Covered Entity Details

CH01007AK Cornell Scott-Hill Health Corporation (Active) - information as of 4/25/2025 6:34:43 PM

Main Details

Name

Cornell Scott-Hill Health Corporation

Subdivision Name

Hamden High School

Type

HRSA-Funded Health Center

Site ID

BPS-H80-024854

340B ID

CH01007AK

Grant Number

H80CS00312

Additional Details

Current Program Status

Active

Registration Date

4/10/2019

Participating Start Date

7/1/2019

Participating Approval Date

4/11/2019

Last Recertification Date

2/19/2025

Contacts

Authorizing Official

Cornell Scott Hill Health Center
Vanessa E Andrews, Chief Corporate
(203) 503-3241

Primary Contact

Cornell Scott-Hill Health
CATHERINE SHARAFANOWICH, DIRECTOR OF PHARMACY
(203) 503-3178

Addresses

Street Address

2040 Dixwell Ave
Hamden, CT 06514-2415

Billing Address

CORNELL SCOTT-HILL HEALTH CORPORATION
400 COLUMBUS AVE
NEW HAVEN, CT 06519

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
CT	004-226-264,004-235-900	1902921380,1750423471

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
CH010070	Active	BPS-H80-000185	CORNELL SCOTT-HILL HEALTH CORPORATION	CORNELL SCOTT-HILL HEALTH CORPORATION	400-428 COLUMBUS AVENUE	NEW HAVEN	CT
CH01007AA	Active	BPS-H80-005992	CORNELL SCOTT-HILL HEALTH CORPORATION	TAKING INITIATIVE CENTER/MARRAKECH	514 Whalley Ave	New Haven	CT
CH01007AC	Terminated	BPS-H80-014119	CORNELL SCOTT-HILL HEALTH CORPORATION	CS-HHC Richrd O. Belden Dental Clinic	30 Elizabeth St	Derby	CT
CH01007AD	Active	BPS-H80-005818	CORNELL SCOTT-HILL HEALTH CORPORATION	FELLOWSHIP PLACE HOMELESS OUTREA	441 Elm St	New Haven	CT
CH01007AE	Active	BPS-H80-005797	CORNELL SCOTT-HILL HEALTH CORPORATION	LIFE HAVEN SHELTER HOMLESS OUT	447 Ferry St	New Haven	CT
CH01007AF	Active	BPS-H80-005738	CORNELL SCOTT-HILL HEALTH CORPORATION	Emergency Shelter Mangement Service	645 Grand Ave	New Haven	CT
CH01007AG	Active	BPS-H80-007166	CORNELL SCOTT-HILL HEALTH CORPORATION	COLUMBUS HOUSE SHELTER CLINIC	586 ELLA T. GRASSO BLVD	NEW HAVEN	CT
CH01007AH	Active	BPS-H80-017908	Cornell Scott-Hill Health Corporation	WILMONT CROSSING HEALTH CENTER	120 Wilmot Road, Suite 1030	New Haven	CT
CH01007AJ	Active	BPS-H80-014687	Cornell Scott-Hill Health Corporation	CS-HHC at Augusta Lewis Troup School	259 EDGEWOOD AVE	NEW HAVEN	CT
CH01007AK	Active	BPS-H80-024854	Cornell Scott-Hill Health Corporation	Hamden High School	2040 Dixwell Ave	Hamden	CT
CH01007AL	Active	BPS-H80-027551	Cornell Scott-Hill Health Corporation	Church Street School SBHC	95 Church St	Hamden	CT
CH01007AM	Active	BPS-H80-027981	Cornell Scott-Hill Health Corporation	Men's Seasonal Overflow Shelter Clinic	209R Terminal Lane	New Haven	CT
CH01007AN	Active	BPS-H80-030213	Cornell Scott-Hill Health Corporation	CS-HHC at The Towers	18 Tower Ln	New Haven	CT
CH01007AP	Active	BPS-H80-029649	Cornell Scott-Hill Health Corporation	Hamden Middle School	2623 Dixwell Ave	Hamden	CT
CH01007AQ	Active	BPS-H80-024853	Cornell Scott-Hill Health Corporation	Brennan-Rogers Magnet School	199-200 Wilmot Road	New Haven	CT
CH01007AR	Active	BPS-H80-030945	Cornell Scott-Hill Health Corporation	CS-HHC at Sargent Drive	150 Sargent Drive STE 1-200	New Haven	CT
CH01007AS	Active	BPS-H80-030946	Cornell Scott-Hill Health Corporation	CS-HHC at Sargent Drive	150 SARGENT DRIVE	NEW HAVEN	CT
CH01007AT	Active	BPS-H80-032921	Cornell Scott-Hill Health Corporation	West Haven Health Center	410 Campbell Ave	West Haven	CT
CH01007AU	Active	BPS-H80-033393	Cornell Scott-Hill Health Corporation	CS-HHC at Beth-El Center Homeless Clinic	90 New Haven Ave	Milford	CT
