340B Drug Pricing Program Database


CHC08238-14 Change, Incorporated (Active) - information as of 5/27/2025 2:44:17 PM

Main Details
Change, Incorporated
FMC - SBHC Steubenville High School
HRSA-Funded Health Center
BPS-H80-038794
CHC08238-14
H80CS08238


Additional Details
Active
1/14/2020
4/1/2020
1/21/2020
2/11/2025

Contacts

CHANGE, Inc.
Lisa Mowry, CEO
(304) 797-7733 Ext: 1311

CHANGE, Inc.
James Boniey, Director of Program Operations
(304) 797-7733 Ext: 1309

Addresses

320 North 4th Street, Room 151
Steubenville, OH 43952-2022

CHANGE, Inc
3158 West St
Weirton, WV 26062


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
WV3810007536,3810008955,3810025567,39100064771063918472,1174074686,1245244367,1528275971,1912311705,1952716433
OH2733993,27642361063918472,1174074686,1245244367,1528275971,1912311705,1952716433
Shipping Addresses

CHANGE, Inc.
3136 West Street
Weirton, WV 26062
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailDAVIS BROTHERS PHARMACYLEGAL BUSINESS NAME: DAVIS BROTHERS PHA 615 N CHESTER ST
NEW CUMBERLANDWV2604701/05/202304/01/2023  04/01/2023
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC08238-00ActiveBPS-H80-000648CHANGE, INCORPORATEDFamily Medical Care Community Health Center - Hancock County3136 West St WeirtonWV
CHC08238-02ActiveBPS-H80-012164CHANGE, INCORPORATEDFamily Medical Care Community Health Center - Jefferson County200 Luray Drive WintersvilleOH
CHC08238-03ActiveBPS-H80-013884CHANGE, INCORPORATEDFMC SBHC - Weirton Elementary3428 Pennsylvania Ave WeirtonWV
CHC08238-04ActiveBPS-H80-017702CHANGE, INCORPORATEDFamily Medical Care Community Health Center - Newell1151 Washington St NewellWV
CHC08238-05ActiveBPS-H80-021757Change, IncorporatedFMC -SBHC Brooke Complex29 Bruin Drive WellsburgWV
CHC08238-06ActiveBPS-H80-022073Change, IncorporatedFMC - SBHC Toronto Complex1305 DENNIS WAY TORONTOOH
CHC08238-07ActiveBPS-H80-022349Change, IncorporatedFMC MAT114 Taylor Ave WeirtonWV
CHC08238-08ActiveBPS-H80-027259Change, IncorporatedFMC - SBHC Weir Complex100 Red Rider Rd WeirtonWV
CHC08238-09ActiveBPS-H80-027370Change, IncorporatedFMC - SBHC Oak Glen Complex39 Golden Bear Dr New CumberlandWV
CHC08238-10ActiveBPS-H80-029429Change, IncorporatedFMC - SBHC Garfield East Elementary School936 N 5th St SteubenvilleOH
CHC08238-11ActiveBPS-H80-029428Change, IncorporatedFMC - SBHC Harding Middle School2002 Sunset Blvd SteubenvilleOH
CHC08238-12ActiveBPS-H80-029426Change, IncorporatedFMC - SBHC McKinley STEM Academy1400 Adams St SteubenvilleOH
CHC08238-13ActiveBPS-H80-029425Change, IncorporatedFMC - SBHC Pugliese West Elementary School435 John Scott Hwy SteubenvilleOH
CHC08238-14ActiveBPS-H80-038794Change, IncorporatedFMC - SBHC Steubenville High School320 North 4th Street, Room 151 SteubenvilleOH
CHC08238-15ActiveBPS-H80-031058Change, IncorporatedFMC SBHC Alternative Learning Center1447 Main St WellsburgWV
CHC08238-16ActiveBPS-H80-033012Change, IncorporatedFMC SBHC Brooke Intermediate North1098 Jefferson St FollansbeeWV
