Covered Entity Details

CH01080L Family Health Center of Worcester, Inc. (Active) - information as of 5/3/2025 11:29:01 PM

Main Details

Name

Family Health Center of Worcester, Inc.

Subdivision Name

Worcester East Middle School - School Based Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-021900

340B ID

CH01080L

Grant Number

H80CS00452

Additional Details

Current Program Status

Active

Registration Date

2/26/2019

Participating Start Date

4/1/2019

Participating Approval Date

3/1/2019

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Family Health Center of Worcester
Louis Arthur Brady, CEO
(617) 519-3117

Primary Contact

Family Health Center of Worcester
Muhammad Xhemali, Pharmacy Manager
(508) 340-2244

Addresses

Street Address

420 Grafton Street
Worcester, MA 01604-3802

Billing Address

Family Health Center of Worcester Inc.
26 Queen St
Worcester, MA 01610

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	110020639B	1841200664

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
Contract Detail	CVS PHARMACY, INC.	CVS PHARMACY # 16687	529 LINCOLN ST	WORCESTER	MA	01605	04/03/2024	07/01/2024			07/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH010800	Active	BPS-H80-003362	FAMILY HEALTH CENTER OF WORCESTER, INC.	FAMILY HEALTH CENTER OF WORCESTER, INC.	26 Queen St	Worcester	MA
CH01080A	Active	BPS-H80-006834	FAMILY HEALTH CENTER OF WORCESTER, INC.	Goddard Health Center	14 RICHARDS ST	WORCESTER	MA
CH01080B	Terminated	BPS-H80-007502	FAMILY HEALTH CENTER OF WORCESTER, INC.	Webster Middle School Health Center	75 Poland St.	Webster	MA
CH01080C	Active	BPS-H80-005779	FAMILY HEALTH CENTER OF WORCESTER, INC.	Academy Health Center	15 CLAREMONT ST	WORCESTER	MA
CH01080D	Active	BPS-H80-006796	FAMILY HEALTH CENTER OF WORCESTER, INC.	Sullivan Health Center	140 APRICOT ST	WORCESTER	MA
CH01080E	Active	BPS-H80-003083	FAMILY HEALTH CENTER OF WORCESTER, INC.	Helen A. Bowditch Health Center	23 N Ashland St	Worcester	MA
CH01080F	Active	BPS-H80-006636	FAMILY HEALTH CENTER OF WORCESTER, INC.	South High Health Center	170 APRICOT ST	WORCESTER	MA
CH01080G	Terminated	BPS-H80-015369	FAMILY HEALTH CENTER OF WORCESTER, INC.	Family Health Center - Southbridge Family Medicine	29 Orchard Street	Southbridge	MA
CH01080H	Active	BPS-H80-000042	FAMILY HEALTH CENTER OF WORCESTER, INC.	Doherty Memorial High School Health Center	299 Highland St	Worcester	MA
CH01080J	Terminated	BPS-H80-013694	FAMILY HEALTH CENTER OF WORCESTER, INC.	Family Health Center - Southbridge	32 ORCHARD ST	SOUTHBRIDGE	MA
CH01080K	Terminated	BPS-H80-000040	FAMILY HEALTH CENTER OF WORCESTER, INC.	Family Health Center of Worcester - Webster Square	645 Park Avenue	Worcester	MA
CH01080L	Active	BPS-H80-021900	Family Health Center of Worcester, Inc.	Worcester East Middle School - School Based Health Center	420 Grafton Street	Worcester	MA
CH01080M	Active	BPS-H80-035395	FAMILY HEALTH CENTER OF WORCESTER INC	Worcester Health Care for the Homeless	199 Chandler St FL 4	Worcester	MA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH010800	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2023
CH010800	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2023
CH010800	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2023
CH010800	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2023
CH010800	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2023
CH010800	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2023
CH010800	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2023
CH010800	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/01/2019
CH010800	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	10/01/2019
CH010800	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	07/01/2025
CH010800	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	10/01/2019
CH010800	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2024
CH010800	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/01/2024
CH010800	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	01/01/2024
CH010800	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/01/2022
CH010800	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2022
CH010800	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2022
CH010800	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2022
CH010800	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2022
CH010800	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2022
CH010800	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2022
