Covered Entity Details

CH10257T COMMUNITY HEALTH ASSOCIATION OF SPOKANE (Active) - information as of 4/29/2025 11:59:19 PM

Main Details

Name

COMMUNITY HEALTH ASSOCIATION OF SPOKANE

Subdivision Name

Southgate Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-024991

340B ID

CH10257T

Grant Number

H80CS00319

Additional Details

Current Program Status

Active

Registration Date

1/26/2019

Participating Start Date

4/1/2019

Participating Approval Date

1/30/2019

Last Recertification Date

2/14/2025

Contacts

Authorizing Official

CHAS Health
John Michael Browne, CFO
(509) 444-8888

Primary Contact

CHAS
Blair Rossow, VP of Pharmacy Operations
(509) 444-8888 Ext: 40436

Addresses

Street Address

5620 S Regal St Ste 11
Spokane, WA 99223

Billing Address

Community Health Association of Spokane
611 N Iron Bridge Way
Spokane, WA 99202

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
WA		1043782626,1134130784,1669485348,1912949215,1548472335,1437401148,1134512874,1477856144,1326461765,1184024960,1750786356,1306393616,1184125346,1619446002,1962162669,1760243091
ID		1134130784,1669485348,1912949215,1548472335,1437401148,1134512874,1477856144,1326461765,1184024960,1750786356,1306393616,1184125346,1619446002,1043782626,1962162669,1760243091

