Covered Entity Details

FQHCLA346A Highland Health Providers Corporation (Terminated) - information as of 6/9/2025 11:05:07 PM

Main Details

Name

Highland Health Providers Corporation

Subdivision Name

Highland Health Providers - HFH

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-021501

340B ID

FQHCLA346A

Grant Number

LALCS00180

Additional Details

Current Program Status

Terminated

Registration Date

4/16/2018

Participating Start Date

7/1/2018

Participating Approval Date

6/4/2018

Last Recertification Date

2/10/2020

Termination Date
Termination Reason

7/1/2020
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

Highland District Hospital
Meghann Ackley, Chief Financial Officer
(937) 840-6617

Primary Contact

Highland Health Providers
Kelsey Cloud, Clinic Manager
(937) 393-8426

Addresses

Street Address

1402 N High St
Hillsboro, OH 45133-8514

Billing Address

Highland Health Providers
1487 N High Street
Suite 102
Hillsboro, OH 45133

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	Termination Date	Last Updated On
Contract Detail	BARR'S PHARMACY OF HILLSBORO	119 S HIGH ST		HILLSBORO	OH	45133	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	CORNER PHARMACY LLC	259 JEFFERSON ST		GREENFIELD	OH	45123	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	KRATZER'S HOMETOWN PHARMACY	179 W LOCUST ST		WILMINGTON	OH	45177	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	KROGER PHARMACY #014380	575 HARRY SAUNER ROAD		HILLSBORO	OH	45133	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	MCFADDEN PHARMACY	115 E MAIN ST		BAINBRIDGE	OH	45612-1102	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03446	1400 N. HIGH ST	HILLSBORO	OH	45133	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06105	610 CHERRY ST.	BLANCHESTER	OH	45107	02/27/2020	04/01/2020	07/01/2020	07/01/2020
Contract Detail	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03408	1795 COLUMBUS AVENUE	WASHINGTONCOURTHSE	OH	43160	02/27/2020	04/01/2020	07/01/2020	07/01/2020
Contract Detail	RICHLAND PHARMACY INC		DBA TOWN DRUG 12459 EAST US ROUTE 22/SR 3	SABINA	OH	45169	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #142	421 NORTH HIGH STREET	HILLSBORO	OH	45133	07/02/2019	10/01/2019	07/01/2020	07/01/2020
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #3466	109 JEFFERSON STREET	GREENFIELD	OH	45123	07/02/2019	10/01/2019	07/01/2020	07/01/2020
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	WAL-MART PHARMACY 10-1289	2825 PROGRESS WAY		WILMINGTON	OH	45177-7710	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	WAL-MART PHARMACY 10-3515	540 HARRY SAUNER ROAD		HILLSBORO	OH	45133	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/14/2019	04/01/2019	07/01/2020	07/01/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11158	1090 NORTHVIEW DR.	HILLSBORO	OH	45133	01/14/2019	04/01/2019	07/01/2020	07/01/2020