CHC08238-17ActiveBPS-H80-033010Change, IncorporatedFMC SBHC Brooke Intermediate South1305 Washington Pike WellsburgWV
CHC08238-18ActiveBPS-H80-033013Change, IncorporatedFMC SBHC Brooke Primary South1448 Main St WellsburgWV
CHC08238-19ActiveBPS-H80-033011Change, IncorporatedFMC SBHC Brooke Primary North200 Rockdale Rd FollansbeeWV
CHC08238-20ActiveBPS-H80-032123Change, IncorporatedMobile Van #11151 Washington St NewellWV
CHC08238-21ActiveBPS-H80-038170CHANGE INCFMC - SBHC Indian Creek High School200 Park Dr WintersvilleOH
CHC08238-22ActiveBPS-H80-037634CHANGE INCFMC - SBHC Indian Creek Middle School2379 Wilson Ave Mingo JunctionOH
CHC08238-23ToBeTerminatedBPS-H80-038794CHANGE INCFMC - SBHC Steubenville High School320 North 4th Street, Room 151 SteubenvilleOH
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC08238-00A & B SUNSET PHCY4201-A SUNSET BLVD
STEUBENVILLEOH4395207/01/2025  
CHC08238-21A & B SUNSET PHCY4201-A SUNSET BLVD
STEUBENVILLEOH4395207/01/2025  
CHC08238-22A & B SUNSET PHCY4201-A SUNSET BLVD
STEUBENVILLEOH4395207/01/2025  
CHC08238-00ACARIAHEALTH PHARMACY #11, INC1311 W SAM HOUSTON PKWY N STE 130
HOUSTONTX77043-401501/01/2023 12/31/2024
CHC08238-00ACARIAHEALTH PHARMACY #12, INC.5 SKYLINE DR STE 240
HAWTHORNENY10532-216601/01/2023 12/31/2024
CHC08238-00ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/01/2024  
CHC08238-00ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750210/01/2024  
CHC08238-00ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/01/2024  
CHC08238-00ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282210/01/2024  
CHC08238-00ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349210/01/2024  
CHC08238-00ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607510/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2024  
CHC08238-16BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CHC08238-17BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522610/01/2024  
CHC08238-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620310/01/2024  
CHC08238-00CITIZENS DRUG STR OF CHESTERLOUCAS/KARNOUPAKIS ENT 501 CAROLINA AVE
PO BOX 198
CHESTERWV2603404/01/2013  
CHC08238-15CITIZENS DRUG STR OF CHESTERLOUCAS/KARNOUPAKIS ENT 501 CAROLINA AVE
PO BOX 198
CHESTERWV2603404/01/2023  
CHC08238-00CYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503301/01/2023 10/14/2022
CHC08238-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/01/2018  
CHC08238-00DAVIS BROTHERS PHARMACYLEGAL BUSINESS NAME: DAVIS BROTHERS PHA 615 N CHESTER ST
NEW CUMBERLANDWV2604701/01/2016  
CHC08238-14DAVIS BROTHERS PHARMACYLEGAL BUSINESS NAME: DAVIS BROTHERS PHA 615 N CHESTER ST
NEW CUMBERLANDWV2604704/01/2023  
CHC08238-00DAVIS BROTHERS PHARMACY - CHESTER559 CAROLINA AVE STE B
CHESTERWV2603404/01/2017 07/01/2024
CHC08238-02DAVIS BROTHERS PHARMACY - CHESTER559 CAROLINA AVE STE B
CHESTERWV2603404/18/2023 07/02/2024
CHC08238-00DIAMOND PHARMACY503 CADIZ RD
WINTERSVILLEOH43953-412607/01/2025  
