Covered Entity Details

CH05198AN Alcona Citizens For Health, Inc. (Active) - information as of 4/30/2025 10:51:14 PM

Main Details

Name

Alcona Citizens For Health, Inc.

Subdivision Name

AHC Richardson Elementary School SBHC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-021280

340B ID

CH05198AN

Grant Number

H80CS00679

Additional Details

Current Program Status

Active

Registration Date

8/25/2020

Participating Start Date

10/1/2020

Participating Approval Date

8/26/2020

Last Recertification Date

2/19/2025

Contacts

Authorizing Official

ALCONA CITIZENS FOR HEALTH, INC
Nancy Spencer, CEO
(989) 358-3916

Primary Contact

Alcona Citizens for Health, Inc.
Katelyn Kane, Pharmacy Director
(989) 358-3922

Addresses

Street Address

3630 E River Rd Rm sw1
Oscoda, MI 48750

Billing Address

ALCONA CITIZENS FOR HEALTH, INC.
P.O. BOX 655
ALPENA, MI 49707

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
MI		1487164257,1326055450

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	WAL-MART PHARMACY 10-1936	3763 I-75 BUSINESS SPUR		SAULT SAINTE MARIE	MI	49783	04/10/2024	07/01/2024			07/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH051980	Active	BPS-H80-021993	ALCONA CITIZENS FOR HEALTH, INC.	Alcona Health Center-Lincoln Services	177 N Barlow Rd	Harrisville	MI
CH05198A	Active	BPS-H80-009556	ALCONA CITIZENS FOR HEALTH, INC.	Alcona Health Centers - Harrisville Services	205 N. State St. STE A	Harrisville	MI
CH05198AB	Active	BPS-H80-003338	ALCONA CITIZENS FOR HEALTH, INC.	AHC TIGER HEALTH EXTENSION	181 N. BARLOW RD	HARRISVILLE	MI
CH05198AC	Active	BPS-H80-019331	ALCONA CITIZENS FOR HEALTH, INC.	Alcona Health Center Pellston Services	421 Stimpson Street Unit 102	Pellston	MI
CH05198AD	Terminated	BPS-H80-021299	Alcona Citizens For Health, Inc.	Alcona Health Center Cheboygan Campus Suite 3A	740 S Main St Ste 3A	Cheboygan	MI
CH05198AE	Active	BPS-H80-021795	Alcona Citizens For Health, Inc.	Dr. Rudy Barba Psychiatry Services	101 S. Union Street Unit 101 RM 1	Plymouth	MI
CH05198AF	Terminated	BPS-H80-021300	Alcona Citizens For Health, Inc.	Alcona Health Center Cheboygan Campus Suite 2B	740 S Main St Ste 2B	Cheboygan	MI
CH05198AG	Active	BPS-H80-021652	Alcona Citizens For Health, Inc.	Alcona Health Center Advanced Psychiatric Services	32905 W 12 Mile Rd Ste 410	Farmington Hills	MI
CH05198AH	Terminated	BPS-H80-021301	Alcona Citizens For Health, Inc.	Alcona Health Center Cheboygan Campus Suite 2A	740 S Main St Ste 2A	Cheboygan	MI
CH05198AJ	Terminated	BPS-H80-021298	Alcona Citizens For Health, Inc.	Alcona Health Center Cheboygan Campus Suite 2C	740 S Main St Ste 2C	Cheboygan	MI
CH05198AK	Terminated	BPS-H80-021794	Alcona Citizens For Health, Inc.	Summit Psychological Services	17444 Dunewood Court, Unit B, Room 1	Spring Lake	MI
CH05198AL	Terminated	BPS-H80-021793	Alcona Citizens For Health, Inc.	Summit Psychological Services	20010 Farmington Road Room 2	Livonia	MI
CH05198AM	Active	BPS-H80-022307	Alcona Citizens For Health, Inc.	Alcona Health Center-Alpena Dental Services	3036 French Rd	Alpena	MI
CH05198AN	Active	BPS-H80-021280	Alcona Citizens For Health, Inc.	AHC Richardson Elementary School SBHC	3630 E River Rd Rm sw1	Oscoda	MI
CH05198AP	Active	BPS-H80-031493	Alcona Citizens For Health, Inc.	Alcona Health Center Cheboygan Campus	740 S Main St Fl 2	Cheboygan	MI
