Covered Entity Details

CH04415Z ALBANY AREA PRIMARY HEALTH CARE, INC (Active) - information as of 5/8/2025 10:13:01 PM

Main Details

Name

ALBANY AREA PRIMARY HEALTH CARE, INC

Subdivision Name

AAPHC Renaissance Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-024750

340B ID

CH04415Z

Grant Number

H80CS00763

Additional Details

Current Program Status

Active

Registration Date

1/10/2019

Participating Start Date

4/1/2019

Participating Approval Date

1/14/2019

Last Recertification Date

2/18/2025

Contacts

Authorizing Official

Albany Area Primary Health Care, Inc.
Clifton Miquel Bush, Chief Operating Officer
(229) 888-6559 Ext: 6261

Primary Contact

Albany Area Primary Health Care, Inc
Susan Rakel, Director of 340B and Pharmacy Services
(229) 888-6559 Ext: 6217

Addresses

Street Address

2403 Osler Court STE B
Albany, GA 31707

Billing Address

ALBANY AREA PRIMARY HEALTH CARE, INC
204 N. WESTOVER BLVD
ALBANY, GA 31707

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
GA	003175066A	1164888491

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
CH044150	Active	BPS-H80-001917	ALBANY AREA PRIMARY HEALTH CARE, INC	ALBANY AREA PRIMARY HEALTH CARE, INC.	204 N.WESTOVER BLVD.	ALBANY	GA
CH0441501	Active	BPS-H80-001917	ALBANY AREA PRIMARY HEALTH CARE, INC	ADMIN OFFICE	204 N. WESTOVER BLVD.	ALBANY	GA
CH044150P	Active	BPS-H80-012343	ALBANY AREA PRIMARY HEALTH CARE, INC	Turner Elementary School-Based Health Center	2001 Leonard Ave	Albany	GA
CH04415A	Active	BPS-H80-003323	ALBANY AREA PRIMARY HEALTH CARE, INC	EDISON MEDICAL CENTER	19519 Hartford St	Edison	GA
CH04415AA	Terminated	BPS-H80-024751	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Womens Health Center	810 13th Ave	Albany	GA
CH04415AB	Terminated	BPS-H80-027014	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Covenant Counseling Center	600 2nd St SE	Moultrie	GA
CH04415AC	Terminated	BPS-H80-024742	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Northwest Family Medical and Dental Center	2403 Osler Court STE A	Albany	GA
CH04415AD	Terminated	BPS-H80-031869	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Americus Behavioral Wellness Center	615 Barlow St	Americus	GA
CH04415AE	Active	BPS-H80-031868	ALBANY AREA PRIMARY HEALTH CARE, INC	Mitchell County School-Based Health Center	1000 Newton Rd	Camilla	GA
CH04415AF	Active	BPS-H80-032590	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Mobile Access Care Unit / MACU-1	1412 W. Oakridge Drive	Albany	GA
CH04415AG	Active	BPS-H80-032589	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Mobile Access Care Unit / MACU-2	1412 W. Oakridge Drive	Albany	GA
CH04415AH	Active	BPS-H80-035209	ALBANY AREA PRIMARY HEALTH CARE, INC	Albany Area Pediatrics	1801 Palmyra Rd	Albany	GA
CH04415AJ	Active	BPS-H80-035764	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Elois Edge Women's Health Center	1912 Arlington St.	Albany	GA
CH04415AK	Active	BPS-H80-036225	ALBANY AREA PRIMARY HEALTH CARE, INC	Lee Health Center	118 Robert B Lee Dr	Leesburg	GA
CH04415AL	Active	BPS-H80-033820	ALBANY AREA PRIMARY HEALTH CARE, INC	Dawson Medical Center	505 Forrester Dr SE	Dawson	GA
CH04415AM	Active	BPS-H80-036905	ALBANY AREA PRIMARY HEALTH CARE, INC	Clay County School-Based Health Center	200 Hobbs Ln	Fort Gaines	GA