CHC08238-21DIAMOND PHARMACY503 CADIZ RD
WINTERSVILLEOH43953-412607/01/2025  
CHC08238-22DIAMOND PHARMACY503 CADIZ RD
WINTERSVILLEOH43953-412607/01/2025  
CHC08238-00DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654104/01/2024  
CHC08238-00ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111210/01/2024  
CHC08238-00EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313410/01/2024  
CHC08238-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801610/01/2024  
CHC08238-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607510/01/2024  
CHC08238-00FOLLANSBEE PHARMACY1415 MAIN ST
FOLLANSBEEWV26037-121706/22/2012  
CHC08238-13FOLLANSBEE PHARMACY1415 MAIN ST
FOLLANSBEEWV26037-121704/01/2023  
CHC08238-00FOUNDATION CARE LLC111 CHESTERFIELD INDUSTRIAL BLVD STE 115
CHESTERFIELDMO6300501/01/2023 12/31/2024
CHC08238-00GIANT EAGLE PHARMACY #147515937 STATE RT 170
EAST LIVERPOOLOH4392010/01/2017 10/01/2018
CHC08238-00GIANT EAGLE PHARMACY #1479619 BRADSHAW AVENUE
EAST LIVERPOOLOH4392010/01/2017 10/01/2018
CHC08238-00HERCHE BLOOR PHARMACY104 E 5TH ST
EAST LIVERPOOLOH4392001/01/2019  
CHC08238-12HERCHE BLOOR PHARMACY104 E 5TH ST
EAST LIVERPOOLOH4392004/01/2023  
CHC08238-00HOOD'S PHARMACY INCJOSEPH A.IERISE 971 MAIN ST
PO BOX 455
FOLLANSBEEWV26037-260310/01/2016  
CHC08238-11HOOD'S PHARMACY INCJOSEPH A.IERISE 971 MAIN ST
PO BOX 455
FOLLANSBEEWV26037-260304/01/2023  
CHC08238-00KROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321704/01/2017  
CHC08238-00KROGER PHARMACY100 ST THOMAS DRIVE
WEIRTONWV2606201/01/2014  
CHC08238-10KROGER PHARMACY100 ST THOMAS DRIVE
WEIRTONWV2606204/18/2023  
CHC08238-00KROGER PHARMACY #26891-27TH STREET
WELLSBURGWV2607001/01/2022  
CHC08238-00KROGER PHARMACY #51213201 RITTENHOUSE DRIVE
MIDLOTHIANVA2311201/01/2022 07/13/2022
CHC08238-00KROGER PHARMACY N-2153558 MAIN STREET
WEIRTONWV2606201/01/2014 08/20/2020
CHC08238-00KROGER PHARMACY N-512264 S HOLLYWOOD BLVD
STEUBENVILLEOH4395210/01/2022  
CHC08238-04KROGER PHARMACY N-512264 S HOLLYWOOD BLVD
STEUBENVILLEOH4395204/18/2023  
CHC08238-00KROGER SAV-ON PHARMACY N-963858 MAIN STREET
WINTERSVILLEOH4395310/01/2014  
CHC08238-10KROGER SAV-ON PHARMACY N-963858 MAIN STREET
WINTERSVILLEOH4395304/01/2023  
CHC08238-00NEW CUMBERLAND PRESCRIPTION107 LINCOLN ST
NEW CUMBERLANDWV26047-955304/01/2013 11/01/2024
CHC08238-09NEW CUMBERLAND PRESCRIPTION107 LINCOLN ST
NEW CUMBERLANDWV26047-955304/01/2023 11/01/2024
CHC08238-00OPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/01/2020 08/31/2020
CHC08238-00OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2020  
CHC08238-00OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/01/2020 09/01/2021
CHC08238-00PENN WAY PHARMACYPENN WAY PHARMACY 3159 MAIN ST
WEIRTONWV2606204/01/2017 01/08/2018
CHC08238-00PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999204/01/2018  
CHC08238-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255004/01/2024  
CHC08238-00RITE AID OF OHIO, INC.RITE AID #450 138 NORTH 5TH STREET