CH01007AV	Terminated	BPS-H80-027980	Cornell Scott-Hill Health Corporation	Safe Haven Homeless Clinic	210 State St	New Haven	CT
CH01007AW	Active	BPS-H80-027625	Cornell Scott-Hill Health Corporation	Lincoln-Bassett Community School SBHC	130 Bassett St	New Haven	CT
CH01007AX	Active	BPS-H80-033901	Cornell Scott-Hill Health Corporation	CS-HHC at Dr. Reginald Mayo Early Learning Center	185 Goffe St	New Haven	CT
CH01007AY	Active	BPS-H80-036200	Cornell Scott-Hill Health Corporation	Cornell Scott-Hill Health Center at “Q” House Behavioral Health Services	197 Dixwell Avenue, 2nd Floor	New Haven	CT
CH01007AZ	Active	BPS-H80-036201	Cornell Scott-Hill Health Corporation	Cornell Scott-Hill Health Center at “Q” House Medical Services	197 Dixwell Avenue, 1st Floor	New Haven	CT
CH01007C	Active	BPS-H80-002819	CORNELL SCOTT-HILL HEALTH CORPORATION	DIXWELL HEALTH CENTER	226 Dixwell Ave	New Haven	CT
CH01007CA	Active	BPS-H80-037152	Cornell Scott Hill Health Corporation	CS-HHC at Helen Street Elementary School	285 Helen Street SBHC Room	Hamden	CT
CH01007CB	Active	BPS-H80-037992	Cornell Scott Hill Health Corporation	CS-HHC Mobile Van	400-428 COLUMBUS AVENUE	NEW HAVEN	CT
CH01007CC	Active	BPS-H80-037991	Cornell Scott Hill Health Corporation	CS-HHC at West Haven High School	1 McDonough Plz RM SBHC Room	West Haven	CT
CH01007CD	Active	BPS-H80-038748	Cornell Scott Hill Health Corporation	Cornell Scott-Hill Health Center at the Recovery and Wellness Center	149 Minor St	New Haven	CT
CH01007CE	Approved	BPS-H80-039935	Cornell Scott Hill Health Corporation	CS-HHC at Hill Regional Career Magnet High School	140 Legion Avenue RM SBHC	New Haven	CT
CH01007CF	Approved	BPS-H80-037039	Cornell Scott Hill Health Corporation	CS-HHC at the Savin Rock Community School	50 Park St	West Haven	CT
CH01007CG	Approved	BPS-H80-037366	Cornell Scott Hill Health Corporation	CS-HHC SBHC at Bailey Middle School	106 Morgan Ln	West Haven	CT
CH01007CH	Approved	BPS-H80-037341	Cornell Scott Hill Health Corporation	CS-HHC West Haven SBHC Van	428 Columbus Avenue SBHC Van	New Haven	CT
CH01007CJ	Approved	BPS-H80-037347	Cornell Scott Hill Health Corporation	CS-HHC SBHC at Carrigan Intermediate School	2 Tetlow St	West Haven	CT
CH01007CK	Approved	BPS-H80-036984	Cornell Scott Hill Health Corporation	CS-HHC at Washington Elementary School at the Anna V. Malloy School	225 Meloy Rd	West Haven	CT
CH01007CL	Approved	BPS-H80-005189	Cornell Scott Hill Health Corporation	Dixwell Child & Family Guidance	226 Dixwell Ave STE ESP	New Haven	CT
CH01007CM	Approved	BPS-H80-037153	Cornell Scott Hill Health Corporation	CS-HHC at Dunbar Hill Elementary School	315 Lane Street SBHC Room	Hamden	CT
CH01007CN	Approved	BPS-H80-037154	Cornell Scott Hill Health Corporation	CS-HHC at the Ridge Hill Elementary School	120 Carew Road SBHC Room	Hamden	CT
CH01007D	Active	BPS-H80-004270	CORNELL SCOTT-HILL HEALTH CORPORATION	GRANT STREET PARTNERSHIP AT WEST HAVEN	285 Main St	West Haven	CT
CH01007E	Active	BPS-H80-001842	CORNELL SCOTT-HILL HEALTH CORPORATION	CS-HHC Ansonia	121 Wakelee Ave	Ansonia	CT
CH01007F	Active	BPS-H80-005393	CORNELL SCOTT-HILL HEALTH CORPORATION	DAVIS STREET SCHOOL CLINIC	35 DAVIS ST	NEW HAVEN	CT
CH01007G	Active	BPS-H80-004048	CORNELL SCOTT-HILL HEALTH CORPORATION	HILL CENTRAL SCHOOL CLINIC	140 Dewitt St	New Haven	CT
CH01007H	Active	BPS-H80-000447	CORNELL SCOTT-HILL HEALTH CORPORATION	KING ROBINSON SBHC	150 FOURNIER ST	NEW HAVEN	CT
CH01007K	Active	BPS-H80-003153	CORNELL SCOTT-HILL HEALTH CORPORATION	ROBERTO CLEMENTE SCHOOL CLINIC	360 COLUMBUS AVE	NEW HAVEN	CT
CH01007L	Active	BPS-H80-003686	CORNELL SCOTT-HILL HEALTH CORPORATION	TRUMAN SCHOOL BASED HEALTH CTR	114 Truman St	New Haven	CT
