Covered Entity Details

CH01146S Lowell Community Health Center, Inc. (Active) - information as of 6/4/2025 12:08:03 PM

Main Details

Name

Lowell Community Health Center, Inc.

Subdivision Name

Lowell CHC - 101 Jackson Street

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017910

340B ID

CH01146S

Grant Number

H80CS00397

Additional Details

Current Program Status

Active

Registration Date

4/11/2018

Participating Start Date

7/1/2018

Participating Approval Date

4/17/2018

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Lowell Community Health Center
Timothy Regan, Sr. Dir. Contracts and Compliance
(978) 937-9700

Primary Contact

Lowell Community Health Center
Amy E Sullivan, Senior Director of Pharmacy Services
(802) 304-9436

Addresses

Street Address

101 Jackson Street
Lowell, MA 01852-2103

Billing Address

Lowell Community Health Center, Inc.
161 Jackson street
Lowell, MA 01852

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?
Yes

State	Medicaid Number	NPI Number
MA	110027964A	1952307530

Shipping Addresses

Shipping Address 1

Lowell Community Health Center, Inc.
161 Jackson Street
Lowell, MA 01852

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
Contract Detail	D.A.W., LLC.	CVS/PHARMACY # 11266	161 JACKSON ST	LOWELL	MA	01852	04/17/2018	07/01/2018		09/28/2024	09/28/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH011460	Active	BPS-H80-009242	LOWELL COMMUNITY HEALTH CENTER, INC.	ACCOUNTS PAYABLE	161 Jackson Street	LOWELL	MA
CH01146D	Terminated	BPS-H80-004565	LOWELL COMMUNITY HEALTH CENTER	Metta Health Center	135 JACKSON STREET	LOWELL	MA
CH01146L	Active	BPS-H80-005959	LOWELL COMMUNITY HEALTH CENTER, INC.	Kathyrn P. Stoklosa Middle School	560 Broadway St	Lowell	MA
CH01146M	Active	BPS-H80-003896	LOWELL COMMUNITY HEALTH CENTER, INC.	LOWELL HIGH SCHOOL HEALTH CTR	50 FATHER MORISSETTE	LOWELL	MA
CH01146N	Terminated	BPS-H80-017427	LOWELL COMMUNITY HEALTH CENTER, INC.	Element Care	166 Central Street	Lowell	MA
CH01146P	Terminated	BPS-H80-017409	LOWELL COMMUNITY HEALTH CENTER, INC.	The Community Family	236 Broadway Street	Lowell	MA
CH01146Q	Terminated	BPS-H80-019053	LOWELL COMMUNITY HEALTH CENTER, INC.	Greater Lowell Technical High School	250 Pawtucket Blvd.	Tyngsboro	MA
CH01146R	Terminated	BPS-H80-019054	Lowell Community Health Center, Inc.	Lowell High School Career Academy	125 Smith Street	Lowell	MA
CH01146S	Active	BPS-H80-017910	Lowell Community Health Center, Inc.	Lowell CHC - 101 Jackson Street	101 Jackson Street	Lowell	MA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH011460	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2020
CH011460	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2020
CH011460	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 05493	336 BRIDGE ST.	LOWELL	MA	01850	04/01/2020
CH011460	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01056	25 WOOD STREET	LOWELL	MA	01851	04/01/2020
CH011460	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01000	35 MERRIMACK STREET	LOWELL	MA	01852	04/01/2020	09/20/2021
CH011460	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 1786	266 BROADWAY	LAWRENCE	MA	01841	04/01/2025
CH011460	CVS PHARMACY, INC.	CVS PHARMACY # 17529	181 PLAIN ST	LOWELL	MA	01852	04/01/2025
CH011460	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00131	210 BOSTON RD.	NORTH BILLERICA	MA	01862	04/01/2025
CH011460	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00983	2019 LAKEVIEW AVENUE	DRACUT	MA	01826	07/01/2025
CH011460	D.A.W., LLC.	CVS/PHARMACY # 11266	161 JACKSON ST	LOWELL	MA	01852	07/01/2013	09/28/2024
CH011460	D.A.W., LLC.	EATON APOTHECARY #3035	2 CENTENNIAL DR STE 1A	PEABODY	MA	01960	04/01/2016	06/30/2019