Shipping Addresses

Shipping Address 1

CHAS Southgate Pharmacy
5620 S Regal St Ste 11
Spokane, WA 99223

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
CH10257AA	Active	BPS-H80-034941	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS Health at Shiloh Hills Elementary	505 E Stonewall Ave	Spokane	WA
CH10257AB	Active	BPS-H80-030673	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS Health Admin Iron Bridge	611 N Iron Bridge Way	Spokane	WA
CH10257AC	Active	BPS-H80-039023	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS WA Mobile - 2	5901 N Lidgerwood St	Spokane	WA
CH10257AD	Active	BPS-H80-033727	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS Health Parkside Clinic	3002 E Mission Ave	Spokane	WA
CH10257AE	Active	BPS-H80-039518	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Spokane Pediatrics, a CHAS Health Clinic	601 W 5th Avenue STE 200	Spokane	WA
CH10257AF	Active	BPS-H80-038839	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS Health at Shadle Park High School	4327 N Ash Street RM B115	Spokane	WA
CH10257AG	Active	BPS-H80-038840	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS Health at North Central High	1600 N Howard St	Spokane	WA
CH10257AH	Approved	BPS-H80-039905	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Iron Bridge IV	731 N Iron Bridge Way	Spokane	WA
CH10257AJ	Approved	BPS-H80-039883	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	East Mission Dental	1502 N Vercler Rd STE 200	Spokane Valley	WA
CH10257B	Active	BPS-H80-015163	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Valley Clinic	15812 E Indiana Ave	Spokane Valley	WA
CH10257E	Active	BPS-H80-005567	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Denny Murphy Clinic	1001 W 2nd Ave	Spokane	WA
CH10257F	Active	BPS-H80-000673	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Maple Street Clinic	3919 N Maple St	Spokane	WA
CH10257G	Active	BPS-H80-003016	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	North County Clinic	401 S. MAIN ST	DEER PARK	WA
CH10257H	Active	BPS-H80-010056	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Market Street Clinic	5921 N Market St	Spokane	WA
CH10257J	Active	BPS-H80-027775	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Lewis & Clark Health Center	1203 Idaho St	Lewiston	ID
CH10257K	Terminated	BPS-H80-011475	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Sunset Elementary Health Center	12824 W 12th Ave	Airway Heights	WA
CH10257L	Active	BPS-H80-010451	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Spokane Urgent Care-North	5901 N. Lidgerwood St. STE 126	Spokane	WA
CH10257M	Active	BPS-H80-009938	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Lewis and Clark Dental Clinic	844 6th St	Clarkston	WA
CH10257N	Active	BPS-H80-018758	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Latah Community Health	803 S Main St Ste 120	Moscow	ID
CH10257P	Active	BPS-H80-014535	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Perry Street Clinic	817 S. Perry St, Unit B	Spokane	WA
CH10257Q	Active	BPS-H80-015534	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Cheney Health Center	1720 2ND ST	CHENEY	WA
CH10257R	Active	BPS-H80-016809	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Spokane Urgent Care-Valley	1502 N Vercler Rd	Spokane Valley	WA
CH10257S	Active	BPS-H80-024973	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	North Central Clinic	914 W Carlisle Ave	Spokane	WA
CH10257T	Active	BPS-H80-024991	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	Southgate Clinic	5620 S Regal St Ste 11	Spokane	WA
CH10257U	Active	BPS-H80-027776	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS Health Family Dental	203 E Dalke Ave	Spokane	WA
CH10257V	Active	BPS-H80-029704	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS Health at Rogers High School	1622 E Wellesley Ave Rm 107	Spokane	WA
CH10257W	Active	BPS-H80-029774	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	East Central Dental	2211 E Hartson Ave	Spokane	WA
CH10257X	Active	BPS-H80-032602	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS Behavioral Health Center	5901 N Lidgerwood St Ste 223	Spokane	WA
CH10257Y	Active	BPS-H80-031587	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS North Idaho Mobile Medical	2337 3rd Ave N	Lewiston	ID
CH10257Z	Active	BPS-H80-039010	COMMUNITY HEALTH ASSOCIATION OF SPOKANE	CHAS WA Mobile 1	5901 N Lidgerwood St	Spokane	WA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH10257B	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2020	01/22/2022
CH10257B	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2020	01/22/2022