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
FQHCLA346	Terminated	BPS-LAL-018247	HIGHLAND HEALTH PROVIDERS CORPORATION	Highland Health Providers	1487 N. High St.	Suite102	Hillsboro	OH
FQHCLA346A	Terminated	BPS-LAL-021501	Highland Health Providers Corporation	Highland Health Providers - HFH	1402 N High St		Hillsboro	OH
FQHCLA346B	Terminated	BPS-LAL-021503	Highland Health Providers Corporation	Highland Health Providers - Lynchburg Medical Center	8900 State Route 134		Lynchburg	OH
FQHCLA346C	Terminated	BPS-LAL-021502	Highland Health Providers Corporation	Highland Health Providers - Greenfield Medical Services	1092 W. Jefferson Street		Greenfield	OH
FQHCLA346D	Terminated	BPS-LAL-027277	Highland Health Providers Corporation	Highland Health Providers - Rocky Fork Medical Center	11130 N Shore Dr		Hillsboro	OH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA346	BARR'S PHARMACY OF HILLSBORO	119 S HIGH ST		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346A	BARR'S PHARMACY OF HILLSBORO	119 S HIGH ST		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346B	BARR'S PHARMACY OF HILLSBORO	119 S HIGH ST		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346C	BARR'S PHARMACY OF HILLSBORO	119 S HIGH ST		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346D	BARR'S PHARMACY OF HILLSBORO	119 S HIGH ST		HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346	CORNER PHARMACY LLC	259 JEFFERSON ST		GREENFIELD	OH	45123	04/01/2019	07/01/2020
FQHCLA346A	CORNER PHARMACY LLC	259 JEFFERSON ST		GREENFIELD	OH	45123	04/01/2019	07/01/2020
FQHCLA346B	CORNER PHARMACY LLC	259 JEFFERSON ST		GREENFIELD	OH	45123	04/01/2019	07/01/2020
FQHCLA346C	CORNER PHARMACY LLC	259 JEFFERSON ST		GREENFIELD	OH	45123	04/01/2019	07/01/2020
FQHCLA346D	CORNER PHARMACY LLC	259 JEFFERSON ST		GREENFIELD	OH	45123	10/01/2019	07/01/2020
FQHCLA346	KRATZER'S HOMETOWN PHARMACY	179 W LOCUST ST		WILMINGTON	OH	45177	04/01/2019	07/01/2020
FQHCLA346A	KRATZER'S HOMETOWN PHARMACY	179 W LOCUST ST		WILMINGTON	OH	45177	04/01/2019	07/01/2020
FQHCLA346B	KRATZER'S HOMETOWN PHARMACY	179 W LOCUST ST		WILMINGTON	OH	45177	04/01/2019	07/01/2020
FQHCLA346C	KRATZER'S HOMETOWN PHARMACY	179 W LOCUST ST		WILMINGTON	OH	45177	04/01/2019	07/01/2020
FQHCLA346D	KRATZER'S HOMETOWN PHARMACY	179 W LOCUST ST		WILMINGTON	OH	45177	10/01/2019	07/01/2020
FQHCLA346	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	04/01/2019	07/01/2020
FQHCLA346A	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	04/01/2019	07/01/2020
FQHCLA346B	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	04/01/2019	07/01/2020
FQHCLA346C	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	04/01/2019	07/01/2020
FQHCLA346D	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2019	07/01/2020
FQHCLA346	KROGER PHARMACY #014380	575 HARRY SAUNER ROAD		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346A	KROGER PHARMACY #014380	575 HARRY SAUNER ROAD		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346B	KROGER PHARMACY #014380	575 HARRY SAUNER ROAD		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346C	KROGER PHARMACY #014380	575 HARRY SAUNER ROAD		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346D	KROGER PHARMACY #014380	575 HARRY SAUNER ROAD		HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346	MCFADDEN PHARMACY	115 E MAIN ST		BAINBRIDGE	OH	45612-1102	04/01/2019	07/01/2020
FQHCLA346A	MCFADDEN PHARMACY	115 E MAIN ST		BAINBRIDGE	OH	45612-1102	04/01/2019	07/01/2020
FQHCLA346B	MCFADDEN PHARMACY	115 E MAIN ST		BAINBRIDGE	OH	45612-1102	04/01/2019	07/01/2020
FQHCLA346C	MCFADDEN PHARMACY	115 E MAIN ST		BAINBRIDGE	OH	45612-1102	04/01/2019	07/01/2020
FQHCLA346D	MCFADDEN PHARMACY	115 E MAIN ST		BAINBRIDGE	OH	45612-1102	10/01/2019	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03446	1400 N. HIGH ST	HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346A	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03446	1400 N. HIGH ST	HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346C	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03446	1400 N. HIGH ST	HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346B	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03446	1400 N. HIGH ST	HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346D	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03446	1400 N. HIGH ST	HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06189	11 CENTENNIAL BLVD.	CHILLICOTHE	OH	45601	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06133	440 OXFORD STATE RD.	MIDDLETOWN	OH	45044	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06098	120 E. MAIN STREET	WILMINGTON	OH	45177	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03978	1137 STATE ROUTE 131	MILFORD	OH	45150	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03453	32 N. LUDLOW ST.	DAYTON	OH	45402	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03408	1795 COLUMBUS AVENUE	WASHINGTONCOURTHSE	OH	43160	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06105	610 CHERRY ST.	BLANCHESTER	OH	45107	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 05431	592 WEST PLANE STREET	BETHEL	OH	45106	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06186	2565 EAST MAIN ST.	SPRINGFIELD	OH	45503	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	CVS/PHARMACY # 11086	210 EAST EMMITT AVE.	WAVERLY	OH	45690	01/01/2020	07/01/2020