CH01146D	D.A.W., LLC.	CVS/PHARMACY # 11266	161 JACKSON ST	LOWELL	MA	01852	07/01/2013	07/01/2018
CH01146L	D.A.W., LLC.	CVS/PHARMACY # 11266	161 JACKSON ST	LOWELL	MA	01852	01/01/2018	09/28/2024
CH01146M	D.A.W., LLC.	CVS/PHARMACY # 11266	161 JACKSON ST	LOWELL	MA	01852	01/01/2018	09/28/2024
CH01146Q	D.A.W., LLC.	CVS/PHARMACY # 11266	161 JACKSON ST	LOWELL	MA	01852	01/01/2018	04/01/2023
CH01146N	D.A.W., LLC.	EATON APOTHECARY #3035	2 CENTENNIAL DR STE 1A	PEABODY	MA	01960	01/01/2018	10/01/2019
CH01146P	D.A.W., LLC.	EATON APOTHECARY #3035	2 CENTENNIAL DR STE 1A	PEABODY	MA	01960	01/01/2018	04/01/2020
CH01146S	D.A.W., LLC.	CVS/PHARMACY # 11266	161 JACKSON ST	LOWELL	MA	01852	07/01/2018	09/28/2024
CH011460	MHHP ACQUISITION COMPANY, LLC	OMNICARE OF CENTRAL MASSACHUSETTS	574 HARTFORD TURNPIKE	SHREWSBURY	MA	01545	07/01/2018	10/31/2023
CH011460	NORTH SHORE PHARMACY SERVICES	OMNICARE OF NORTHERN MASSACHUSETTS	2 TECHNOLOGY DRIVE	PEABODY	MA	01960	07/01/2018	10/31/2023
CH011460	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2020
CH011460	WALGREEN EASTERN CO., INC.	WALGREENS #18338	121 CHURCH ST	LOWELL	MA	01852	04/01/2020	03/03/2023
CH011460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02011	446 BOSTON RD	BILLERICA	MA	01821	04/01/2020	04/18/2023
CH011460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11726	1765 MIDDLESEX ST.	LOWELL	MA	01851	04/01/2020	05/01/2025
CH011460	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY #21179	25 MERRIMACK ST.	LOWELL	MA	01852	04/01/2020
CH011460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06739	54 PLAIN ST	LOWELL	MA	01851-4419	04/01/2020
CH011460	WALGREEN EASTERN CO., INC.	WALGREENS #19465	276 BROADWAY ST	LOWELL	MA	01854	04/01/2020
CH011460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #13642	1161 BRIDGE ST	LOWELL	MA	01850	04/01/2020
CH011460	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	10/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/31/2024 2:17:03 PM	2/10/2025 12:47:34 PM	2/10/2025 12:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2024 3:49 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		110027964A	8/23/2024 3:49 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MA	8/23/2024 3:49 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1305557 (MA)		8/23/2024 3:49 PM
Contacts	Primary Contact	Update	Profile Change Request	Sullivan, Amy E Director of Clinical Pharmacy Services Lowell Community Health Center 8023049436	Sullivan, Amy E Senior Director of Pharmacy Services Lowell Community Health Center 8023049436	5/6/2024 11:29 AM
Details	Last Recertification Date	Update	Recertification	2/20/2023 7:40:05 AM	1/31/2024 2:17:03 PM	1/31/2024 2:17 PM
Contacts	Primary Contact	Update		Sullivan, Amy Director of Clinical Pharmacy Services Lowell Community Health Center 8023049436	Sullivan, Amy E Director of Clinical Pharmacy Services Lowell Community Health Center 8023049436	3/1/2023 9:29 AM
Contacts	Primary Contact	Update	Recertification	Licata, Robin Director of Financial Operations Lowell Community Health Center 9783228593	Sullivan, Amy Director of Clinical Pharmacy Services Lowell Community Health Center 8023049436	2/20/2023 7:40 AM
Details	Last Recertification Date	Update	Recertification	2/8/2022 2:34:58 PM	2/20/2023 7:40:05 AM	2/20/2023 7:40 AM
Details	Last Recertification Date	Update	Recertification	2/24/2021 1:18:28 PM	2/8/2022 2:34:58 PM	2/8/2022 2:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1952307530	2/24/2021 1:18 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	2/24/2021 1:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1952307530 ( )		2/24/2021 1:18 PM