CH10257B	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2024
CH10257B	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2024
CH10257B	ACCREDO HEALTH GROUP INC	22623 68TH AVE S		KENT	WA	98032-1981	07/01/2024
CH10257B	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2024
CH10257B	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2020	01/22/2022
CH10257B	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2024
CH10257B	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2024
CH10257B	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2024
CH10257B	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2025
CH10257B	ALBERTSON'S LLC	SAFEWAY PHARMACY #1268	3010 E 57TH AVENUE	SPOKANE	WA	99223	07/01/2020
CH10257B	ALBERTSON'S LLC	SAFEWAY PHARMACY #246	8851 E TRENT AVE	SPOKANE VALLEY	WA	99212	07/01/2020
CH10257B	ALBERTSON'S LLC	SAFEWAY PHARMACY #265	6520 N NEVADA ST	SPOKANE	WA	99208	07/01/2020
CH10257B	ALBERTSON'S LLC	SAV-ON PHARMACY #241	400 BRIDGE ST.	CLARKSTON	WA	99403	07/01/2020
CH10257B	ALBERTSON'S LLC	SAFEWAY PHARMACY #2248	1304 N. LIBERTY LAKE RD.	LIBERTY LAKE	WA	99019	07/01/2020
CH10257B	ALBERTSON'S LLC	SAFEWAY PHARMACY #258	13606 E 32ND AVE	SPOKANE	WA	99216	07/01/2020
CH10257B	ALBERTSONS LLC	SAV-ON PHARMACY #238	1024 21ST ST	LEWISTON	ID	83501	07/01/2020
CH10257B	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2025
CH10257B	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2025
CH10257B	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2025
CH10257B	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2025
CH10257B	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2025
CH10257B	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
CH10257B	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2025
CH10257B	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2025
CH10257B	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2025
CH10257B	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2025
CH10257B	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2025
CH10257B	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2020	01/22/2022
CH10257B	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2024
CH10257B	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2024
CH10257B	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2024
CH10257B	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2024
CH10257B	FRED MEYER STORES	400 SOUTH THOR ST		SPOKANE	WA	99202-5075	10/01/2016
CH10257B	FRED MEYER STORES	FRED MEYER PHARMACY 214	12120 N DIVISION STREET	SPOKANE	WA	99218	10/01/2016
CH10257B	FRED MEYER STORES, INC	FRED MEYER PHARMACY 351	15609 EAST SPRAGUE AVE	SPOKANE VALLEY	WA	99037	10/01/2016
CH10257B	GENOA HEALTHCARE LLC	6 E 1ST AVE		SPOKANE	WA	99202	07/01/2024
CH10257B	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	10/01/2016
CH10257B	MARKETIME DRUGS OF MOSCOW INC	872 TROY RD STE 120		MOSCOW	ID	83843-5037	01/01/2020	08/31/2023
CH10257B	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	07/01/2024
CH10257B	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	07/01/2024
CH10257B	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2024
CH10257B	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2024
CH10257B	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2025
CH10257B	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2025
CH10257B	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2025
CH10257B	REIDT PHARMACY CORPORATION	DBA HART AND DILATUSH PHARMACY	601 W RIVERSIDE AVE STE 140	SPOKANE	WA	99201-0622	01/01/2017	06/21/2018
CH10257B	SAFEWAY INC	SAFEWAY PHARMACY #1799	3919 N MARKET ST	SPOKANE	WA	99207-5813	07/01/2020
CH10257B	SAFEWAY INC	SAFEWAY PHARMACY #1740	2710 1ST STREET	CHENEY	WA	99004	07/01/2020
CH10257B	SAFEWAY INC	SAFEWAY PHARMACY #0342	1616 W NORTHWEST BLVD	SPOKANE	WA	99205	07/01/2020
CH10257B	SAFEWAY INC	SAFEWAY PHARMACY #1473	14020 E SPRAGUE AVE	SPOKANE VALLEY	WA	99216	07/01/2020
CH10257B	SAFEWAY INC	SAFEWAY PHARMACY #3255	933 E MISSION AVE	SPOKANE	WA	99202	07/01/2020
CH10257B	SAFEWAY INC	SAFEWAY PHARMACY #1159	121 W. WALNUT ST	NEWPORT	WA	99156	07/01/2020
CH10257B	SHOPKO PHARMACY #2066	NORTH 9520 NEWPORT HWY		SPOKANE	WA	99218	01/01/2017	02/18/2019
CH10257B	SHOPKO PHARMACY #2070	EAST 13414 SPRAGUE AVENUE		SPOKANE	WA	99216	01/01/2017	02/18/2019
CH10257B	SIXTH AVENUE LTC PHARMACY	508 W 6TH AVE	STE 100	SPOKANE	WA	99204	01/01/2025
CH10257B	SIXTH AVENUE MEDICAL PHARMACY	508 W 6TH AVE, STE 104		SPOKANE	WA	99204	10/01/2018
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5302	112 NORTH HOWARD ST SUITE 115	SPOKANE	WA	99201	10/01/2016	06/16/2019
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5304	2215A WEST WELLESLEY AVENUE	SPOKANE	WA	99205	10/01/2016	06/16/2019
