Covered Entity Details

CH03126E Southbridge Medical Advisory Council Inc (Terminated) - information as of 5/12/2025 10:12:40 PM

Main Details

Name

Southbridge Medical Advisory Council Inc

Subdivision Name

HJMC Family Practice

Type

HRSA-Funded Health Center

Site ID

BPS-H80-021468

340B ID

CH03126E

Grant Number

H80CS00385

Additional Details

Current Program Status

Terminated

Registration Date

2/12/2018

Participating Start Date

4/1/2018

Participating Approval Date

2/13/2018

Last Recertification Date

2/27/2019

Termination Date
Termination Reason

10/1/2019
Business decision by the Covered Entity

Contacts

Authorizing Official

Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center
Shay Scott, CEO
(302) 655-6187 Ext: 230

Primary Contact

Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center
Yvette Gbemudu, CMO
(302) 655-6187 Ext: 233

Addresses

Street Address

1100 S Broom St
Wilmington, DE 19805-4585

Billing Address

Henrietta Johnson Medical Center
601 New Castle Avenue
Wilmington, DE 19801

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
CH031260	Active	BPS-H80-001099	SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.	DBA HENRIETTA JOHNSON MEDICAL CENTER	601 NEW CASTLE AVENUE	WILMINGTON	DE
CH03126C	Terminated	BPS-H80-012295	SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.	DBA HENRIETTA JOHNSON MEDICAL CENTER @ EASTSIDE	600 N Lombard Street	WILMINGTON	DE
CH03126D	Active	BPS-H80-027639	SOUTHBRIDGE MEDICAL ADVISORY COUNCIL INC	HENRIETTA JOHNSON MEDICAL CENTER at CLAYMONT	2722 PHILADELPHIA PIKE	CLAYMONT	DE
CH03126E	Terminated	BPS-H80-021468	Southbridge Medical Advisory Council Inc	HJMC Family Practice	1100 S Broom St	Wilmington	DE