CH04415AN	Active	BPS-H80-036661	ALBANY AREA PRIMARY HEALTH CARE, INC	Sumter County School-Based Health Center	123 Learning Lane	Americus	GA
CH04415AP	Active	BPS-H80-038789	Albany Area Primary Health Care, Inc.	AAPHC Wellness Center	512 Liberty Expressway	Albany	GA
CH04415B	Active	BPS-H80-005242	ALBANY AREA PRIMARY HEALTH CARE, INC	EAST ALBANY MEDICAL CENTER	1712 E. Broad Avenue, Suite A	ALBANY	GA
CH04415C	Active	BPS-H80-000458	ALBANY AREA PRIMARY HEALTH CARE, INC	LEE MEDICAL ARTS CENTER	235 Walnut Ave S	Leesburg	GA
CH04415D	Active	BPS-H80-004105	ALBANY AREA PRIMARY HEALTH CARE, INC	Baker County Primary Health Care	327 Sunset Avenue, SW STE 3	NEWTON	GA
CH04415E	Active	BPS-H80-003053	ALBANY AREA PRIMARY HEALTH CARE, INC	RURAL HIV CLINIC	2202 E Oglethorpe Blvd	Albany	GA
CH04415F	Active	BPS-H80-007152	ALBANY AREA PRIMARY HEALTH CARE, INC	Rural HIV Model Thomasville	14540 US HWY 19 S STE 1	THOMASVILLE	GA
CH04415G	Terminated	BPS-H80-000322	ALBANY AREA PRIMARY HEALTH CARE, INC	DAWSON MEDICAL CENTER	420 Johnson St SE	Dawson	GA
CH04415H	Active	BPS-H80-001862	ALBANY AREA PRIMARY HEALTH CARE, INC	East Albany Family Medical Center	1712 E. BROAD AVE STE C	ALBANY	GA
CH04415J	Active	BPS-H80-000722	ALBANY AREA PRIMARY HEALTH CARE, INC	SOUTH ALBANY MEDICAL CENTER	1300 Newton Rd	Albany	GA
CH04415K	Active	BPS-H80-008438	ALBANY AREA PRIMARY HEALTH CARE, INC	West Albany Dental Center	1412 W. Oakridge Drive	Albany	GA
CH04415L	Active	BPS-H80-007932	ALBANY AREA PRIMARY HEALTH CARE, INC	Hotz Scoggins Family Medical Center	401 S Madison St	Albany	GA
CH04415M	Active	BPS-H80-009597	ALBANY AREA PRIMARY HEALTH CARE, INC	S. Trussell Medical Center	1212 E Union St	Vienna	GA
CH04415N	Active	BPS-H80-012112	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Glover Dental Center	2607 Gillionville Rd	Albany	GA
CH04415P	Active	BPS-H80-017035	ALBANY AREA PRIMARY HEALTH CARE, INC	Alice Coachman Elementary School-Based Health Center	1425 W. Oakridge Drive	Albany	GA
CH04415Q	Active	BPS-H80-016962	ALBANY AREA PRIMARY HEALTH CARE, INC	Albany Middle School-Based Health Center	1700 Cordell Avenue	Albany	GA
CH04415R	Terminated	BPS-H80-006513	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Behavioral Wellness Center	1712 E Broad Ave, Ste B	Albany	GA
CH04415S	Active	BPS-H80-017585	ALBANY AREA PRIMARY HEALTH CARE, INC	Terrell County School-Based Health Center	455 Greenwave Blvd	Dawson	GA
CH04415T	Active	BPS-H80-017586	ALBANY AREA PRIMARY HEALTH CARE, INC	Mirian Worthy Women's Health Center	2100 Palmyra Road	Albany	GA
CH04415U	Terminated	BPS-H80-017583	ALBANY AREA PRIMARY HEALTH CARE, INC	Crisp County School-Based Health Center	330 Old Hatley Road	Cordele	GA
CH04415V	Active	BPS-H80-017584	ALBANY AREA PRIMARY HEALTH CARE, INC	Dooly County School-Based Health Center	11949 US Hwy 41	Pinehurst	GA
CH04415W	Active	BPS-H80-021638	ALBANY AREA PRIMARY HEALTH CARE, INC	Live Oak Elementary School-Based Health Center	4529 Gillionville Road	Albany	GA
CH04415X	Active	BPS-H80-021636	ALBANY AREA PRIMARY HEALTH CARE, INC	Robert Harvey Elementary School-Based Health Center	1305 E. Second Avenue	Albany	GA
CH04415Y	Active	BPS-H80-012963	ALBANY AREA PRIMARY HEALTH CARE, INC	Rural HIV Clinic Annex	2200 E Oglethorpe Blvd	Albany	GA