FQHCLA346	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06190	1021 NORTH BRIDGE ST.	CHILLICOTHE	OH	45601	01/01/2020	07/01/2020
FQHCLA346A	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06105	610 CHERRY ST.	BLANCHESTER	OH	45107	04/01/2020	07/01/2020
FQHCLA346A	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03408	1795 COLUMBUS AVENUE	WASHINGTONCOURTHSE	OH	43160	04/01/2020	07/01/2020
FQHCLA346	RICHLAND PHARMACY INC		DBA TOWN DRUG 12459 EAST US ROUTE 22/SR 3	SABINA	OH	45169	04/01/2019	07/01/2020
FQHCLA346A	RICHLAND PHARMACY INC		DBA TOWN DRUG 12459 EAST US ROUTE 22/SR 3	SABINA	OH	45169	04/01/2019	07/01/2020
FQHCLA346B	RICHLAND PHARMACY INC		DBA TOWN DRUG 12459 EAST US ROUTE 22/SR 3	SABINA	OH	45169	04/01/2019	07/01/2020
FQHCLA346C	RICHLAND PHARMACY INC		DBA TOWN DRUG 12459 EAST US ROUTE 22/SR 3	SABINA	OH	45169	04/01/2019	07/01/2020
FQHCLA346D	RICHLAND PHARMACY INC		DBA TOWN DRUG 12459 EAST US ROUTE 22/SR 3	SABINA	OH	45169	10/01/2019	07/01/2020
FQHCLA346	RITE AID OF OHIO, INC.	RITE AID #142	421 NORTH HIGH STREET	HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346	RITE AID OF OHIO, INC.	RITE AID #3466	109 JEFFERSON STREET	GREENFIELD	OH	45123	10/01/2019	07/01/2020
FQHCLA346A	RITE AID OF OHIO, INC.	RITE AID #142	421 NORTH HIGH STREET	HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346A	RITE AID OF OHIO, INC.	RITE AID #3466	109 JEFFERSON STREET	GREENFIELD	OH	45123	10/01/2019	07/01/2020
FQHCLA346B	RITE AID OF OHIO, INC.	RITE AID #142	421 NORTH HIGH STREET	HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346B	RITE AID OF OHIO, INC.	RITE AID #3466	109 JEFFERSON STREET	GREENFIELD	OH	45123	10/01/2019	07/01/2020
FQHCLA346C	RITE AID OF OHIO, INC.	RITE AID #142	421 NORTH HIGH STREET	HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346C	RITE AID OF OHIO, INC.	RITE AID #3466	109 JEFFERSON STREET	GREENFIELD	OH	45123	10/01/2019	07/01/2020
FQHCLA346D	RITE AID OF OHIO, INC.	RITE AID #142	421 NORTH HIGH STREET	HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346D	RITE AID OF OHIO, INC.	RITE AID #3466	109 JEFFERSON STREET	GREENFIELD	OH	45123	10/01/2019	07/01/2020
FQHCLA346	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019	07/01/2020
FQHCLA346A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019	07/01/2020
FQHCLA346B	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019	07/01/2020
FQHCLA346C	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019	07/01/2020
FQHCLA346D	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2019	07/01/2020
FQHCLA346	WAL-MART PHARMACY 10-1289	2825 PROGRESS WAY		WILMINGTON	OH	45177-7710	04/01/2019	07/01/2020
FQHCLA346A	WAL-MART PHARMACY 10-1289	2825 PROGRESS WAY		WILMINGTON	OH	45177-7710	04/01/2019	07/01/2020
FQHCLA346B	WAL-MART PHARMACY 10-1289	2825 PROGRESS WAY		WILMINGTON	OH	45177-7710	04/01/2019	07/01/2020
FQHCLA346C	WAL-MART PHARMACY 10-1289	2825 PROGRESS WAY		WILMINGTON	OH	45177-7710	04/01/2019	07/01/2020
FQHCLA346D	WAL-MART PHARMACY 10-1289	2825 PROGRESS WAY		WILMINGTON	OH	45177-7710	10/01/2019	07/01/2020
FQHCLA346	WAL-MART PHARMACY 10-3515	540 HARRY SAUNER ROAD		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346A	WAL-MART PHARMACY 10-3515	540 HARRY SAUNER ROAD		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346B	WAL-MART PHARMACY 10-3515	540 HARRY SAUNER ROAD		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346C	WAL-MART PHARMACY 10-3515	540 HARRY SAUNER ROAD		HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346D	WAL-MART PHARMACY 10-3515	540 HARRY SAUNER ROAD		HILLSBORO	OH	45133	10/01/2019	07/01/2020
FQHCLA346	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2019	07/01/2020
FQHCLA346A	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2019	07/01/2020
FQHCLA346B	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2019	07/01/2020
FQHCLA346C	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2019	07/01/2020
FQHCLA346D	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2019	07/01/2020
FQHCLA346	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019	07/01/2020