CH05198AQ	Terminated	BPS-H80-032005	Alcona Citizens For Health, Inc.	Alcona Health Center Cheboygan Campus Annex, Lincoln Bridge Plaza	722 S Main St	Cheboygan	MI
CH05198AR	Active	BPS-H80-039517	ALCONA CITIZENS FOR HEALTH INC	Alcona Health Center Mobile Unit	1185 US-23 N	Alpena	MI
CH05198B	Active	BPS-H80-003692	ALCONA CITIZENS FOR HEALTH, INC.	ALCONA HLTH CTRS-OSSINEKE SVCS	11745 Us Highway 23 S	Ossineke	MI
CH05198C	Active	BPS-H80-001145	ALCONA CITIZENS FOR HEALTH, INC.	ALCONA HLTH CTR-ALPENA SERVICES	1185 Us Highway 23 N	Alpena	MI
CH05198D	Terminated	BPS-H80-002206	ALCONA CITIZENS FOR HEALTH, INC.	ALCONA HLTH CTRS - OSCODA SVCS	5671 N Skeel Ave Ste 8	Oscoda	MI
CH05198F	Active	BPS-H80-008471	ALCONA CITIZENS FOR HEALTH, INC.	Alcona Health Center Emmet County Site	3434 M 119	Harbor Springs	MI
CH05198G	Active	BPS-H80-010929	ALCONA CITIZENS FOR HEALTH, INC.	Lincoln School Wildcat Health Extension	309 W. Lake St.	Alpena	MI
CH05198H	Active	BPS-H80-021260	ALCONA CITIZENS FOR HEALTH, INC.	Alcona Health Center Pickford Medical Clinic	416 N M 129	Pickford	MI
CH05198J	Terminated	BPS-H80-014904	ALCONA CITIZENS FOR HEALTH, INC.	Alcona Health Center Cheboygan Site	740 S MAIN ST	CHEBOYGAN	MI
CH05198JK	Active	BPS-H80-033444	ALCONA CITIZENS FOR HEALTH INC	Alcona Health Center Pediatrics	1209 US Highway 23 N	Alpena	MI
CH05198K	Active	BPS-H80-010971	ALCONA CITIZENS FOR HEALTH, INC.	AHC Tiger Health Extension - Alcona Middle & High School	51 N. Barlow Rd	Harrisville	MI
CH05198L	Active	BPS-H80-015377	ALCONA CITIZENS FOR HEALTH, INC.	Indian River Health Center	6135 Cressy St	Indian River	MI
CH05198M	Active	BPS-H80-019031	ALCONA CITIZENS FOR HEALTH, INC.	Alcona Health Center Petoskey Child Health Associates	2390 Mitchell Park Dr Ste A	Petoskey	MI
CH05198N	Active	BPS-H80-020820	ALCONA CITIZENS FOR HEALTH, INC.	Alcona Health Center-Long Rapids Plaza	346 Long Rapids Plaza	Alpena	MI
CH05198P	Active	BPS-H80-034460	Alcona Citizens For Health, Inc.	Alcona Health Center - Oscoda Services	208 S State St	Oscoda	MI
CH05198Q	Active	BPS-H80-017022	Alcona Citizens For Health, Inc.	Alpena High School	3303 S Third Ave Ste D-128	Alpena	MI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH051980	APEX DRUG STORES, INC.	RITE AID #4532	2140 US HIGHWAY 23 S	ALPENA	MI	49707	04/01/2014	07/18/2024
CH05198Q	APEX DRUG STORES, INC.	RITE AID #4532	2140 US HIGHWAY 23 S	ALPENA	MI	49707	07/01/2024	07/18/2024
CH051980	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2022
CH051980	FAMILY FARE PHARMACY #1504	992 S MAIN		CHEBOYGAN	MI	49721	07/01/2024
CH051980	GILBERTS DRUG STORE INC	212 S STATE ST	PO BOX 130	OSCODA	MI	48750-1635	01/01/2015
CH05198P	GILBERTS DRUG STORE INC	212 S STATE ST	PO BOX 130	OSCODA	MI	48750-1635	07/01/2024
CH051980	INDIAN RIVER VILLAGE PHARMACY, INC	6433 BARBARA AVENUE	P.O. BOX 2039	INDIAN RIVER	MI	49749	04/01/2016	12/12/2016
CH051980	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	10/01/2015
CH051980	MEIJER INC #257	1201 LEARS ROAD		PETOSKEY	MI	49770	10/01/2015	09/30/2016
CH051980	MEIJER PHARMACY #282	1251 M-32 W		ALPENA	MI	49707	10/01/2015
CH05198N	MEIJER PHARMACY #282	1251 M-32 W		ALPENA	MI	49707	07/01/2024
CH051980	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	01/01/2022
CH051980	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	10/01/2015
CH051980	MODERN MEDICAL SERVICE, INC.	DBA MODERN PHARMACY	127 N MAIN ST PO BOX 345	CHEBOYGAN	MI	49721	11/08/2022
