	Longview	WA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
CH102480	FRED MEYER STORES	3184 OCEAN BEACH HIGHWAY		LONGVIEW	WA	98632	07/01/2022
CH102480	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	07/01/2022
CH102480	SAFEWAY INC	SAFEWAY PHARMACY #0091	1227 15TH AVENUE	LONGVIEW	WA	98632	12/10/2010
CH102480	SAFEWAY INC	SAFEWAY PHARMACY #2637	411 THREE RIVERS DRIVE	KELSO	WA	98626	11/04/2011
CH102480	SAFEWAY INC	SAFEWAY PHARMACY #1762	1725 PACIFIC AVE	WOODLAND	WA	98674	11/01/2011
CH102480	SAFEWAY INC	SAFEWAY PHARMACY #1078	2930 OCEAN BEACH HWY	LONGVIEW	WA	98632	04/01/2015
CH10248F	SAFEWAY INC	SAFEWAY PHARMACY #0091	1227 15TH AVENUE	LONGVIEW	WA	98632	01/01/2015
CH10248F	SAFEWAY INC	SAFEWAY PHARMACY #2637	411 THREE RIVERS DRIVE	KELSO	WA	98626	01/01/2015
CH10248F	SAFEWAY INC	SAFEWAY PHARMACY #1762	1725 PACIFIC AVE	WOODLAND	WA	98674	01/01/2015
CH10248A	THE GALLERY PHARMACY	1108 PACIFIC AVENUE SOUTH		LONG BEACH	WA	98631	01/01/2004
CH102480	THRIFTY PAYLESS, INC.	RITE AID #5288	364 TRIANGLE SHOPPING CENTER	LONGVIEW	WA	98632	07/01/2022
CH102480	THRIFTY PAYLESS, INC.	RITE AID #5287	230 KELSO DRIVE	KELSO	WA	98626	07/01/2022
CH102480	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2022
CH102480	WAL-MART PHARMACY 10-2469	540 7TH AVE		LONGVIEW	WA	98632-1605	07/01/2022
CH102480	WAL-MART PHARMACY 10-3742	1486 DIKE ACCESS ROAD		WOODLAND	WA	98674	07/01/2022
CH102480	WAL-MART PHARMACY 10-5853	3715 OCEAN BEACH HWY 2		LONGVIEW	WA	98632	07/01/2022
CH102480	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2022
CH102480	WALGREEN CO.	DBA: WALGREENS # 09812	2939 OCEAN BEACH HWY	LONGVIEW	WA	98632-3513	01/25/2012
CH102480	WALGREEN CO.	DBA: WALGREENS # 09671	1625 E HARBOR DR	WARRENTON	OR	97146	01/25/2012
CH102480	WALGREEN CO.	DBA: WALGREENS # 05816	9812 NE HIGHWAY 99	VANCOUVER	WA	98665	01/25/2012
CH10248F	WALGREEN CO.	DBA: WALGREENS # 09812	2939 OCEAN BEACH HWY	LONGVIEW	WA	98632-3513	01/01/2015
CH10248F	WALGREEN CO.	DBA: WALGREENS # 09671	1625 E HARBOR DR	WARRENTON	OR	97146	01/01/2015
CH10248F	WALGREEN CO.	DBA: WALGREENS # 05816	9812 NE HIGHWAY 99	VANCOUVER	WA	98665	01/01/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 11:54:41 AM	2/11/2025 9:51:25 AM	2/11/2025 9:51 AM
Details	Last Recertification Date	Update	Recertification	2/1/2023 7:31:26 PM	1/29/2024 11:54:41 AM	1/29/2024 11:54 AM
Contacts	Primary Contact	Update	Recertification	Lim-Pedery, Katherine CFO Cowlitz Family Health Center 3607036701	Merrill, Jim CFO Cowlitz Family Health Center 3606363892	2/1/2023 7:31 PM
Details	Last Recertification Date	Update	Recertification	1/31/2022 11:57:07 AM	2/1/2023 7:31:26 PM	2/1/2023 7:31 PM
Details	Last Recertification Date	Update	Recertification	2/3/2021 11:27:44 AM	1/31/2022 11:57:07 AM	1/31/2022 11:57 AM
Contacts	Authorizing Official	Update	Profile Change Request	Coffee, JIm COO Cowlitz Family Health Center 3606363892	Coffee, JIm CEO Cowlitz Family Health Center 3606363892	1/19/2022 10:44 AM