STEUBENVILLEOH4395201/01/2014 02/09/2018
CHC08238-00RITE AID OF OHIO, INC.RITE AID #875 4402 SUNSET BOULEVARD
STEUBENVILLEOH4395201/01/2014 02/09/2018
CHC08238-00RITE AID OF OHIO, INC.RITE AID #2565 1820 FRANKLIN STREET
TORONTOOH4396401/01/2014 02/09/2018
CHC08238-00RITE AID OF WEST VIRGINIA, INC.RITE AID #1949 1600 MAIN STREET
FOLLANSBEEWV2603701/01/2014 02/09/2018
CHC08238-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2024  
CHC08238-00ROSS PARK PHARMACY1 ROSS PARK BLVD
STEUBENVILLEOH43952-268110/01/2014 09/14/2015
CHC08238-00SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2024  
CHC08238-00THREE SPRINGS VILLAGE PHARMACY LLCDBA VILLAGE PHARMACY 204 THREE SPRINGS DR
SUITE A
WEIRTONWV2606207/01/2020  
CHC08238-00THRIFT DRUG, INC.RITE AID #11308 1360 COVE ROAD
WEIRTONWV2606201/01/2014 02/09/2018
CHC08238-00TRI-STATE PHARMACY651 COLLIERS WAY STE 204 JOHN J. BERNABEI, RPH
WEIRTONWV26062-505501/01/2014  
CHC08238-08TRI-STATE PHARMACY651 COLLIERS WAY STE 204 JOHN J. BERNABEI, RPH
WEIRTONWV26062-505504/01/2023  
CHC08238-00VALUE LEADER PHARMACYDBA VALUE LEADER PHARMACY 201 LURAY DR STE B
WINTERSVILLEOH4395310/01/2013  
CHC08238-07VALUE LEADER PHARMACYDBA VALUE LEADER PHARMACY 201 LURAY DR STE B
WINTERSVILLEOH4395304/01/2023  
CHC08238-11VALUE LEADER PHARMACYDBA VALUE LEADER PHARMACY 201 LURAY DR STE B
WINTERSVILLEOH4395304/18/2023  
CHC08238-00VILLAGE LONG TERM PHARMACY LLCVILLAGE LONG TERM CARE PHARMACY 204 THREE SPRINGS DR
SUITE B
WEIRTONWV2606207/01/2025  
CHC08238-22VILLAGE LONG TERM PHARMACY LLCVILLAGE LONG TERM CARE PHARMACY 204 THREE SPRINGS DR
SUITE B
WEIRTONWV2606207/01/2025  
CHC08238-21VILLAGE LONG TERM PHARMACY LLCVILLAGE LONG TERM CARE PHARMACY 204 THREE SPRINGS DR
SUITE B
WEIRTONWV2606207/01/2025  
CHC08238-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2019  
CHC08238-00WAL-MART PHARMACY 10-170716280 DRESDEN DR
EAST LIVERPOOLOH4392001/01/2019  
CHC08238-09WAL-MART PHARMACY 10-170716280 DRESDEN DR
EAST LIVERPOOLOH4392004/18/2023  
CHC08238-00WAL-MART PHARMACY 10-1948400 THREE SPRINGS DR
WEIRTONWV2606201/01/2019  
CHC08238-05WAL-MART PHARMACY 10-1948400 THREE SPRINGS DR
WEIRTONWV2606204/18/2023  
CHC08238-00WAL-MART PHARMACY 10-2193100 MALL DRIVE
STEUBENVILLEOH4395201/01/2019  
CHC08238-03WAL-MART PHARMACY 10-2193100 MALL DRIVE
STEUBENVILLEOH4395204/18/2023  
CHC08238-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2019  
CHC08238-00WALGREEN CO.DBA: WALGREENS #11695 2001 SUNSET BLVD.
STEUBENVILLEOH4395204/01/2015 04/15/2016
CHC08238-00WALGREEN CO.WALGREENS #19676 1360 COVE RD
WEIRTONWV26062-420502/27/2018  
CHC08238-00WALGREEN CO.WALGREENS #19743 1600 MAIN ST
FOLLANSBEEWV2603702/27/2018  
CHC08238-00WALGREEN CO.RITE AID #00450 138 N 5TH ST
STEUBENVILLEOH4395202/28/2018 08/23/2018
CHC08238-00WALGREEN CO.WALGREEN #19910 1820 FRANKLIN ST
TORONTOOH4396402/28/2018  
CHC08238-00WALGREEN CO.WALGREENS #17303 4402 SUNSET BLVD
STEUBENVILLEOH4395202/28/2018  
CHC08238-00WALGREEN CO.DBA: WALGREENS #11695 2001 SUNSET BLVD.