CH01007M	Terminated	BPS-H80-001064	CORNELL SCOTT-HILL HEALTH CORPORATION	GRANT STREET PARTNERSHIP	62 Grant St	New Haven	CT
CH01007N	Active	BPS-H80-004868	CORNELL SCOTT-HILL HEALTH CORPORATION	SOUTH CENTRAL REHAB CENTER	232 Cedar St	New Haven	CT
CH01007P	Active	BPS-H80-000155	CORNELL SCOTT-HILL HEALTH CORPORATION	State Street Health & Counseling Services	911-913 STATE ST	NEW HAVEN	CT
CH01007Q	Active	BPS-H80-012447	CORNELL SCOTT-HILL HEALTH CORPORATION	CS-HHC at CMHC	34 Park St	New Haven	CT
CH01007S	Terminated	BPS-H80-008068	CORNELL SCOTT-HILL HEALTH CORPORATION	Crossroads Clinic	54 E Ramsdell St	New Haven	CT
CH01007T	Terminated	BPS-H80-012492	CORNELL SCOTT-HILL HEALTH CORPORATION	CS-HHC at Bridges...A Community Support System	949 Bridgeport Ave	Milford	CT
CH01007U	Terminated	BPS-H80-012489	CORNELL SCOTT-HILL HEALTH CORPORATION	CS-HHC at Gateway Community College	20 Church St	New Haven	CT
CH01007V	Terminated	BPS-H80-012503	CORNELL SCOTT-HILL HEALTH CORPORATION	CS-HHC at Harbor Health Services	14 Sycamore way	Branford	CT
CH01007W	Terminated	BPS-H80-012536	CORNELL SCOTT-HILL HEALTH CORPORATION	CS-HHC at BHCares Valley	435 E Main St	Ansonia	CT
CH01007X	Active	BPS-H80-007100	CORNELL SCOTT-HILL HEALTH CORPORATION	Martha's Place	559 Howard Ave	New Haven	CT
CH01007Y	Active	BPS-H80-006765	CORNELL SCOTT-HILL HEALTH CORPORATION	CAREWAYS SHELTER	223 Portsea St	New Haven	CT
CH01007Z	Active	BPS-H80-006376	CORNELL SCOTT-HILL HEALTH CORPORATION	COMMUNITY SOUP KITCHEN-BROADWAY	84 BROADWAY STREET	NEW HAVEN	CT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH010070	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2024
CH010070	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2024
CH010070	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2025
CH010070	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2024
CH010070	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2024
CH010070	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2024
CH010070	ACCREDO HEALTH GROUP, INC.	WHOLESALE DIVISION	1680 CENTURY CENTER PARKWAY, SUITE 8 SUITE 8	MEMPHIS	TN	38134	10/01/2024	01/07/2025
CH010070	AEV INC	DBA BEACON PRESCRIPTIONS	875 FOXON RD	EAST HAVEN	CT	06513	01/01/2025
CH010070	APOTHECARY & WELLNESS CENTER	1450 CHAPEL STREET		NEW HAVEN	CT	06511-4405	01/01/2023
CH010070	BELLA VISTA PHARMACY	321 EASTERN ST BLDG A		NEW HAVEN	CT	06513	01/01/2025
CH010070	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2018	03/14/2025
CH010070	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2020
CH010070	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2020
CH010070	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2020
CH010070	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2020
CH010070	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2020
CH010070	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2020
CH010070	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2020
CH010070	CAREMARK PUERTO RICO SPECIALTY PHARMACY,	CAREMARK PUERTO RICO SPECIALTY PHARMACY	6020 AVE ROBERTO SANCHEZ VILELLA	CAROLINA	PR	00982	10/01/2020	02/26/2021
CH010070	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2020
CH010070	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2020
CH010070	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2020
CH010070	CHAPEL STREET PHARMACY	CHAPEL STREET PHARMACY	1245 CHAPEL ST STE 1	NEW HAVEN	CT	06511-4611	04/01/2018
CH010070	COLUMBUS CHEMISTS LLC	BERNEYS PHARMACY	615 HOWARD AVE	NEW HAVEN	CT	06519-2112	04/01/2018