CH01080D	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2024
CH010800	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2022
CH010800	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2022
CH010800	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2022
CH010800	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2022
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00008	197 BOSTON TURNPIKE RTE 9	SHREWSBURY	MA	01545	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00038	142 WORCESTER RD.	CHARLTON	MA	01507	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00127	110 FRONT ST., SUITE #102	WORCESTER	MA	01608	07/01/2020	10/31/2023
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00153	481 LINCOLN STREET	WORCESTER	MA	01605	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00166	115 STAFFORD ST.	WORCESTER	MA	01603	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00299	44 W. BOYLSTON ST.	WORCESTER	MA	01605	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00444	74 EAST MAIN STREET	WESTBOROUGH	MA	01581	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00498	112 E. MAIN ST.	WEBSTER	MA	01570	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00582	95 MAIN ST	SPENCER	MA	01562	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00657	400 PARK AVE.	WORCESTER	MA	01610	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00703	256 LINCOLN STREET	WORCESTER	MA	01605	07/01/2020	03/01/2023
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00704	24 WEST MAIN STREET	NORTHBOROUGH	MA	01532	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00705	264 W. BOYLSTON ST.	WEST BOYLSTON	MA	01583	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00707	500 GRAFTON STREET	WORCESTER	MA	01604	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00708	676 SOUTHBRIDGE STREET	AUBURN	MA	01501	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00765	399 MAIN STREET	SOUTHBRIDGE	MA	01550	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01035	638 CHANDLER STREET	WORCESTER	MA	01602	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01050	160 RESERVOIR ROAD	HOLDEN	MA	01520	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01273	50 SW CUTOFF	WORCESTER	MA	01604	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02161	302 MAIN STREET	OXFORD	MA	01540	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02171	63 CANAL STREET	MILLBURY	MA	01527	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02172	104 WORCESTER ST,	NORTH GRAFTON	MA	01536	07/01/2020
CH010800	CVS PHARMACY, INC.	CVS/PHARMACY # 10649	362 MAIN STREET	STURBRIDGE	MA	01566	07/01/2020
CH010800	CVS PHARMACY, INC.	CVS PHARMACY # 16687	529 LINCOLN ST	WORCESTER	MA	01605	07/01/2020
CH010800	CVS PHARMACY, INC.	CVS PHARMACY # 16827	330 TURNPIKE RD	WESTBOROUGH	MA	01581	07/01/2020
CH010800	CVS PHARMACY, INC.	CVS PHARMACY # 16956	70 WORCESTER PROVIDENCE TPKE #100	MILLBURY	MA	01527	07/01/2020
CH010800	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 8441	301 CENTRAL STREET	WINCHENDON	MA	01475	07/01/2022
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01198	9 NELSON STREET	LEOMINSTER	MA	01453	07/01/2022
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00920	792 MAIN ST.	CLINTON	MA	01510	07/01/2022
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01130	615-621 BELMONT AVENUE	SPRINGFIELD	MA	01108	07/01/2022
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01111	104 WEST ST.	WARE	MA	01082	07/01/2022
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00220	264 E MAIN ST	MARLBOROUGH	MA	01752-2669	10/01/2023
CH010800	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00505	161 MAIN STREET	FITCHBURG	MA	01420	10/01/2023
CH010800	CVS PHARMACY, INC.	CVS/PHARMACY #10596	720 BOSTON TURNPIKE	SHREWSBURY	MA	01545	10/01/2023
CH01080H	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00166	115 STAFFORD ST.	WORCESTER	MA	01603	07/01/2024
CH01080M	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00707	500 GRAFTON STREET	WORCESTER	MA	01604	07/01/2024
CH01080L	CVS PHARMACY, INC.	CVS PHARMACY # 16687	529 LINCOLN ST	WORCESTER	MA	01605	07/01/2024
CH01080E	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00657	400 PARK AVE.	WORCESTER	MA	01610	07/01/2024
CH01080F	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00153	481 LINCOLN STREET	WORCESTER	MA	01605	07/01/2024
CH010800	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2022
CH010800	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	01/01/2024
CH010800	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2023