STEUBENVILLEOH4395201/01/2019 11/08/2023
CHC08238-00WALGREEN CO.WALGREENS #19991 126 12TH ST.
WELLSBURGWV26070-157207/01/2019  
CHC08238-00WALGREEN CO.WALGREENS #18289 400 PUBLIC RD
YORKVILLEOH4397101/01/2022 04/24/2025
CHC08238-06WALGREEN CO.WALGREENS #19743 1600 MAIN ST
FOLLANSBEEWV2603704/18/2023  
CHC08238-07WALGREEN CO.WALGREENS #19991 126 12TH ST.
WELLSBURGWV26070-157204/18/2023  
CHC08238-08WALGREEN CO.DBA: WALGREENS #11695 2001 SUNSET BLVD.
STEUBENVILLEOH4395204/18/2023  
CHC08238-00Walgreens #21423Walgreens Central Fill #21423 6275 Winchester Blvd
Canal WInchesterOH43110-653701/01/2024  
CHC08238-00WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528404/01/2015 07/06/2015
CHC08238-00WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904904/01/2015 07/06/2015
CHC08238-00WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/01/2018  
CHC08238-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/01/2018  
CHC08238-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/01/2018  
CHC08238-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/01/2018  
CHC08238-00WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275607/01/2023  
CHC08238-00Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesMain AddressUpdateChange Request 420 N 4th St Steubenville, OH 43952-2022 320 North 4th Street, Room 151 Steubenville, OH 43952-20225/7/2025 8:36 AM
DetailsLast Recertification DateUpdateRecertification1/29/2024 8:05:43 AM2/11/2025 11:14:18 AM2/11/2025 11:14 AM
DetailsLast Recertification DateUpdateRecertification1/31/2023 7:56:21 AM1/29/2024 8:05:43 AM1/29/2024 8:05 AM
DetailsLast Recertification DateUpdateRecertification2/9/2022 12:46:01 PM1/31/2023 7:56:21 AM1/31/2023 7:56 AM
AddressesShipping AddressInsertGroup Change Request CHANGE, Inc. 3136 West Street Weirton, WV 260622/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1013565571 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1043546443 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1053365262 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1083124036 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1104949338 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1154893840 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1235680372 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1265416929 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1346537321 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1346587409 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1437551918 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1457722555 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1457727281 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1457847667 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1497208847 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1548608896 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1568438539 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1588069561 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1588652499 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1598249393 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1629196571 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1639169923 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1689671703 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1730176900 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1740624337 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1831281856 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1891129441 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1891781084 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1902875743 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1912259920 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1932677507 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1942592035 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1942725684 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1013565571 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1043546443 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1053365262 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1083124036 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1104949338 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1154893840 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1235680372 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1265416929 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1346537321 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1346587409 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1437551918 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1457722555 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1457727281 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1457847667 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1497208847 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1548608896 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1568438539 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1588069561 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1588652499 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1598249393 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1629196571 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1639169923 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1689671703 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1730176900 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1740624337 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1831281856 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1891129441 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1891781084 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1902875743 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1912259920 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1932677507 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1942592035 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1942725684 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1629366463 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1548860471 (OH) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1629366463 (WV) 2/28/2022 9:18 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1548860471 (WV) 2/28/2022 9:18 AM
DetailsLast Recertification DateUpdateRecertification2/4/2021 9:19:50 AM2/9/2022 12:46:01 PM2/9/2022 12:46 PM
ContactsAuthorizing OfficialUpdateAO Change RequestRaveaux, Judy CEO CHANGE, Incorporated 3047977733-1311Mowry, Lisa CEO CHANGE, Inc. 3047977733-13112/8/2022 9:51 AM
DetailsLast Recertification DateUpdateRecertification 2/4/2021 9:19:50 AM2/4/2021 9:19 AM
Medicaid BillingNPI: NumberInsertChange Request 16293664631/6/2021 11:23 AM
Medicaid BillingNPI: StateInsertChange Request OH1/6/2021 11:23 AM
Medicaid BillingNPI: NumberInsertChange Request 15488604711/6/2021 11:23 AM
Medicaid BillingNPI: StateInsertChange Request OH1/6/2021 11:23 AM
Medicaid BillingNPI: NumberInsertChange Request 16293664631/6/2021 11:23 AM