CH04415Z	Active	BPS-H80-024750	ALBANY AREA PRIMARY HEALTH CARE, INC	AAPHC Renaissance Center	2403 Osler Court STE B	Albany	GA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH044150	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2022
CH044150	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2022
CH044150	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2024
CH044150	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2021
CH044150	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2021
CH044150	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2021
CH044150	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2021
CH044150	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2021
CH044150	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2021
CH044150	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2021
CH044150	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2021
CH044150	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2021
CH044150	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2021
CH044150	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	01/01/2017	08/01/2017
CH044150	COORDINATED CARE NETWORK	COORDINATED CARE NETWORK	300 PENN CENTER BLVD STE 405	PITTSBURGH	PA	15235-5511	07/01/2024
CH044150	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2022
CH044150	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2022
CH044150	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2021
CH044150	ECKERD CORPORATION	RITE AID #11857	2400 DAWSON ROAD	ALBANY	GA	31707	01/01/2014	03/23/2018
CH044150	ECKERD CORPORATION	RITE AID #11856	2400 SYLVESTER ROAD	ALBANY	GA	31705	01/01/2014	03/23/2018
CH044150	ECKERD CORPORATION	RITE AID #11855	2425 NORTH SLAPPEY BLVD.	ALBANY	GA	31701	01/01/2014	03/23/2018
CH044150	ECKERD CORPORATION	RITE AID #11854	300 SOUTH SLAPPEY BLVD.	ALBANY	GA	31701	01/01/2014	03/23/2018
CH044150	EDISON PHARMACY LLC	D/B/A LANE DRUG CO	19427 HARTFORD ST	EDISON	GA	39846	04/01/2020
CH044150	FRED'S PHARMACY #2524	2601 SOUTH MAIN STREET		MOULTRIE	GA	31768	04/01/2017	11/26/2018
CH044150	FRED'S PHARMACY #2544	118 ROBERT B LEE DR		LEESBURG	GA	31763-2600	04/01/2017	03/01/2019
CH044150	FRED'S PHARMACY 1026	1001 N. SLAPPEY BLVD		ALBANY	GA	31701	04/01/2017	11/14/2018
CH044150	GENOA HEALTHCARE LLC	601 W 11TH AVE		ALBANY	GA	31701	01/01/2025
CH044150	GENOA HEALTHCARE LLC	4451 PAULSEN ST STE 100		SAVANNAH	GA	31405	01/01/2025
CH044150	GENOA HEALTHCARE LLC	1650 COUNTY SERVICES PARKWAY, SUITE 300,		MARIETTA	GA	30008	01/01/2025
CH044150	GENOA HEALTHCARE LLC	252 WOODLANDS BLVD STE P		THOMASVILLE	GA	31792	01/01/2025
CH044150	GENOA HEALTHCARE LLC	445 WINN WAY STE 220		DECATUR	GA	30030	01/01/2025
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2593	1193 US HIGHWAY 19 SOUTH	LEESBURG	GA	31763	04/01/2017
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04560	1509 RADIUM SPRINGS	ALBANY	GA	31705	04/01/2017	05/01/2023
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04569	609 N. WESTOVER BLVD.	ALBANY	GA	31707	04/01/2017
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04267	214 EAST 16TH AVE.	CORDELE	GA	31015	01/01/2021
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05618	11685 COLUMBIA ST.,	BLAKELY	GA	39823	01/01/2021
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04672	1036 E. FORSYTH ST.	AMERICUS	GA	31709	01/01/2021
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04203	1027 S. MAIN ST.	MOULTRIE	GA	31768	01/01/2022