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH031260	APOVIA PHARMACY SERVICES	313 HENDERSON DR		SHARON HILL	PA	19079-1034	10/01/2020
CH031260	ECKERD CORPORATION	RITE AID #11177	2713 PHILADELPHIA PIKE	CLAYMONT	DE	19703	10/01/2020	11/15/2023
CH031260	FAMILY PHARMACY INC	1416 LANCASTER AVE	PO BOX 30410	WILMINGTON	DE	19805	08/13/2008	02/27/2019
CH031260	GADDE & CHIRRA, INC	D/B/A KIRKWOOD PHARMACY	4524 KIRKWOOD HWAY	WILMINGTON	DE	19808	04/01/2014	08/28/2017
CH031260	GREATER PHILADELPHIA PHARMACY	UNIVERSAL PHARMACY SERVICES	432 N 6TH. ST.	PHILADELPHIA	PA	19123-4004	10/01/2020
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11009	1413 NORTH DUPONT HWY	NEW CASTLE	DE	19720-1843	07/01/2015	02/19/2025
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11020	839 N MARKET ST FL1	WILMINGTON	DE	19801	07/01/2015
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11034	NEW CASTLE 740 FERRY CUT-OFF	NEW CASTLE	DE	19720	07/01/2015
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11010	CANNERY 3301 LANCASTER PIKE	WILMINGTON	DE	19805-1436	01/01/2022	11/13/2023
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS #11014	1A TROLLEY SQ	WILMINGTON	DE	19806	01/01/2022	11/14/2024
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS #11032	1508 PHILADELPHIA PIKE	WILMINGTON	DE	19809-1826	01/01/2022
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11049	PHILADELPHIA PIKE 802 PHILADELPHIA PIKE	WILMINGTON	DE	19809	01/01/2022
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11070	UNION STREET 1313 N UNION STREET	WILMINGTON	DE	19806	01/01/2022	11/14/2024
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS #13823	2121 KIRKWOOD HIGHWAY	WILMINGTON	DE	19805-4921	01/01/2022
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11017	1120 PULASKI HIGHWAY	BEAR	DE	19701	01/01/2022
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11022	FOX RUN 128 FOX HUNT DR	BEAR	DE	19701-2535	01/01/2022
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11058	287 CHRISTIANA RD STE 17A	NEW CASTLE	DE	19720	01/01/2022
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11067	MIDDLETOWN CROSSING 396 E MAIN STREET	MIDDLETOWN	DE	19709	01/01/2022
CH031260	HAPPY HARRY'S INC.	DBA: WALGREENS # 11011	CANBY PARK 1900 MARYLAND AVE	WILMINGTON	DE	19805-4605	01/01/2022	02/21/2024
CH031260	Newcastle Discount Pharmacy	232 NEW CASTLE AVENUE		NEW CASTLE	DE	19720	11/02/2010	09/24/2021
CH031260	RITE AID OF DELAWARE, INC.	RITE AID #172	2034 NEW CASTLE AVENUE	NEW CASTLE	DE	19720	10/01/2020
CH031260	RITE AID OF DELAWARE, INC.	RITE AID #1782	3801 N. MARKET STREET	WILMINGTON	DE	19802	10/01/2020
CH031260	RITE AID OF DELAWARE, INC.	RITE AID #1658	800 WEST 4TH STREET	WILMINGTON	DE	19801	10/01/2020
CH031260	SHOPRITE OF CHRISTINA LANDING CENTER, LL	SHOPRITE PHARMACY #589	501 S. WALNUT ST	WILMINGTON	DE	19801-5286	01/01/2015	02/26/2021
CH03126C	SHOPRITE OF CHRISTINA LANDING CENTER, LL	SHOPRITE PHARMACY #589	501 S. WALNUT ST	WILMINGTON	DE	19801-5286	10/12/2010	04/01/2018
CH031260	SYNERGY RX EXPRESS PHARMACY	18 PENN MART SHOPPING CENTER		NEW CASTLE	DE	19720-4207	10/01/2019	08/05/2021
CH03126C	SYNERGY RX EXPRESS PHARMACY	18 PENN MART SHOPPING CENTER		NEW CASTLE	DE	19720-4207	10/01/2019	04/01/2022
CH031260	UNIVERSAL PHARMACY SERVICES, LLC	DBA SYNERGY RX EXPRESS PHARMACY	601 NEW CASTLE AVE	WILMINGTON	DE	19801	08/04/2021
CH031260	WALGREEN EASTERN CO., INC.	DBA; WALGREENS #12040	3513 NORTH MARKET STREET	WILMINGTON	DE	19802	07/01/2015	11/07/2019
CH031260	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY #16532	1201 N MARKET ST STE 101	WILMINGTON	DE	19801	10/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Recertification	Gbemudu, Yvette CMO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-528	Gbemudu, Yvette CMO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-233	2/21/2020 11:12 AM
Contacts	Authorizing Official	Update	Profile Change Request	Scott, Shay Acting CEO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-230	Scott, Shay CEO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-230	2/21/2020 10:51 AM
Contacts	Signed By	Update	Profile Change Request	Scott, Shay Acting CEO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-230	Scott, Shay CEO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-230	2/21/2020 10:51 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Details	State	Update	Termination Request	Active	To Be Terminated	9/24/2019 3:16 PM
Terminations	Termination Comments	Update	Termination Request		The health center has not provided services at this location in over a year. No 340b activity should have occurred out of this site for the past 18 month if ever at all. I used the ineligibility date.	9/24/2019 3:16 PM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	9/24/2019 3:16 PM
Terminations	Termination Effective Date	Update	Termination Request		9/12/2019 12:00:00 AM	9/24/2019 3:16 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	9/24/2019 3:16 PM
Details	Last Recertification Date	Update	Recertification		2/27/2019 3:55:37 PM	2/27/2019 3:55 PM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Scott, Shay Acting CEO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-230	2/13/2018 10:59 AM
Details	340B ID	Update	New Registration		CH03126E	2/13/2018 10:59 AM
Dates	Participating Approval Date	Update	New Registration		2/13/2018 10:59:22 AM	2/13/2018 10:59 AM
Details	State	Update	New Registration	Pending	Approved	2/13/2018 10:59 AM
Dates	Signed By Date	Update	New Registration		2/12/2018 6:36:57 PM	2/13/2018 10:59 AM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	2/13/2018 10:59 AM
Addresses	Main Address	Insert	New Registration		1100 S Broom St Wilmington, DE 19805-4585	2/12/2018 6:36 PM
Addresses	Billing Address	Insert	New Registration		Henrietta Johnson Medical Center 601 New Castle Avenue Wilmington, DE 19801	2/12/2018 6:36 PM
Contacts	Authorizing Official	Insert	New Registration		Scott, Shay Acting CEO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-230	2/12/2018 6:36 PM
Contacts	Primary Contact	Insert	New Registration		Gbemudu, Yvette CMO Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center 3026556187-528	2/12/2018 6:36 PM
Details	Last Recertification Date	Insert	New Registration			2/12/2018 6:36 PM
Details	Grant Number	Insert	New Registration		H80CS00385	2/12/2018 6:36 PM
Details	340B ID	Insert	New Registration			2/12/2018 6:36 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			2/12/2018 6:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			2/12/2018 6:36 PM
Details	Medicare Provider Number	Insert	New Registration			2/12/2018 6:36 PM
Details	Entity Name	Insert	New Registration		Southbridge Medical Advisory Council Inc	2/12/2018 6:36 PM
Details	Program Code	Insert	New Registration		CH	2/12/2018 6:36 PM
Details	Entity Subname	Insert	New Registration		HJMC Family Practice	2/12/2018 6:36 PM
Dates	Participating Approval Date	Insert	New Registration			2/12/2018 6:36 PM
Details	State	Insert	New Registration		Pending	2/12/2018 6:36 PM
Dates	Registration Date	Insert	New Registration		2/12/2018 6:36:53 PM	2/12/2018 6:36 PM
Dates	Signed By Date	Insert	New Registration			2/12/2018 6:36 PM
Dates	Start Date	Insert	New Registration			2/12/2018 6:36 PM
Terminations	Termination Comments	Insert	New Registration			2/12/2018 6:36 PM
Terminations	Termination Date	Insert	New Registration			2/12/2018 6:36 PM
Terminations	Termination Effective Date	Insert	New Registration			2/12/2018 6:36 PM
Terminations	Termination Reason	Insert	New Registration			2/12/2018 6:36 PM

340B Drug Pricing Program Database