CH010070	COMMUNITY HEALTH PHARMACY	COMMUNITY HEALTH PHARMACY LLC	224 DIXWELL AVE	NEW HAVEN	CT	06511	07/01/2018
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02584	252 ORANGE AVENUE	WEST HAVEN	CT	06516	01/01/2018	07/20/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00718	24 PERSHING DR # 36	ANSONIA	CT	06401-2214	01/01/2018
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00377	915 POQUONNOCK RD.	GROTON	CT	06340	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06807	153 BROAD STREET	MERIDEN	CT	06450	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02097	279 BOSTON POST RD.	ORANGE	CT	06477	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02259	215 WHALLEY AVENUE	NEW HAVEN	CT	06511	04/01/2020	02/18/2022
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01241	734 BRIDGEPORT AVE	MILFORD	CT	06460	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02502	581 HIGHLAND AVE.	CHESHIRE	CT	06410	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 556	1657 ROUTE 12	GALES FERRY	CT	06335	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17072	120 HAWLEY LN	TRUMBULL	CT	06611	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #7856	281 CONNECTICUT AVENUE	NORWALK	CT	06854-1938	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01284	17 WEST MAIN STREET	CLINTON	CT	06413	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04473	15 CHESTERFIELD RD.	EAST LYME	CT	06333	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01968	369 MAIN STREET	EAST HAVEN	CT	06512	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01153	1875 BOSTON AVE, CVS PLAZA	BRIDGEPORT	CT	06610	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01244	26 WATERBURY ROAD	PROSPECT	CT	06712	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01960	1279 WEST MAIN STREET	WATERBURY	CT	06708	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00172	2-6 SHORT BEACH RD,	BRANFORD	CT	06405	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00916	26 DAVIS STREET	OAKVILLE	CT	06779	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00145	330 MAIN STREET	FARMINGTON	CT	06032	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02572	1 HAWLEY LANE	STRATFORD	CT	06614	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01912	1968 BLACK ROCK TURNPIKE. FAIRWAY PLAZA	FAIRFIELD	CT	06825	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05450	766 NEW LONDON TURNPIKE	GLASTONBURY	CT	06033	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01941	511 MONROE TURNPIKE, RT 111 CENTURY PLZ	MONROE	CT	06468	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01060	326 MAIN STREET	SOUTHINGTON	CT	06489	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00854	327 MAIN AVENUE	NORWALK	CT	06851	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02573	1425 BARNUM AVENUE	STRATFORD	CT	06614	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02388	2000 NORTH MAIN STREET	WATERBURY	CT	06704	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00185	215 WEST STREET	SEYMOUR	CT	06483	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01080	817 BANK STREET	NEW LONDON	CT	06320	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00775	2045 DIXWELL AVE.	HAMDEN	CT	06514	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00071	989 BOSTON POST ROAD	MILFORD	CT	06460	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00692	162 WASHINGTON AVENUE	NORTH HAVEN	CT	06473	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00857	660 FOXON RD.	