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04535	817 EAST SHOTWELL ST	BAINBRIDGE	GA	39819	01/01/2022
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04577	800 BLAKELY ST.	CUTHBERT	GA	39840	01/01/2022	08/01/2024
CH044150	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05606	104 W. FRANKLIN ST.	SYLVESTER	GA	31791	07/01/2022
CH044150	HALORX, LLC	DBA MEDI-SAVE PHARMACY	800 S SLAPPEY BLVD	ALBANY	GA	31701	07/01/2019
CH044150	MEDI-SAVE PHARMACY	800 SOUTH SLAPPEY DRIVE		ALBANY	GA	31701	01/01/2017	02/01/2019
CH04415J	MEDI-SAVE PHARMACY	800 SOUTH SLAPPEY DRIVE		ALBANY	GA	31701	06/16/2011	04/11/2017
CH044150	MOSELEY DRUG CO	412 JOHNSON ST SE	PO BOX 5	DAWSON	GA	39842	01/01/2017	04/01/2019
CH04415G	MOSELEY DRUG CO	412 JOHNSON ST SE	PO BOX 5	DAWSON	GA	39842	08/27/2010	04/11/2017
CH044150	MOSELEY DRUG CO	412 JOHNSON ST SE	PO BOX 5	DAWSON	GA	39842	01/01/2024
CH044150	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	01/01/2025
CH044150	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/01/2025
CH044150	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CH044150	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	01/01/2025
CH044150	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2025
CH044150	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2021
CH044150	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/01/2021
CH044150	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2021
CH044150	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2021
CH044150	PUBLIX PHARMACY #0450	2715 DAWSON ROAD		ALBANY	GA	31707	07/01/2022
CH044150	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1349	1212 US HIGHWAY 19 SOUTH	LEESBURG	GA	31763	07/01/2022
CH044150	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	04/01/2023
CH044150	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	04/01/2023
CH044150	RITE AID OF GEORGIA, INC.	RITE AID #1631	74 NORTH SCOTT STREET	CAMILLA	GA	31730	01/01/2014	03/23/2018
CH04415J	U Save It	400 NORTH JEFFERSON STREET		ALBANY	GA	31701	08/17/2010	04/11/2017
CH044150	U SAVE IT PHARMACY NORTHWEST	2624 MEREDYTH DR		ALBANY	GA	31707	01/01/2017
CH04415J	U SAVE IT PHARMACY NORTHWEST	2624 MEREDYTH DR		ALBANY	GA	31707	08/17/2010	04/11/2017
CH044150	U SAVE IT PHARMACY SOUTH ALBANY	1310 NEWTON RD		ALBANY	GA	31701-3480	01/01/2017
CH04415J	U SAVE IT PHARMACY SOUTH ALBANY	1310 NEWTON RD		ALBANY	GA	31701-3480	08/17/2010	04/11/2017
CH04415C	U-SAVE IT PHARMACY-LEESBURG	100 TABATHA ST		LEESBURG	GA	31763	08/17/2010	04/11/2017
CH044150	U-SAVE IT PHARMACY-LEESBURG	100 TABATHA ST		LEESBURG	GA	31763	01/01/2017
CH044150	U-SAVE-IT PHARMACY	405 4TH AVE EAST		CORDELE	GA	31015	01/01/2017
CH04415B	U-SAVE-IT PHARMACY	405 4TH AVE EAST		CORDELE	GA	31015	08/17/2010	04/11/2017
CH044150	U-SAVE-IT PHARMACY #3	1315 DAWSON ROAD	P.O. BOX 72148	ALBANY	GA	31708	01/01/2017
CH04415B	U-SAVE-IT PHARMACY #3	1315 DAWSON ROAD	P.O. BOX 72148	ALBANY	GA	31708	08/17/2010	04/11/2017
CH044150	U-SAVE-IT PHARMACY, INC. #1	400 N JEFFERSON ST		ALBANY	GA	31701	01/01/2017
CH04415C	U-SAVE-IT PHARMACY-PALMYRA	2112 PALMYRA RD		ALBANY	GA	31701	08/17/2010	04/11/2017
CH044150	U-SAVE-IT PHARMACY-PALMYRA	2112 PALMYRA RD		ALBANY	GA	31701	01/01/2017
CH044150	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2019