CH010800	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2023
CH010800	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2023
CH010800	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2023
CH010800	GENOA HEALTHCARE LLC	12 QUEEN ST RM 129		WORCESTER	MA	01610	10/01/2023
CH010800	GENOA HEALTHCARE LLC	435 SHREWSBURY ST STE P		WORCESTER	MA	01604-1689	10/01/2023
CH010800	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	10/01/2019
CH010800	MEDCART SPECIALTY PHARMACY	32131 INDUSTRIAL RD.		LIVONIA	MI	48150	07/01/2022
CH010800	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	10/01/2019
CH010800	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2022
CH010800	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2971	350 LONGWOOD AVE., STE B	BOSTON	MA	02115	07/01/2022
CH010800	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2022
CH010800	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2022
CH010800	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2022
CH010800	QUALITY PHARMACY CORP	664 MAIN ST		WORCESTER	MA	01610	07/01/2022
CH01080A	QUALITY PHARMACY CORP	664 MAIN ST		WORCESTER	MA	01610	07/01/2024
CH010800	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/01/2024
CH010800	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00590	1054 CASS AVENUE	WOONSOCKET	RI	02895	07/01/2022
CH010800	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/01/2024
CH010800	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	01/01/2024
CH010800	SHAWS SUPERMARKETS INC	SHAWS PHARMACY #0624	14 WEST BOYLSTON STREET	WORCESTER	MA	01605	07/01/2022
CH010800	SHAWS SUPERMARKETS INC	SHAWS PHARMACY #2470	50 BOSTON TURNPIKE ROAD	SHREWSBURY	MA	01545	07/01/2022
CH010800	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #079	PERKIN FARMS MARKET PLACE 949 GRAFTON STREET	WORCESTER	MA	01604	07/01/2022	04/16/2024
CH010800	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #091	539-571 BOSTON TURNPIKE	SHREWSBURY	MA	01545	07/01/2022	04/16/2024
CH010800	THE STOP & SHOP SUPERMRKT CO	STOP & SHOP PHARMACY #2418	126 MEDWAY ROAD	MILFORD	MA	01757	07/01/2022	04/16/2024
CH010800	VICTORY DISTRIBUTORS, LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #80	158 NORTH MAIN STREET	UXBRIDGE	MA	01569	07/01/2022
CH010800	VICTORY DISTRIBUTORS, LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #80	5 GILBERT STREET	NORTH BROOKFIELD	MA	01535	07/01/2022
CH010800	VICTORY DISTRIBUTORS, LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #83	333 MASS AVE	LUNENBURG	MA	01462	07/01/2022
CH010800	WALGREEN EASTERN CO., INC.	WALGREENS #18421	455 MAIN ST	SOUTHBRIDGE	MA	01550	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10401	220 GRAFTON ST	WORCESTER	MA	01604-4906	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10639	99 STAFFORD ST	WORCESTER	MA	01603	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	WALGREENS #19240	5 SCHOFIELD AVE	DUDLEY	MA	01571	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03151	320 PARK AVE	WORCESTER	MA	01610	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09233	225 BOSTON TURNPIKE	SHREWSBURY	MA	01545-5223	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY 16486	398 BELMONT ST SUITE A	WORCESTER	MA	01604	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #09152	937 W BOYLSTON ST	WORCESTER	MA	01606	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #12558	571 JOHN FITCH HWY	FITCHBURG	MA	01420	10/01/2022
CH010800	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01233	100 E MAIN ST	WEBSTER	MA	01570	10/01/2023
CH010800	WALGREEN EASTERN CO., INC.	WALGREENS #10319	472 LINCOLN ST	WORCESTER	MA	01605	10/01/2023
CH010800	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY #16537	619 CHESTNUT ST.	SPRINGFIELD	MA	01107	10/01/2023
CH010800	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05445	1440 BOSTON ROAD	SPRINGFIELD	MA	01129	10/01/2023
CH010800	WALGREEN EASTERN CO., INC.	WALGREENS #19452	348 GREENWOOD ST	WORCESTER	MA	01607	10/01/2023
CH01080B	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY 16486	398 BELMONT ST SUITE A	WORCESTER	MA	01604	07/01/2024	12/01/2022
CH01080C	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03151	320 PARK AVE	WORCESTER	MA	01610	07/01/2024
CH010800	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	04/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/6/2024 8:05:17 AM	2/10/2025 12:59:00 PM	2/10/2025 12:59 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0401421 (MA)		9/25/2024 10:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/25/2024 10:03 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		110020639B	9/25/2024 10:03 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	9/25/2024 10:03 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1841200664	9/25/2024 10:03 PM