EAST HAVEN	CT	06513	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02143	3710 MAIN STREET	BRIDGEPORT	CT	06606	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01268	106 BOSTON POST ROAD	WATERFORD	CT	06385	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00865	839 EAST MAIN STREET	MERIDEN	CT	06450	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10367	965 WHITE PLAINS RD.	TRUMBULL	CT	06611	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00124	98 BRIDGE ST.	NAUGATUCK	CT	06770	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #388	613 BOSTON POST RD	MADISON	CT	06443	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #3549	355 CAMPBELL AVE.	WEST HAVEN	CT	06516-5329	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01152	58 PENNSYLVANIA AVE.	NIANTIC	CT	06357	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02056	25 BROADWAY	MYSTIC	CT	06355	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01966	1057 BOSTON POST ROAD, ROUTE 1	GUILFORD	CT	06437	04/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17425	5065 MAIN ST STE TARGET	TRUMBULL	CT	06611	10/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02682	47 MAIN ST.	WINSTED	CT	06098	10/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01097	661 MAIN STREET	TORRINGTON	CT	06790	10/01/2020
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00811	1150 WHALLEY AVENUE	NEW HAVEN	CT	06515	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17324	20 W MAIN ST	ANSONIA	CT	06401	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17238	300 CHASE AVE	WATERBURY	CT	06704	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02018	540 WEST MAIN STREET	MERIDEN	CT	06451	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00941	844 JONES HILL ROAD	WEST HAVEN	CT	06516-5643	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17071	25 BOSTON POST RD	ORANGE	CT	06477	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01148	905 SOUTH MAIN ST.	CHESHIRE	CT	06410	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	CVS/PHARMACY #1044	656 NEW HAVEN AVE	DERBY	CT	06418-2528	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11081	1245 DIXWELL AVE	HAMDEN	CT	06514	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00785	632 MIDDLE TURNPIKE	STORRS MANSFIELD	CT	06268	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 935	891 NORTH COLONY RD.	WALLINGFORD	CT	06492	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01151	464 REIDVILLE DRIVE	WATERBURY	CT	06705	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11007	123 CHURCH ST.	NEW HAVEN	CT	06510	01/01/2023
CH010070	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01109	7 DURANT AVE.	BETHEL	CT	06801	04/01/2023
CH010070	CORNERSTONE PHARMACY, DBA WHALLEY DRUG	399 WHALLEY AVE STE 2		NEW HAVEN	CT	06511-3013	04/01/2018	01/31/2020
CH010070	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CH010070	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2024
CH010070	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2020
CH010070	DIXWELL PHARMACY LLC	APEX PHARMACY & HOME CARE CTR	2380 DIXWELL AVE STE 1	HAMDEN	CT	06514-1837	01/01/2025
CH010070	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	07/01/2018	03/14/2025
CH010070	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2024
CH010070	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2024
CH010070	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2024
CH010070	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2024
CH010070	GENOA HEALTHCARE LLC	941 BRIDGEPORT AVE	SUITE M5	MILFORD	CT	06460-3142	10/01/2024
CH010070	GENOA HEALTHCARE LLC	287 MAIN STREET, SUITE A-2		EAST HARTFORD	CT	06118-1885	10/01/2024
CH010070	GENOA HEALTHCARE LLC	855 LAKEWOOD RD STE 100		WATERBURY	CT	06704	10/01/2024