CH044150	WAL-MART PHARMACY #10-2801	108 S WESTOVER BLVD		ALBANY	GA	31707	01/01/2019
CH044150	WAL-MART PHARMACY #10-5797	262 CORDELE ROAD		ALBANY	GA	31705	04/01/2014
CH044150	WAL-MART PHARMACY #10-7245	1102 E. FRANKLIN		SYLVESTER	GA	31791	07/01/2022
CH044150	WAL-MART PHARMACY 10-0588	2825 LEDO ROAD		ALBANY	GA	31707	04/01/2014
CH044150	WAL-MART PHARMACY 10-0758	1711 E LAMAR ST STE F		AMERICUS	GA	31709	01/01/2019
CH044150	WAL-MART PHARMACY 10-0843	165 US HWY 19 N		CAMILLA	GA	31730-1412	04/01/2014
CH044150	WAL-MART PHARMACY 10-0952	641 VETERANS PARKWAY		MOULTRIE	GA	31788	04/01/2025
CH044150	WAL-MART PHARMACY 10-1006	1215 EAST 16TH AVENUE		CORDELE	GA	31015	01/01/2019
CH044150	WAL-MART PHARMACY 10-5422	500 EAST ALICE STREET		BAINBRIDGE	GA	39819	04/01/2025
CH044150	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2019
CH044150	WALGREEN CO	DBA: WALGREENS #10796	2414 SYLVESTER RD	ALBANY	GA	31705	02/14/2012
CH044150	WALGREEN CO	DBA: WALGREENS #10797	300 N. SLAPPEY BLVD	ALBANY	GA	31701-1406	02/14/2012	02/20/2025
CH044150	WALGREEN CO	DBA: WALGREENS #10969	106 E FRANKLIN ST	SYLVESTER	GA	31791-2104	02/14/2012	04/11/2017
CH044150	WALGREEN CO	DBA: WALGREENS #11106	733 E FORSYTH ST	AMERICUS	GA	31709-3718	01/01/2015
CH0441501	WALGREEN CO	DBA: WALGREENS #11106	733 E FORSYTH ST	AMERICUS	GA	31709-3718	05/04/2012	10/01/2021
CH044150	WALGREEN CO.	DBA: WALGREENS #12553	266 E BROAD ST	CAMILLA	GA	31730	09/20/2011	02/20/2025
CH044150	WALGREEN CO.	DBA: WALGREENS # 06201	2351 DAWSON RD	ALBANY	GA	31707-2435	02/14/2012
CH044150	WALGREEN CO.	DBA WALGREENS #15913	2200A E. OGLETHORPE BLVD.	ALBANY	GA	31705	04/01/2014	11/11/2021
CH044150	WALGREEN CO.	DBA: WALGREENS # 09849	1024 E 16TH AVE	CORDELE	GA	31015-1595	01/01/2015
CH0441501	WALGREEN CO.	DBA: WALGREENS # 09849	1024 E 16TH AVE	CORDELE	GA	31015-1595	05/04/2012	10/01/2021
CH044150	WALGREEN CO.	RITE AID #11857	2400 DAWSON RD	ALBANY	GA	31707	04/06/2018	08/29/2018
CH044150	WALGREEN CO.	RITE AID #11856	2400 SYLVESTER RD	ALBANY	GA	31705	04/06/2018	08/15/2018
CH044150	WALGREEN CO.	WALGREENS #17983	2425 N SLAPPEY BLVD	ALBANY	GA	31701	04/06/2018	04/10/2024
CH044150	WALGREEN CO.	RITE AID #11854	300 S SLAPPEY BLVD	ALBANY	GA	31701	04/06/2018	08/20/2018
CH044150	WALGREEN CO.	RITE AID #01631	74 N SCOTT ST	CAMILLA	GA	31730	04/06/2018	08/22/2018
CH044150	WALGREEN CO.	COMMUNITY A WALGREENS PHARMACY #15304	1874 PIEDMONT AVE NE STE 100A	ATLANTA	GA	30324	10/01/2024
CH044150	WALMART PHARMACY 10-4517	2586 N SLAPPEY BLVD		ALBANY	GA	31701	01/01/2019
CH044150	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2023
CH044150	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/14/2024 9:00:59 AM	2/18/2025 9:30:44 AM	2/18/2025 9:30 AM
Details	Last Recertification Date	Update	Recertification	2/17/2023 1:04:23 PM	2/14/2024 9:00:59 AM	2/14/2024 9:00 AM
Details	Last Recertification Date	Update	Recertification	2/18/2022 12:10:12 PM	2/17/2023 1:04:23 PM	2/17/2023 1:04 PM
Addresses	Billing Address	Insert	Recertification		ALBANY AREA PRIMARY HEALTH CARE, INC 204 N. WESTOVER BLVD ALBANY, GA 31707	2/18/2022 12:10 PM
Details	Last Recertification Date	Update	Recertification	2/19/2021 12:58:22 PM	2/18/2022 12:10:12 PM	2/18/2022 12:10 PM
Contacts	Primary Contact	Update	Change Request	Bush, Clifton Miquel Chief Operating Officer Albany Area Primary Health Care, Inc. 2298886559-6261	Rakel, Susan Director of 340B and Pharmacy Services Albany Area Primary Health Care, Inc 2298886559-6217	10/6/2021 2:27 PM