Medicaid Billing	NPI: State	Insert	Change Request		MA	9/25/2024 10:03 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1447399225 (MA)		9/25/2024 10:03 PM
Contacts	Primary Contact	Update	PC Change Request	Zavoski, Robert Chief Clinical Officer Family Health Center of Worcester 5088607985	Xhemali, Muhammad Pharmacy Manager Family Health Center of Worcester 5083402244	3/29/2024 2:37 PM
Details	Last Recertification Date	Update	Recertification	1/30/2023 4:05:40 PM	2/6/2024 8:05:17 AM	2/6/2024 8:05 AM
Details	Last Recertification Date	Update	Recertification	2/24/2022 3:48:25 PM	1/30/2023 4:05:40 PM	1/30/2023 4:05 PM
Contacts	Primary Contact	Update	Recertification	PIETRY, VALERIE MEDICAL DIRECTOR Family Health Center of Worcester 5088607700-7899	Zavoski, Robert Chief Clinical Officer Family Health Center of Worcester 5088607985	2/24/2022 3:48 PM
Details	Last Recertification Date	Update	Recertification	2/9/2021 3:26:05 PM	2/24/2022 3:48:25 PM	2/24/2022 3:48 PM
Addresses	Billing Address	Insert	Recertification		Family Health Center of Worcester Inc. 26 Queen St Worcester, MA 01610	2/9/2021 3:26 PM
Medicaid Billing	NPI: State	Update	Recertification		MA	2/9/2021 3:26 PM
Details	Last Recertification Date	Update	Recertification	2/24/2020 11:11:16 AM	2/9/2021 3:26:05 PM	2/9/2021 3:26 PM
Details	Last Recertification Date	Update	Recertification		2/24/2020 11:11:16 AM	2/24/2020 11:11 AM
Contacts	Authorizing Official	Update	AO Change Request	ANTHES, FRANCES Mary CEO Family Health Center of Worcester,Inc. 5088607700-7999	Brady, Louis Arthur CEO Family Health Center of Worcester 6175193117	2/24/2020 7:29 AM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		ANTHES, FRANCES Mary CEO Family Health Center of Worcester,Inc. 5088607700-7999	3/1/2019 7:50 AM
Details	340B ID	Update	New Registration		CH01080L	3/1/2019 7:50 AM
Dates	Participating Approval Date	Update	New Registration		3/1/2019 7:50:06 AM	3/1/2019 7:50 AM
Details	State	Update	New Registration	Pending	Approved	3/1/2019 7:50 AM
Dates	Signed By Date	Update	New Registration		2/26/2019 6:00:33 PM	3/1/2019 7:50 AM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	3/1/2019 7:50 AM
Addresses	Main Address	Insert	New Registration		420 Grafton Street Worcester, MA 01604-3802	2/26/2019 6:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	2/26/2019 6:00 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0401421	2/26/2019 6:00 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	2/26/2019 6:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1447399225	2/26/2019 6:00 PM
Contacts	Authorizing Official	Insert	New Registration		ANTHES, FRANCES Mary CEO Family Health Center of Worcester,Inc. 5088607700-7999	2/26/2019 6:00 PM
Contacts	Primary Contact	Insert	New Registration		PIETRY, VALERIE MEDICAL DIRECTOR Family Health Center of Worcester 5088607700-7899	2/26/2019 6:00 PM
Details	Last Recertification Date	Insert	New Registration			2/26/2019 6:00 PM
Details	Grant Number	Insert	New Registration		H80CS00452	2/26/2019 6:00 PM
Details	340B ID	Insert	New Registration			2/26/2019 6:00 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			2/26/2019 6:00 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			2/26/2019 6:00 PM
Details	Medicare Provider Number	Insert	New Registration			2/26/2019 6:00 PM
Details	Entity Name	Insert	New Registration		Family Health Center of Worcester, Inc.	2/26/2019 6:00 PM
Details	Program Code	Insert	New Registration		CH	2/26/2019 6:00 PM
Details	Entity Subname	Insert	New Registration		Worcester East Middle School - School Based Health Center	2/26/2019 6:00 PM
Dates	Participating Approval Date	Insert	New Registration			2/26/2019 6:00 PM
Details	State	Insert	New Registration		Pending	2/26/2019 6:00 PM
Dates	Registration Date	Insert	New Registration		2/26/2019 6:00:32 PM	2/26/2019 6:00 PM
Dates	Signed By Date	Insert	New Registration			2/26/2019 6:00 PM
Dates	Start Date	Insert	New Registration			2/26/2019 6:00 PM
Terminations	Termination Comments	Insert	New Registration			2/26/2019 6:00 PM
Terminations	Termination Date	Insert	New Registration			2/26/2019 6:00 PM
Terminations	Termination Effective Date	Insert	New Registration			2/26/2019 6:00 PM
Terminations	Termination Reason	Insert	New Registration			2/26/2019 6:00 PM

340B Drug Pricing Program Database