CH010070	HANCOCK PHARMACY 2	HANCOCK PHARMACY II, LLC	1020 FAIRFIELD AVE	BRIDGEPORT	CT	06605	01/01/2025
CH010070	HANCOCK PHARMACY AT LONG WHARF INC	1 LONG WHARF DR	SUITE 116	NEW HAVEN	CT	06511-5991	01/01/2025
CH010070	HANCOCK PHARMACY III	3768 MAIN ST		BRIDGEPORT	CT	06606-3610	01/01/2025
CH010070	HANCOCK PHARMACY VI	95 WAKELEE AVE		ANSONIA	CT	06401	01/01/2025
CH010070	HANCOCK PHARMACY VII	306 GRAND AVE		NEW HAVEN	CT	06513	01/01/2025
CH010070	HANCOCK'S PHARMACY	HANCOCK'S PHARMACY AND SURGICAL, INC.	840 E MAIN ST., STE A	MERIDEN	CT	06450	01/01/2025
CH010070	MY FAIR HAVEN PHARMACY LLC	D/B/A FAIR HAVEN PHARMACY	72 GRAND AVE	NEW HAVEN	CT	06513	07/01/2018
CH010070	NEW HAVEN PHARMACY INC	374 GRAND AVE		NEW HAVEN	CT	06513	01/01/2025
CH010070	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	10/01/2024
CH010070	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/01/2024
CH010070	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2024
CH010070	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	10/01/2024
CH010070	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2024
CH010070	OUTPATIENT PHARMACY SVCS AT YALE NEW HAV	1100 SHERMAN AVE	C/O TERRI SUE RUBINO	HAMDEN	CT	06514	01/01/2023
CH010070	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2020
CH010070	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2020
CH010070	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2020
CH010070	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2020
CH010070	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2018	03/14/2025
CH010070	RITE AID OF CONNECTICUT, INC.	RITE AID #3264	10 HEMINGWAY AVENUE	EAST HAVEN	CT	06512	01/01/2025
CH010070	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2018	03/14/2025
CH010070	THE STOP & SHOP SUPERMARKET	DBA STOP & SHOP PHARMACY #687	22 LEETES ISLAND RD	BRANFORD	CT	06405	10/01/2024
CH010070	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #648	112 AMITY RD, AMITY PLAZA	NEW HAVEN	CT	06515-1405	10/01/2024
CH010070	THE STOP&SHOP SUPERMARKET CO	STOP & SHOP PHARMACY #696	460 ELM STREET	WEST HAVEN	CT	06516	10/01/2024
CH010070	UNITY PHARMACY	URX2, LLC	1351 WHALLEY AVE	NEW HAVEN	CT	06515	01/01/2025
CH010070	VISEL'S DRUG STORE INC	714 DIXWELL AVE		NEW HAVEN	CT	06511	04/01/2018
CH010070	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CH010070	WAL-MART PHARMACY 10-3803	515 SAWMILL ROAD		WEST HAVEN	CT	06516	01/01/2018
CH010070	WAL-MART PHARMACY 10-5439	315 FOXON BLVD		NEW HAVEN	CT	06513	10/01/2024
CH010070	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CH010070	WAL-MART PHARMACY WHSE #45	2250 NORTH 8TH STREET	SUITE 102-A	ROGERS	AR	72756	10/01/2024
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02410	1697 WHITNEY AVE STE 3	HAMDEN	CT	06517	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03579	1471 WHALLEY AVENUE	NEW HAVEN	CT	06515	10/01/2013	11/13/2024
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03944	329 E MAIN ST	BRANFORD	CT	06405	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05406	1191 DIXWELL AVE	HAMDEN	CT	06514	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #06474	88 YORK ST	NEW HAVEN	CT	06511-5619	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06503	541 BRIDGEPORT AVE	MILFORD	CT	06460-4203	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06914	87 FOXON ST	NEW HAVEN	CT	06513-2365	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07584	394 CAMPBELL AVE	WEST HAVEN	CT	06516-5012	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07935	54 BOSTON POST RD	ORANGE	CT	06477-3201	10/01/2013	05/03/2023