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5305	12222 EAST SPRAGUE AVENUE	SPOKANE VALLEY	WA	99206	10/01/2016	06/16/2019
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5307	5840 NORTH DIVISION STREET	SPOKANE	WA	99208	10/01/2016	06/16/2019
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5308	9120 NORTH DIVISION STREET	SPOKANE	WA	99218	10/01/2016	06/16/2019
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5309	1443 NORTH ARGONNE ROAD	SPOKANE VALLEY	WA	99212	10/01/2016	06/16/2019
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5312	2929 EAST 29TH AVENUE	SPOKANE	WA	99223	10/01/2016	06/16/2019
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5408	1904 19TH AVENUE	LEWISTON	ID	83501	07/01/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5311	12420 NORTH DIVISION STREET	SPOKANE	WA	99218	07/01/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5308	9120 NORTH DIVISION STREET	SPOKANE	WA	99218	07/01/2020	01/24/2024
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5421	1810 WEST PULLMAN ROAD	MOSCOW	ID	83843	07/01/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5553	10823 ZELZAH AVENUE BLDG D	GRANADA HILLS	CA	91344	07/01/2020	04/27/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5312	2929 EAST 29TH AVENUE	SPOKANE	WA	99223	07/01/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5305	12222 EAST SPRAGUE AVENUE	SPOKANE VALLEY	WA	99206	07/01/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5302	112 NORTH HOWARD ST SUITE 115	SPOKANE	WA	99201	07/01/2020	12/06/2023
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5307	5840 NORTH DIVISION STREET	SPOKANE	WA	99208	07/01/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5304	2215A WEST WELLESLEY AVENUE	SPOKANE	WA	99205	07/01/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #5309	1443 NORTH ARGONNE ROAD	SPOKANE VALLEY	WA	99212	07/01/2020
CH10257B	THRIFTY PAYLESS, INC.	RITE AID #6553	9007 N INDIAN TRAIL ROAD	SPOKANE	WA	99208	07/01/2020
CH10257B	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017
CH10257B	WAL-MART PHARMACY 10-2006	306 5TH STREET		CLARKSTON	WA	99403	10/01/2016
CH10257B	WAL-MART PHARMACY 10-2539	15727 EAST BROADWAY		SPOKANE VALLEY	WA	99037	10/01/2016
CH10257B	WAL-MART PHARMACY 10-2549	9212 NORTH COLTON STREET		SPOKANE (NORTH)	WA	99218	10/01/2016
CH10257B	WAL-MART PHARMACY 10-2865	2301 WEST WELLESLEY AVENUE		SPOKANE (W)	WA	99205	10/01/2016
CH10257B	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2017
CH10257B	WAL-MART PHARMACY 10-5869	2470 W. PULLMAN RD		MOSCOW	ID	83843-4034	10/01/2016
CH10257B	WAL-MART PHARMACY 10-5883	5025 E SPRAGUE AVE		SPOKANE VALLEY	WA	99212	10/01/2016
CH10257B	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017
CH10257B	WAL-MART.PHARMACY 10-4394	1221 S. HAYFORD RD.		SPOKANE	WA	99224	10/01/2016
CH10257B	WALGREEN CO.	DBA: WALGREENS # 01993	12312 E SPRAGUE AVE	SPOKANE VALLEY	WA	99216-0720	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS # 02205	12315 N DIVISION ST	SPOKANE	WA	99218	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS # 02679	2102 NEZ PERCE DR	LEWISTON	ID	83501	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS # 05817	1708 W NORTHWEST BLVD	SPOKANE	WA	99205	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS # 05818	2105 E WELLESLEY AVE	SPOKANE	WA	99207	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS # 05913	7905 N DIVISION ST	SPOKANE	WA	99208	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS # 05914	15510 E SPRAGUE	SPOKANE VALLEY	WA	99037	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS # 07034	12 E EMPIRE AVE	SPOKANE	WA	99207-1706	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS #07846	2702 N. ARGONNE RD.	MILLWOOD	WA	99212	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS #10788	1502 N. LIBERTY LAKE RD.	LIBERTY LAKE	WA	99019-8631	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS #10946	2830 S. GRAND BLVD.	SPOKANE	WA	99203	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS #12503	414 N MAIN ST	MOSCOW	ID	83843-2631	10/01/2015
CH10257B	WALGREEN CO.	DBA: WALGREENS #15643	910 W. FIFTH AVENUE SUITE 270	SPOKANE	WA	99204	10/01/2015	09/29/2022
CH10257B	WALGREEN CO.	DBA: WALGREENS #16025	425 BRIDGE ST	CLARKSTON	WA	99403-1930	07/01/2018
CH10257B	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #21243	327 W 3RD AVE STE A	SPOKANE	WA	99201	07/01/2019
CH10257B	WALGREEN CO.	DBA: WALGREENS # 06863	335 W APPLEWAY AVE	COEUR D ALENE	ID	83814	07/01/2019
CH10257B	WALGREEN CO.	DBA: WALGREENS # 07949	706 E SELTICE WAY	POST FALLS	ID	83854	07/01/2020
CH10257B	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2021