FQHCLA346A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019	07/01/2020
FQHCLA346B	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019	07/01/2020
FQHCLA346C	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019	07/01/2020
FQHCLA346D	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2019	07/01/2020
FQHCLA346	WALGREEN CO.	DBA: WALGREENS #11158	1090 NORTHVIEW DR.	HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346A	WALGREEN CO.	DBA: WALGREENS #11158	1090 NORTHVIEW DR.	HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346B	WALGREEN CO.	DBA: WALGREENS #11158	1090 NORTHVIEW DR.	HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346C	WALGREEN CO.	DBA: WALGREENS #11158	1090 NORTHVIEW DR.	HILLSBORO	OH	45133	04/01/2019	07/01/2020
FQHCLA346D	WALGREEN CO.	DBA: WALGREENS #11158	1090 NORTHVIEW DR.	HILLSBORO	OH	45133	10/01/2019	07/01/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Ackley, Meghann VP Finance Highland District Hospital 9378406617	Ackley, Meghann Chief Financial Officer Highland District Hospital 9378406617	12/7/2022 8:56 AM
Details	State	Update		To Be Terminated	Terminated	7/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		3/31/2020 12:00:00 AM	5/8/2020 12:19 PM
Details	State	Update	Termination Request	Active	To Be Terminated	5/8/2020 12:19 PM
Terminations	Termination Comments	Update	Termination Request		Went from FQHCLA to CHC.	5/8/2020 12:19 PM
Terminations	Termination Date	Update	Termination Request		7/1/2020 12:00:00 AM	5/8/2020 12:19 PM
Terminations	Termination Effective Date	Update	Termination Request		4/1/2020 12:00:00 AM	5/8/2020 12:19 PM
Terminations	Termination Reason	Update	Termination Request		Change of covered entity type (non-hospital)	5/8/2020 12:19 PM
Details	Last Recertification Date	Update	Recertification	1/29/2019 7:25:36 AM	2/10/2020 3:42:22 PM	2/10/2020 3:42 PM
Contacts	Authorizing Official	Update	Change Request	Warix, Amanda M Executive Director Highland Health Providers 9373935753	Ackley, Meghann VP Finance Highland District Hospital 9378406617	10/3/2019 9:30 AM
Details	Last Recertification Date	Update	Recertification		1/29/2019 7:25:36 AM	1/29/2019 7:25 AM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Warix, Amanda M Executive Director Highland Health Providers 9373935753	6/4/2018 10:47 AM
Details	Grant Number	Update	New Registration	LAL000180	LALCS00180	6/4/2018 10:47 AM
Details	340B ID	Update	New Registration		FQHCLA346A	6/4/2018 10:47 AM
Dates	Participating Approval Date	Update	New Registration		6/4/2018 10:47:22 AM	6/4/2018 10:47 AM
Details	State	Update	New Registration	Pending	Approved	6/4/2018 10:47 AM
Dates	Signed By Date	Update	New Registration		4/16/2018 4:02:48 PM	6/4/2018 10:47 AM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	6/4/2018 10:47 AM
Addresses	Main Address	Insert	New Registration		1402 N High St Hillsboro, OH 45133-8514	4/16/2018 4:02 PM
Addresses	Billing Address	Insert	New Registration		Highland Health Providers 1487 N High Street Suite 102 Hillsboro, OH 45133	4/16/2018 4:02 PM
Contacts	Authorizing Official	Insert	New Registration		Warix, Amanda M Executive Director Highland Health Providers 9373935753	4/16/2018 4:02 PM
Contacts	Primary Contact	Insert	New Registration		Cloud, Kelsey Clinic Manager Highland Health Providers 9373938426	4/16/2018 4:02 PM
Details	Last Recertification Date	Insert	New Registration			4/16/2018 4:02 PM
Details	Grant Number	Insert	New Registration		LAL000180	4/16/2018 4:02 PM
Details	340B ID	Insert	New Registration			4/16/2018 4:02 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/16/2018 4:02 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/16/2018 4:02 PM
Details	Medicare Provider Number	Insert	New Registration			4/16/2018 4:02 PM
Details	Entity Name	Insert	New Registration		Highland Health Providers Corporation	4/16/2018 4:02 PM
Details	Program Code	Insert	New Registration		FQHCLA	4/16/2018 4:02 PM
Details	Entity Subname	Insert	New Registration		Highland Health Providers - HFH	4/16/2018 4:02 PM
Dates	Participating Approval Date	Insert	New Registration			4/16/2018 4:02 PM
Details	State	Insert	New Registration		Pending	4/16/2018 4:02 PM
Dates	Registration Date	Insert	New Registration		4/16/2018 4:02:45 PM	4/16/2018 4:02 PM
Dates	Signed By Date	Insert	New Registration			4/16/2018 4:02 PM
Dates	Start Date	Insert	New Registration			4/16/2018 4:02 PM
Terminations	Termination Comments	Insert	New Registration			4/16/2018 4:02 PM
Terminations	Termination Date	Insert	New Registration			4/16/2018 4:02 PM
Terminations	Termination Effective Date	Insert	New Registration			4/16/2018 4:02 PM
Terminations	Termination Reason	Insert	New Registration			4/16/2018 4:02 PM

340B Drug Pricing Program Database