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09612	700 BRIDGEPORT AVE STE 101	SHELTON	CT	06484	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #9785	436 WHALLEY AVENUE	NEW HAVEN	CT	06511-3012	10/01/2013	03/20/2025
CH010070	WALGREEN EASTERN CO., INC.	WALGREENS #11605	73 CENTER STREET	SHELTON	CT	06484	10/01/2013	05/20/2019
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 11619	144 BANK STREET	SEYMOUR	CT	06483	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #13969	55 PARK ST STE 1A	NEW HAVEN	CT	06511	10/01/2013
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #13947	1415 CHAPEL ST	NEW HAVEN	CT	06511	01/01/2015	02/17/2020
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #13945	800 HOWARD AVE STE 197	NEW HAVEN	CT	06519-1369	01/01/2015	01/21/2021
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09101	2505 WHITNEY AVENUE	HAMDEN	CT	06518-3019	10/01/2016
CH010070	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #21180	60 BANK ST STE 100	WATERBURY	CT	06702	07/01/2018
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10309	1036 W MAIN ST	BRANFORD	CT	06405	07/01/2018
CH010070	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16548	300 FAIRFIELD AVE STE 103	BRIDGEPORT	CT	06604	07/01/2019
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #12120	157 MAIN ST	EAST HAVEN	CT	06512	10/01/2019
CH010070	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09071	49 WASHINGTON AVE	NORTH HAVEN	CT	06473-1704	04/01/2020
CH01007AZ	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03579	1471 WHALLEY AVENUE	NEW HAVEN	CT	06515	01/01/2024
CH01007AY	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #9785	436 WHALLEY AVENUE	NEW HAVEN	CT	06511-3012	01/01/2024
CH01007AR	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #06474	88 YORK ST	NEW HAVEN	CT	06511-5619	01/01/2024
CH01007E	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 11619	144 BANK STREET	SEYMOUR	CT	06483	01/01/2024
CH01007P	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #13969	55 PARK ST STE 1A	NEW HAVEN	CT	06511	01/01/2024
CH01007D	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07584	394 CAMPBELL AVE	WEST HAVEN	CT	06516-5012	01/01/2024
CH01007AH	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02410	1697 WHITNEY AVE STE 3	HAMDEN	CT	06517	01/01/2024
CH01007AT	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07584	394 CAMPBELL AVE	WEST HAVEN	CT	06516-5012	01/01/2024
CH010070	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	07/22/2015
CH010070	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2013	07/22/2015
CH010070	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/01/2024
CH010070	WEST HAVEN PHARMACY	764 CAMPBELL AVE STE A		WEST HAVEN	CT	06516-3786	04/01/2018
CH010070	YALE NEW HAVEN HEALTH PHARMACY	NORTH HAVEN MEDICAL CENTER	6 DEVINE ST	NORTH HAVEN	CT	06473	07/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/19/2024 11:46:23 AM	2/19/2025 4:38:35 PM	2/19/2025 4:38 PM
Contacts	Authorizing Official	Update	Group Change Request	TAYLOR, MICHAEL R. CEO CORNELL SCOTT-HILL HEALTH CORPORATION 2035033274	Andrews, Vanessa E Chief Corporate Cornell Scott Hill Health Center 2035033241	5/13/2024 10:10 AM
Details	Last Recertification Date	Update	Recertification	2/15/2023 3:33:40 PM	2/19/2024 11:46:23 AM	2/19/2024 11:46 AM
Details	Last Recertification Date	Update	Recertification	2/14/2022 12:01:46 PM	2/15/2023 3:33:40 PM	2/15/2023 3:33 PM