Medicaid BillingNPI: StateInsertChange Request WV1/6/2021 11:23 AM
Medicaid BillingNPI: NumberInsertChange Request 15488604711/6/2021 11:23 AM
Medicaid BillingNPI: StateInsertChange Request WV1/6/2021 11:23 AM
Medicaid BillingNPI: NumberDeleteChange Request1346537321 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1588652499 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1639169923 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1598249393 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1932677507 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1013565571 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1245244367 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1528275971 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1437551918 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1235680372 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1457847667 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1568438539 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1730176900 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1083124036 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1629196571 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1588069561 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1902875743 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1104949338 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1346587409 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1043546443 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1265416929 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1891781084 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1942725684 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1154893840 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1740624337 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1912259920 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1831281856 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1497208847 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1548608896 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1053365262 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1689671703 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1942592035 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1457727281 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1912311705 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1952716433 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1174074686 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1063918472 ( ) 10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 101356557110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 104354644310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 105336526210/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 106391847210/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 108312403610/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 110494933810/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 115489384010/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 117407468610/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 123568037210/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 124524436710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 126541692910/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 134653732110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 134658740910/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 143755191810/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 145772255510/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 145772728110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 145784766710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 149720884710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 152827597110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 154860889610/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 156843853910/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 158806956110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 158865249910/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 159824939310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 162919657110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 163916992310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 168967170310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 173017690010/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 174062433710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 183128185610/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 189112944110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 189178108410/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 190287574310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 191225992010/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 191231170510/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 193267750710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 194259203510/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 194272568410/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 195271643310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request OH10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 101356557110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 104354644310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 105336526210/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 106391847210/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 108312403610/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 110494933810/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 115489384010/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 117407468610/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 123568037210/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 124524436710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 126541692910/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 134653732110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 134658740910/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 143755191810/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 145772255510/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 145772728110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 145784766710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 149720884710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 152827597110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 154860889610/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 156843853910/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 158806956110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 158865249910/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 159824939310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 162919657110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 163916992310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 168967170310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 173017690010/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 174062433710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 183128185610/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 189112944110/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 189178108410/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 190287574310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 191225992010/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 191231170510/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 193267750710/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 194259203510/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 194272568410/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 195271643310/15/2020 2:07 PM