CH10257B	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2021	10/01/2021
CH10257B	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2021
CH10257B	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH10257B	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH10257B	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17669	4915 S REGAL ST	SPOKANE	WA	99223	10/01/2019
CH10257B	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16172	9770 N NEWPORT HWY	SPOKANE	WA	99218	10/01/2019
CH10257B	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	01/01/2017	07/04/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 4:50:57 PM	2/14/2025 12:26:14 PM	2/14/2025 12:26 PM
Contacts	Authorizing Official	Update	AO Change Request	Wilson, Aaron CEO Community Health Association of Spokane 5094448888	Browne, John Michael CFO CHAS Health 5094448888	12/19/2024 2:14 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1760243091	2/29/2024 12:35 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	2/29/2024 12:35 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1760243091	2/29/2024 12:35 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	2/29/2024 12:35 PM
Details	Last Recertification Date	Update	Recertification	2/1/2023 9:06:42 AM	1/30/2024 4:50:57 PM	1/30/2024 4:50 PM
Addresses	Main Address	Update	Change Request	5620 S Regal St Ste 11 Spokane, WA 99223	5620 S Regal St Ste 11 Spokane, WA 99223	12/7/2023 3:11 PM
Addresses	Shipping Address	Update	Change Request	CHAS Southgate Pharmacy 5620 S Regal St STE 11 Spokane, WA 99223	CHAS Southgate Pharmacy 5620 S Regal St Ste 11 Spokane, WA 99223	12/7/2023 3:11 PM
Details	Last Recertification Date	Update	Recertification	2/7/2022 5:50:41 PM	2/1/2023 9:06:42 AM	2/1/2023 9:06 AM
Contacts	Primary Contact	Update	Group Change Request	Glass, Ryley 340B Program Director Community Health Association of Spokane 5094448888-54216	Rossow, Blair VP of Pharmacy Operations CHAS 5094448888-40436	11/21/2022 4:00 PM
Contacts	Primary Contact	Update	Profile Change Request	Glass, Ryley 340B Program Manager Community Health Association of Spokane 5094448888-54216	Glass, Ryley 340B Program Director Community Health Association of Spokane 5094448888-54216	9/1/2022 11:51 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1962162669	6/15/2022 11:55 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		ID	6/15/2022 11:55 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1962162669	6/15/2022 11:55 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	6/15/2022 11:55 AM
Addresses	Shipping Address	Delete	Recertification	CHAS Southgate Pharmacy 5620 S Regal 11 Spokane, WA 99223		2/7/2022 5:50 PM
Addresses	Shipping Address	Insert	Recertification		CHAS Southgate Pharmacy 5620 S Regal St STE 11 Spokane, WA 99223	2/7/2022 5:50 PM
Details	Last Recertification Date	Update	Recertification	2/4/2021 1:59:44 PM	2/7/2022 5:50:41 PM	2/7/2022 5:50 PM
Contacts	Primary Contact	Update	Group Change Request	Rossow, Blair VP of Pharmacy Programs CHAS 5094448888	Glass, Ryley 340B Program Manager Community Health Association of Spokane 5094448888-54216	9/13/2021 7:41 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	2124174 (WA)		2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134130784	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669485348	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912949215	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1548472335	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437401148	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134512874	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1477856144	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326461765	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1184024960	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1750786356	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1306393616	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1184125346	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619446002	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134130784	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669485348	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1912949215	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1548472335	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1437401148	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134512874	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1477856144	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326461765	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1184024960	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1750786356	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1306393616	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1184125346	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619446002	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1043782626	2/4/2021 1:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	2/4/2021 1:59 PM