Contacts	Authorizing Official	Update	Change Request	Spires, Shelley Chief Executive Officer Albany Area Primary Health Care, Inc. 2298886559-6209	Bush, Clifton Miquel Chief Operating Officer Albany Area Primary Health Care, Inc. 2298886559-6261	10/6/2021 2:27 PM
Medicaid Billing	NPI: State	Update	Recertification		GA	2/19/2021 12:58 PM
Details	Last Recertification Date	Update	Recertification	1/30/2020 2:54:08 PM	2/19/2021 12:58:22 PM	2/19/2021 12:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	1/30/2020 2:54 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003175066A	1/30/2020 2:54 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	1/30/2020 2:54 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1164888491	1/30/2020 2:54 PM
Details	Last Recertification Date	Update	Recertification		1/30/2020 2:54:08 PM	1/30/2020 2:54 PM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Spires, Shelley Chief Executive Officer Albany Area Primary Health Care, Inc. 2298886559-6209	1/14/2019 2:16 PM
Details	340B ID	Update	New Registration		CH04415Z	1/14/2019 2:16 PM
Dates	Participating Approval Date	Update	New Registration		1/14/2019 2:16:56 PM	1/14/2019 2:16 PM
Details	State	Update	New Registration	Pending	Approved	1/14/2019 2:16 PM
Dates	Signed By Date	Update	New Registration		1/10/2019 3:28:54 PM	1/14/2019 2:16 PM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	1/14/2019 2:16 PM
Addresses	Main Address	Insert	New Registration		2403 Osler Court STE B Albany, GA 31707	1/10/2019 3:28 PM
Contacts	Authorizing Official	Insert	New Registration		Spires, Shelley Chief Executive Officer Albany Area Primary Health Care, Inc. 2298886559-6209	1/10/2019 3:28 PM
Contacts	Primary Contact	Insert	New Registration		Bush, Clifton Miquel Chief Operating Officer Albany Area Primary Health Care, Inc. 2298886559-6261	1/10/2019 3:28 PM
Details	Last Recertification Date	Insert	New Registration			1/10/2019 3:28 PM
Details	Grant Number	Insert	New Registration		H80CS00763	1/10/2019 3:28 PM
Details	340B ID	Insert	New Registration			1/10/2019 3:28 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2019 3:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2019 3:28 PM
Details	Medicare Provider Number	Insert	New Registration			1/10/2019 3:28 PM
Details	Entity Name	Insert	New Registration		ALBANY AREA PRIMARY HEALTH CARE, INC	1/10/2019 3:28 PM
Details	Program Code	Insert	New Registration		CH	1/10/2019 3:28 PM
Details	Entity Subname	Insert	New Registration		AAPHC Renaissance Center	1/10/2019 3:28 PM
Dates	Participating Approval Date	Insert	New Registration			1/10/2019 3:28 PM
Details	State	Insert	New Registration		Pending	1/10/2019 3:28 PM
Dates	Registration Date	Insert	New Registration		1/10/2019 3:28:52 PM	1/10/2019 3:28 PM
Dates	Signed By Date	Insert	New Registration			1/10/2019 3:28 PM
Dates	Start Date	Insert	New Registration			1/10/2019 3:28 PM
Terminations	Termination Comments	Insert	New Registration			1/10/2019 3:28 PM
Terminations	Termination Date	Insert	New Registration			1/10/2019 3:28 PM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2019 3:28 PM
Terminations	Termination Reason	Insert	New Registration			1/10/2019 3:28 PM

340B Drug Pricing Program Database