Medicaid BillingNPI: StateInsertChange Request WV10/15/2020 2:07 PM
Medicaid BillingNPI: NumberDeleteChange Request1285642793 ( ) 7/9/2020 6:56 AM
Medicaid BillingNPI: NumberInsertChange Request 19123117057/9/2020 6:56 AM
Medicaid BillingNPI: NumberInsertChange Request 19527164337/9/2020 6:56 AM
Medicaid BillingNPI: NumberInsertChange Request 11740746867/9/2020 6:56 AM
Medicaid BillingNPI: NumberInsertChange Request 10639184727/9/2020 6:56 AM
Medicaid BillingNPI: NumberInsertChange Request 12452443674/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 15282759714/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 14375519184/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 12356803724/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 14578476674/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 15684385394/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 17301769004/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 10831240364/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 16291965714/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 15880695614/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 19028757434/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 12856427934/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 11049493384/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 13465874094/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 10435464434/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 12654169294/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 18917810844/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 19427256844/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 11548938404/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 17406243374/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 19122599204/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 18312818564/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 14972088474/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 15486088964/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 10533652624/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 16896717034/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 19425920354/3/2020 12:16 PM
Medicaid BillingNPI: NumberInsertChange Request 14577272814/3/2020 12:16 PM
DetailsStateUpdate ApprovedActive4/1/2020 12:05 AM
ContactsSigned ByInsertNew Registration Raveaux, Judy CEO CHANGE, Incorporated 3047977733-13111/21/2020 11:05 AM
Details340B IDUpdateNew Registration CHC08238-141/21/2020 11:05 AM
DatesParticipating Approval DateUpdateNew Registration 1/21/2020 11:05:25 AM1/21/2020 11:05 AM
DetailsStateUpdateNew RegistrationPendingApproved1/21/2020 11:05 AM
DatesSigned By DateUpdateNew Registration 1/14/2020 6:55:00 AM1/21/2020 11:05 AM
DatesStart DateUpdateNew Registration 4/1/2020 12:00:00 AM1/21/2020 11:05 AM
AddressesMain AddressInsertNew Registration  420 N 4th St Steubenville, OH 43952-20221/14/2020 6:54 AM
AddressesBilling AddressInsertNew Registration CHANGE, Inc 3158 West St Weirton, WV 260621/14/2020 6:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/14/2020 6:54 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 38100075361/14/2020 6:54 AM
Medicaid BillingMedicaid: StateInsertNew Registration WV1/14/2020 6:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/14/2020 6:54 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 38100089551/14/2020 6:54 AM
Medicaid BillingMedicaid: StateInsertNew Registration WV1/14/2020 6:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/14/2020 6:54 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 38100255671/14/2020 6:54 AM
Medicaid BillingMedicaid: StateInsertNew Registration WV1/14/2020 6:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/14/2020 6:54 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 39100064771/14/2020 6:54 AM
Medicaid BillingMedicaid: StateInsertNew Registration WV1/14/2020 6:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/14/2020 6:54 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 27339931/14/2020 6:54 AM
Medicaid BillingMedicaid: StateInsertNew Registration OH1/14/2020 6:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/14/2020 6:54 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 27642361/14/2020 6:54 AM
Medicaid BillingMedicaid: StateInsertNew Registration OH1/14/2020 6:54 AM
Medicaid BillingNPI: NumberInsertNew Registration 13465373211/14/2020 6:54 AM
Medicaid BillingNPI: NumberInsertNew Registration 15886524991/14/2020 6:54 AM
Medicaid BillingNPI: NumberInsertNew Registration 16391699231/14/2020 6:54 AM
Medicaid BillingNPI: NumberInsertNew Registration 15982493931/14/2020 6:54 AM
Medicaid BillingNPI: NumberInsertNew Registration 19326775071/14/2020 6:54 AM
Medicaid BillingNPI: NumberInsertNew Registration 10135655711/14/2020 6:54 AM
ContactsAuthorizing OfficialInsertNew Registration Raveaux, Judy CEO CHANGE, Incorporated 3047977733-13111/14/2020 6:54 AM
ContactsPrimary ContactInsertNew Registration Boniey, James Director of Program Operations CHANGE, Inc. 3047977733-13091/14/2020 6:54 AM
DetailsLast Recertification DateInsertNew Registration  1/14/2020 6:54 AM
DetailsGrant NumberInsertNew Registration H80CS082381/14/2020 6:54 AM
Details340B IDInsertNew Registration  1/14/2020 6:54 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/14/2020 6:54 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/14/2020 6:54 AM
DetailsMedicare Provider NumberInsertNew Registration  1/14/2020 6:54 AM
DetailsEntity NameInsertNew Registration Change, Incorporated1/14/2020 6:54 AM
DetailsProgram CodeInsertNew Registration CH1/14/2020 6:54 AM
DetailsEntity SubnameInsertNew Registration FMC - SBHC Steubenville High School1/14/2020 6:54 AM
DatesParticipating Approval DateInsertNew Registration  1/14/2020 6:54 AM
DetailsStateInsertNew Registration Pending1/14/2020 6:54 AM
DatesRegistration DateInsertNew Registration 1/14/2020 6:54:57 AM1/14/2020 6:54 AM
DatesSigned By DateInsertNew Registration  1/14/2020 6:54 AM
DatesStart DateInsertNew Registration  1/14/2020 6:54 AM
TerminationsTermination CommentsInsertNew Registration  1/14/2020 6:54 AM
TerminationsTermination DateInsertNew Registration  1/14/2020 6:54 AM
TerminationsTermination Effective DateInsertNew Registration  1/14/2020 6:54 AM
TerminationsTermination ReasonInsertNew Registration  1/14/2020 6:54 AM