Details	Last Recertification Date	Update	Recertification	1/31/2020 8:09:47 AM	2/4/2021 1:59:44 PM	2/4/2021 1:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/25/2020 3:03 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2124174	8/25/2020 3:03 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	8/25/2020 3:03 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1407067317 ( )		8/25/2020 3:03 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1043782626	8/25/2020 3:03 PM
Medicaid Billing	NPI: State	Insert	Change Request		WA	8/25/2020 3:03 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1043782626 ( )		8/25/2020 3:03 PM
Addresses	Billing Address	Update	Change Request	Community Health Association of Spokane 203 N Washington 300 Spokane, WA 99201	Community Health Association of Spokane 611 N Iron Bridge Way Spokane, WA 99202	7/10/2020 6:02 PM
Contacts	Primary Contact	Update	Recertification	Halvorson, Nathan CCO Community Health Association of Spokane 5094448888	Rossow, Blair VP of Pharmacy Programs CHAS 5094448888	1/31/2020 8:09 AM
Details	Last Recertification Date	Update	Recertification		1/31/2020 8:09:47 AM	1/31/2020 8:09 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1407067317	7/23/2019 7:40 PM
Addresses	Shipping Address	Insert	Change Request		CHAS Southgate Pharmacy 5620 S Regal 11 Spokane, WA 99223	4/15/2019 8:42 AM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Addresses	Main Address	Update	OPA Edit	5620 S Regal St 11 Spokane, WA 99223	5620 S Regal St STE 11 Spokane, WA 99223	2/21/2019 12:50 PM
Addresses	Main Address	Update	Change Request	260 North Little Tor Road Spokane, WA 99223	5620 S Regal St 11 Spokane, WA 99223	2/21/2019 12:49 PM
Contacts	Signed By	Insert	New Registration		Wilson, Aaron CEO Community Health Association of Spokane 5094448888	1/30/2019 12:04 PM
Details	340B ID	Update	New Registration		CH10257T	1/30/2019 12:04 PM
Dates	Participating Approval Date	Update	New Registration		1/30/2019 12:04:24 PM	1/30/2019 12:04 PM
Details	State	Update	New Registration	Pending	Approved	1/30/2019 12:04 PM
Dates	Signed By Date	Update	New Registration		1/26/2019 7:44:24 PM	1/30/2019 12:04 PM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	1/30/2019 12:04 PM
Addresses	Main Address	Insert	New Registration		260 North Little Tor Road Spokane, WA 99223	1/26/2019 7:44 PM
Addresses	Billing Address	Insert	New Registration		Community Health Association of Spokane 203 N Washington 300 Spokane, WA 99201	1/26/2019 7:44 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1043782626	1/26/2019 7:44 PM
Contacts	Authorizing Official	Insert	New Registration		Wilson, Aaron CEO Community Health Association of Spokane 5094448888	1/26/2019 7:44 PM
Contacts	Primary Contact	Insert	New Registration		Halvorson, Nathan CCO Community Health Association of Spokane 5094448888	1/26/2019 7:44 PM
Details	Last Recertification Date	Insert	New Registration			1/26/2019 7:44 PM
Details	Grant Number	Insert	New Registration		H80CS00319	1/26/2019 7:44 PM
Details	340B ID	Insert	New Registration			1/26/2019 7:44 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/26/2019 7:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/26/2019 7:44 PM
Details	Medicare Provider Number	Insert	New Registration			1/26/2019 7:44 PM
Details	Entity Name	Insert	New Registration		COMMUNITY HEALTH ASSOCIATION OF SPOKANE	1/26/2019 7:44 PM
Details	Program Code	Insert	New Registration		CH	1/26/2019 7:44 PM
Details	Entity Subname	Insert	New Registration		Southgate Clinic	1/26/2019 7:44 PM
Dates	Participating Approval Date	Insert	New Registration			1/26/2019 7:44 PM
Details	State	Insert	New Registration		Pending	1/26/2019 7:44 PM
Dates	Registration Date	Insert	New Registration		1/26/2019 7:44:22 PM	1/26/2019 7:44 PM
Dates	Signed By Date	Insert	New Registration			1/26/2019 7:44 PM
Dates	Start Date	Insert	New Registration			1/26/2019 7:44 PM
Terminations	Termination Comments	Insert	New Registration			1/26/2019 7:44 PM
Terminations	Termination Date	Insert	New Registration			1/26/2019 7:44 PM
Terminations	Termination Effective Date	Insert	New Registration			1/26/2019 7:44 PM
Terminations	Termination Reason	Insert	New Registration			1/26/2019 7:44 PM

340B Drug Pricing Program Database