Covered Entity Details

CH10717B Peninsula Community Health Services of Alaska, Inc. (Active) - information as of 5/6/2025 12:02:18 AM

Main Details

Name

Peninsula Community Health Services of Alaska, Inc.

Subdivision Name

PCHS - KENAI MEDICAL AND BEHAVIORAL HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-015445

340B ID

CH10717B

Grant Number

H80CS01139

Additional Details

Current Program Status

Active

Registration Date

4/1/2019

Participating Start Date

7/1/2019

Participating Approval Date

4/2/2019

Last Recertification Date

2/19/2025

Contacts

Authorizing Official

Peninsula Community Health Services of AK
Benjamin Wright, Chief Executive Officer
(907) 260-7314

Primary Contact

Peninsula Community Health Services
Michelle J McKay, 340B Program Coordinator
(907) 260-7372

Addresses

Street Address

805 Frontage Rd
Kenai, AK 99611

Billing Address
Same as Street Address

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	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
CH10717A	Active	BPS-H80-002461	PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.	Peninsula Community Health Services of Alaska	230 East Marydale Ave	SOLDOTNA	AK
CH10717B	Active	BPS-H80-015445	Peninsula Community Health Services of Alaska, Inc.	PCHS - KENAI MEDICAL AND BEHAVIORAL HEALTH CENTER	805 Frontage Rd	Kenai	AK
CH10717C	Active	BPS-H80-005568	PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.	Peninsula Community Health Services of Alaska - Dental	395 Main Street Loop	Kenai	AK

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH10717A	CARR-GOTTSTEIN FOODS, CO.	SAFEWAY PHARMACY #1808	10576 KENAI SPUR HIGHWAY	KENAI	AK	99611	10/01/2016
CH10717A	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/01/2019
CH10717A	FRED MEYER STORES	DBA: FRED MEYER	43843 STERLING HWY STE 400	SOLDOTNA	AK	99669	01/01/2017
CH10717A	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	01/01/2017	08/27/2020
CH10717A	PENINSULA COMMUNITY PHARMACY	230 E MARYDALE AVE	STE 100	SOLDOTNA	AK	99669	01/01/2017	10/18/2017
CH10717A	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	10/01/2017	01/05/2019
CH10717A	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/01/2019	10/01/2022
CH10717A	SAFEWAY INC	SAFEWAY PHARMACY #0548	44428 STERLING HIGHWAY	SOLDOTNA	AK	99669	10/01/2016
CH10717A	SOLDOTNA PROFESSIONAL PHARMACY	BUSINESS WILL BE CONDUCTED BY KAPUNA PHA	299 NORTH BINKLEY STREET	SOLDOTNA	AK	99669-7523	10/01/2016	07/01/2020
CH10717A	SOLDOTNA PROFESSIONAL PHRMCY		299 N BINKLEY STREET	SOLDOTNA	AK	99669	10/01/2016
CH10717A	THREE BEARS PHARMACY #50	10575 KENAI SPUR HWY		KENAI	AK	99611-7812	01/01/2023
CH10717A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH10717A	WAL-MART PHARMACY 10-4474	10096 KENAI SPUR HWY		KENAI	AK	99611	01/01/2017
CH10717A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH10717A	WALGREEN CO.	DBA: WALGREENS #16059	44001 STERLING HWY	SOLDOTNA	AK	99669	10/01/2019
CH10717A	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/01/2019	03/01/2024
CH10717A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/01/2019
CH10717A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/01/2019
CH10717A	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/01/2019
CH10717A	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH10717A	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	1/29/2024 6:19:29 PM	2/19/2025 2:07:43 PM	2/19/2025 2:07 PM
Details	Last Recertification Date	Update	Recertification	1/30/2023 1:07:32 PM	1/29/2024 6:19:29 PM	1/29/2024 6:19 PM
Details	Last Recertification Date	Update	Recertification	1/31/2022 6:14:30 PM	1/30/2023 1:07:32 PM	1/30/2023 1:07 PM
Contacts	Primary Contact	Update	Profile Change Request	McKay, Michelle J 340B Program Support Peninsula Community Health Services 9072607372	McKay, Michelle J 340B Program Coordinator Peninsula Community Health Services 9072607372	8/24/2022 1:19 PM
Addresses	Main Address	Update	Change Request	805 Frontage Rd Kenai, AK 99611-9104	805 Frontage Rd Kenai, AK 99611	2/1/2022 10:04 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 5:15:14 PM	1/31/2022 6:14:30 PM	1/31/2022 6:14 PM
Details	Last Recertification Date	Update	Recertification	1/29/2020 6:30:17 PM	2/4/2021 5:15:14 PM	2/4/2021 5:15 PM
Details	Last Recertification Date	Update	Recertification		1/29/2020 6:30:17 PM	1/29/2020 6:30 PM
Contacts	Authorizing Official	Update	Change Request	Youngberg, Jennifer Lynn CFO PCHS 9072607312	Wright, Benjamin Chief Executive Officer Peninsula Community Health Services of AK 9072607314	1/28/2020 10:01 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Youngberg, Jennifer Lynn CFO PCHS 9072607312	4/2/2019 7:44 AM
Details	340B ID	Update	New Registration		CH10717B	4/2/2019 7:44 AM
Dates	Participating Approval Date	Update	New Registration		4/2/2019 7:44:35 AM	4/2/2019 7:44 AM
Details	State	Update	New Registration	Pending	Approved	4/2/2019 7:44 AM
Dates	Signed By Date	Update	New Registration		4/1/2019 4:10:26 PM	4/2/2019 7:44 AM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	4/2/2019 7:44 AM
Addresses	Main Address	Insert	New Registration		805 Frontage Rd Kenai, AK 99611-9104	4/1/2019 4:10 PM
Contacts	Authorizing Official	Insert	New Registration		Youngberg, Jennifer Lynn CFO PCHS 9072607312	4/1/2019 4:10 PM
Contacts	Primary Contact	Insert	New Registration		McKay, Michelle J 340B Program Support Peninsula Community Health Services 9072607372	4/1/2019 4:10 PM
Details	Last Recertification Date	Insert	New Registration			4/1/2019 4:10 PM
Details	Grant Number	Insert	New Registration		H80CS01139	4/1/2019 4:10 PM
Details	340B ID	Insert	New Registration			4/1/2019 4:10 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2019 4:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2019 4:10 PM
Details	Medicare Provider Number	Insert	New Registration			4/1/2019 4:10 PM
Details	Entity Name	Insert	New Registration		Peninsula Community Health Services of Alaska, Inc.	4/1/2019 4:10 PM
Details	Program Code	Insert	New Registration		CH	4/1/2019 4:10 PM
Details	Entity Subname	Insert	New Registration		PCHS - KENAI MEDICAL AND BEHAVIORAL HEALTH CENTER	4/1/2019 4:10 PM
Dates	Participating Approval Date	Insert	New Registration			4/1/2019 4:10 PM
Details	State	Insert	New Registration		Pending	4/1/2019 4:10 PM
Dates	Registration Date	Insert	New Registration		4/1/2019 4:10:24 PM	4/1/2019 4:10 PM
Dates	Signed By Date	Insert	New Registration			4/1/2019 4:10 PM
Dates	Start Date	Insert	New Registration			4/1/2019 4:10 PM
Terminations	Termination Comments	Insert	New Registration			4/1/2019 4:10 PM
Terminations	Termination Date	Insert	New Registration			4/1/2019 4:10 PM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2019 4:10 PM
Terminations	Termination Reason	Insert	New Registration			4/1/2019 4:10 PM

340B Drug Pricing Program Database