Contacts	Authorizing Official	Update	Change Request	COOPER, DIAN CEO Cowlitz Family Health Center 3606363892	Coffee, JIm COO Cowlitz Family Health Center 3606363892	6/7/2021 12:28 PM
Details	Last Recertification Date	Update	Recertification	1/29/2020 6:53:06 AM	2/3/2021 11:27:44 AM	2/3/2021 11:27 AM
Contacts	Primary Contact	Update	Recertification	Spears, Pam CFO Cowlitz Family Health Center 3607036701	Lim-Pedery, Katherine CFO Cowlitz Family Health Center 3607036701	1/29/2020 6:53 AM
Details	Last Recertification Date	Update	Recertification	1/31/2019 11:47:11 AM	1/29/2020 6:53:06 AM	1/29/2020 6:53 AM
Details	Last Recertification Date	Update	Recertification		1/31/2019 11:47:11 AM	1/31/2019 11:47 AM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		COOPER, DIAN CEO Cowlitz Family Health Center 3606363892	1/16/2018 12:26 PM
Details	340B ID	Update	New Registration		CH10248H	1/16/2018 12:26 PM
Dates	Participating Approval Date	Update	New Registration		1/16/2018 12:26:44 PM	1/16/2018 12:26 PM
Details	State	Update	New Registration	Pending	Approved	1/16/2018 12:26 PM
Dates	Signed By Date	Update	New Registration		1/12/2018 11:39:07 AM	1/16/2018 12:26 PM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/16/2018 12:26 PM
Addresses	Main Address	Insert	New Registration		784 14th Avenue Longview, WA 98632	1/12/2018 11:39 AM
Contacts	Primary Contact	Insert	New Registration		Spears, Pam CFO Cowlitz Family Health Center 3607036701	1/12/2018 11:39 AM
Contacts	Authorizing Official	Insert	New Registration		COOPER, DIAN CEO Cowlitz Family Health Center 3606363892	1/12/2018 11:39 AM
Details	Last Recertification Date	Insert	New Registration			1/12/2018 11:39 AM
Details	Grant Number	Insert	New Registration		H80CS00542	1/12/2018 11:39 AM
Details	340B ID	Insert	New Registration			1/12/2018 11:39 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2018 11:39 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2018 11:39 AM
Details	Medicare Provider Number	Insert	New Registration			1/12/2018 11:39 AM
Details	Entity Name	Insert	New Registration		Cowlitz Family Health Center	1/12/2018 11:39 AM
Details	Program Code	Insert	New Registration		CH	1/12/2018 11:39 AM
Details	Entity Subname	Insert	New Registration		14th Avenue Clinic	1/12/2018 11:39 AM
Dates	Participating Approval Date	Insert	New Registration			1/12/2018 11:39 AM
Details	State	Insert	New Registration		Pending	1/12/2018 11:39 AM
Dates	Registration Date	Insert	New Registration		1/12/2018 11:39:05 AM	1/12/2018 11:39 AM
Dates	Signed By Date	Insert	New Registration			1/12/2018 11:39 AM
Dates	Start Date	Insert	New Registration			1/12/2018 11:39 AM
Terminations	Termination Comments	Insert	New Registration			1/12/2018 11:39 AM
Terminations	Termination Date	Insert	New Registration			1/12/2018 11:39 AM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2018 11:39 AM
Terminations	Termination Reason	Insert	New Registration			1/12/2018 11:39 AM

340B Drug Pricing Program Database