Addresses	Billing Address	Update	Recertification	CORNELL SCOTT-HILL HEALTH CORPORATION 400-428 COLUMBUS AVE NEW HAVEN, CT 06519	CORNELL SCOTT-HILL HEALTH CORPORATION 400 COLUMBUS AVE NEW HAVEN, CT 06519	2/14/2022 12:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/14/2022 12:01 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		004-235-900	2/14/2022 12:01 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	2/14/2022 12:01 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1750423471	2/14/2022 12:01 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	2/14/2022 12:01 PM
Details	Last Recertification Date	Update	Recertification	2/18/2021 2:30:01 PM	2/14/2022 12:01:46 PM	2/14/2022 12:01 PM
Medicaid Billing	NPI: State	Update	Recertification		CT	2/18/2021 2:30 PM
Details	Last Recertification Date	Update	Recertification	2/21/2020 10:55:53 AM	2/18/2021 2:30:01 PM	2/18/2021 2:30 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2020 10:55 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		004-226-264	2/21/2020 10:55 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	2/21/2020 10:55 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1902921380	2/21/2020 10:55 AM
Details	Last Recertification Date	Update	Recertification		2/21/2020 10:55:53 AM	2/21/2020 10:55 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		TAYLOR, MICHAEL R. CEO CORNELL SCOTT-HILL HEALTH CORPORATION 2035033274	4/11/2019 11:24 AM
Details	340B ID	Update	New Registration		CH01007AK	4/11/2019 11:24 AM
Dates	Participating Approval Date	Update	New Registration		4/11/2019 11:24:48 AM	4/11/2019 11:24 AM
Details	State	Update	New Registration	Pending	Approved	4/11/2019 11:24 AM
Dates	Signed By Date	Update	New Registration		4/10/2019 3:40:45 PM	4/11/2019 11:24 AM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	4/11/2019 11:24 AM
Addresses	Main Address	Insert	New Registration		2040 Dixwell Ave Hamden, CT 06514-2415	4/10/2019 12:01 PM
Addresses	Billing Address	Insert	New Registration		CORNELL SCOTT-HILL HEALTH CORPORATION 400-428 COLUMBUS AVE NEW HAVEN, CT 06519	4/10/2019 12:01 PM
Contacts	Authorizing Official	Insert	New Registration		TAYLOR, MICHAEL R. CEO CORNELL SCOTT-HILL HEALTH CORPORATION 2035033274	4/10/2019 12:01 PM
Contacts	Primary Contact	Insert	New Registration		SHARAFANOWICH, CATHERINE DIRECTOR OF PHARMACY Cornell Scott-Hill Health 2035033178	4/10/2019 12:01 PM
Details	Last Recertification Date	Insert	New Registration			4/10/2019 12:01 PM
Details	Grant Number	Insert	New Registration		H80CS00312	4/10/2019 12:01 PM
Details	340B ID	Insert	New Registration			4/10/2019 12:01 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2019 12:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2019 12:01 PM
Details	Medicare Provider Number	Insert	New Registration			4/10/2019 12:01 PM
Details	Entity Name	Insert	New Registration		Cornell Scott-Hill Health Corporation	4/10/2019 12:01 PM
Details	Program Code	Insert	New Registration		CH	4/10/2019 12:01 PM
Details	Entity Subname	Insert	New Registration		Hamden High School	4/10/2019 12:01 PM
Dates	Participating Approval Date	Insert	New Registration			4/10/2019 12:01 PM
Details	State	Insert	New Registration		Pending	4/10/2019 12:01 PM
Dates	Registration Date	Insert	New Registration		4/10/2019 12:01:07 PM	4/10/2019 12:01 PM
Dates	Signed By Date	Insert	New Registration			4/10/2019 12:01 PM
Dates	Start Date	Insert	New Registration			4/10/2019 12:01 PM
Terminations	Termination Comments	Insert	New Registration			4/10/2019 12:01 PM
Terminations	Termination Date	Insert	New Registration			4/10/2019 12:01 PM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2019 12:01 PM
Terminations	Termination Reason	Insert	New Registration			4/10/2019 12:01 PM

340B Drug Pricing Program Database