Details	Last Recertification Date	Update	Recertification	1/30/2020 12:19:57 PM	2/24/2021 1:18:28 PM	2/24/2021 1:18 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	11002796A	1305557	4/16/2020 3:46 PM
Contacts	Authorizing Official	Update	Change Request	Och, Henry Chief of Operations Lowell Community Health Center 9783228519	Regan, Timothy Sr. Dir. Contracts and Compliance Lowell Community Health Center 9789379700	4/16/2020 1:08 PM
Details	Last Recertification Date	Update	Recertification	2/26/2019 2:20:08 PM	1/30/2020 12:19:57 PM	1/30/2020 12:19 PM
Details	Last Recertification Date	Update	Recertification		2/26/2019 2:20:08 PM	2/26/2019 2:20 PM
Contacts	Authorizing Official	Update	AO Change Request	Ebersole, Robert CFO Lowell Community Health Center 9783228596	Och, Henry Chief of Operations Lowell Community Health Center 9783228519	2/26/2019 1:36 PM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Ebersole, Robert CFO Lowell Community Health Center 9783228596	4/17/2018 1:06 PM
Details	340B ID	Update	New Registration		CH01146S	4/17/2018 1:06 PM
Dates	Participating Approval Date	Update	New Registration		4/17/2018 1:06:20 PM	4/17/2018 1:06 PM
Details	State	Update	New Registration	Pending	Approved	4/17/2018 1:06 PM
Dates	Signed By Date	Update	New Registration		4/11/2018 12:35:05 PM	4/17/2018 1:06 PM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	4/17/2018 1:06 PM
Addresses	Main Address	Insert	New Registration		101 Jackson Street Lowell, MA 01852-2103	4/11/2018 12:35 PM
Addresses	Billing Address	Insert	New Registration		Lowell Community Health Center, Inc. 161 Jackson street Lowell, MA 01852	4/11/2018 12:35 PM
Addresses	Shipping Address	Insert	New Registration		Lowell Community Health Center, Inc. 161 Jackson Street Lowell, MA 01852	4/11/2018 12:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2018 12:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		11002796A	4/11/2018 12:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	4/11/2018 12:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1952307530	4/11/2018 12:35 PM
Contacts	Authorizing Official	Insert	New Registration		Ebersole, Robert CFO Lowell Community Health Center 9783228596	4/11/2018 12:35 PM
Contacts	Primary Contact	Insert	New Registration		Licata, Robin Director of Financial Operations Lowell Community Health Center 9783228593	4/11/2018 12:35 PM
Details	Last Recertification Date	Insert	New Registration			4/11/2018 12:35 PM
Details	Grant Number	Insert	New Registration		H80CS00397	4/11/2018 12:35 PM
Details	340B ID	Insert	New Registration			4/11/2018 12:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2018 12:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2018 12:35 PM
Details	Medicare Provider Number	Insert	New Registration			4/11/2018 12:35 PM
Details	Entity Name	Insert	New Registration		Lowell Community Health Center, Inc.	4/11/2018 12:35 PM
Details	Program Code	Insert	New Registration		CH	4/11/2018 12:35 PM
Details	Entity Subname	Insert	New Registration		Lowell CHC - 101 Jackson Street	4/11/2018 12:35 PM
Dates	Participating Approval Date	Insert	New Registration			4/11/2018 12:35 PM
Details	State	Insert	New Registration		Pending	4/11/2018 12:35 PM
Dates	Registration Date	Insert	New Registration		4/11/2018 12:35:01 PM	4/11/2018 12:35 PM
Dates	Signed By Date	Insert	New Registration			4/11/2018 12:35 PM
Dates	Start Date	Insert	New Registration			4/11/2018 12:35 PM
Terminations	Termination Comments	Insert	New Registration			4/11/2018 12:35 PM
Terminations	Termination Date	Insert	New Registration			4/11/2018 12:35 PM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2018 12:35 PM
Terminations	Termination Reason	Insert	New Registration			4/11/2018 12:35 PM

340B Drug Pricing Program Database