CH05198H	MODERN MEDICAL SERVICE, INC.	DBA MODERN PHARMACY	127 N MAIN ST PO BOX 345	CHEBOYGAN	MI	49721	07/01/2024
CH05198AC	MODERN MEDICAL SERVICE, INC.	DBA MODERN PHARMACY	127 N MAIN ST PO BOX 345	CHEBOYGAN	MI	49721	07/01/2024
CH051980	MODERN MEDICAL SERVICES INC	DBA MODERN PHARMACY	127 N MAIN ST P.O. BOX 345	CHEBOYGAN	MI	49721-1637	10/01/2015	05/31/2022
CH051980	MODERN MEDICAL SERVICES INC	DBA MODERN PHARMACY	127 N MAIN ST P.O. BOX 345	CHEBOYGAN	MI	49721-1637	07/11/2022	07/11/2022
CH051980	MODERN RX	3944 S STRAITS HWY		INDIAN RIVER	MI	49749-5135	01/01/2022
CH05198L	MODERN RX	3944 S STRAITS HWY		INDIAN RIVER	MI	49749-5135	07/01/2024
CH05198B	OSSINEKE PHARMACY		11745 US 23 SOUTH	OSSINEKE	MI	49766-0155	01/01/2002	01/08/2021
CH05198D	OSSINEKE PHARMACY		11745 US 23 SOUTH	OSSINEKE	MI	49766-0155	01/06/2005	01/08/2021
CH051980	OSSINEKE PHARMACY		11745 US 23 SOUTH	OSSINEKE	MI	49766-0155	01/06/2005
CH05198A	OSSINEKE PHARMACY		11745 US 23 SOUTH	OSSINEKE	MI	49766-0155	01/06/2005	01/08/2021
CH05198C	OSSINEKE PHARMACY		11745 US 23 SOUTH	OSSINEKE	MI	49766-0155	01/06/2005	01/08/2021
CH05198AB	OSSINEKE PHARMACY		11745 US 23 SOUTH	OSSINEKE	MI	49766-0155	08/22/2006	01/08/2021
CH05198B	OSSINEKE PHARMACY		11745 US 23 SOUTH	OSSINEKE	MI	49766-0155	07/01/2024
CH051980	PDS-I MICHIGAN, INC.	RITE AID #4410	630 WEST MITCHELL STREET	PETOSKEY	MI	49770	04/01/2014	10/05/2022
CH051980	PDS-I MICHIGAN, INC.	RITE AID #4579	1025 ASHMUN STREET	SAULT STE MARIE	MI	49783	10/01/2018	07/16/2024
CH051980	PERRY DRUG STORES, INC.	RITE AID #4502	211 E LAKE STREET	TAWAS CITY	MI	48763-9305	04/01/2014	08/20/2024
CH051980	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2022	10/01/2022
CH051980	RITE AID OF MICHIGAN, INC.	RITE AID #2473	5280 NORTH HURON ROAD	OSCODA	MI	48750	04/01/2014	08/21/2024
CH051980	RITE AID OF MICHIGAN, INC.	RITE AID #1691	1133 NORTH US 31	PETOSKEY	MI	49770	04/01/2014	07/08/2024
CH051980	RITE AID OF MICHIGAN, INC.	RITE AID #2606	110 SOUTH BRADLEY HIGHWAY	ROGERS CITY	MI	49779	10/01/2018	08/20/2024
CH05198AB	RITE AID OF MICHIGAN, INC.	RITE AID #2473	5280 NORTH HURON ROAD	OSCODA	MI	48750	07/01/2024	08/21/2024
CH05198AE	RITE AID OF MICHIGAN, INC.	RITE AID #1691	1133 NORTH US 31	PETOSKEY	MI	49770	07/01/2024	07/08/2024
CH051980	THE DRUG STORE INC	PRESIDENT	2236 US HIGHWAY 23 S	ALPENA	MI	49707-4544	01/01/2023
CH05198JK	THE DRUG STORE INC	PRESIDENT	2236 US HIGHWAY 23 S	ALPENA	MI	49707-4544	07/01/2024
CH051980	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2015
CH051980	WAL-MART PHARMACY 10-1936	3763 I-75 BUSINESS SPUR		SAULT SAINTE MARIE	MI	49783	01/01/2016
CH05198AN	WAL-MART PHARMACY 10-1936	3763 I-75 BUSINESS SPUR		SAULT SAINTE MARIE	MI	49783	07/01/2024
CH05198H	WAL-MART PHARMACY 10-1936	3763 I-75 BUSINESS SPUR		SAULT SAINTE MARIE	MI	49783	07/01/2024
CH051980	WAL-MART PHARMACY 10-2100	1150 SOUTH MAIN		CHEBOYGAN	MI	49721	01/01/2015
CH05198AP	WAL-MART PHARMACY 10-2100	1150 SOUTH MAIN		CHEBOYGAN	MI	49721	07/01/2024
CH051980	WAL-MART PHARMACY 10-2358	1180 M-32 WEST		ALPENA	MI	49707	07/01/2014
CH05198A	WAL-MART PHARMACY 10-2358	1180 M-32 WEST		ALPENA	MI	49707	01/01/2013	01/08/2021
CH05198AM	WAL-MART PHARMACY 10-2358	1180 M-32 WEST		ALPENA	MI	49707	07/01/2024
CH051980	WAL-MART PHARMACY 10-2417	1850 ANDERSON RD		PETOSKEY	MI	49770	07/01/2014
CH05198A	WAL-MART PHARMACY 10-2417	1850 ANDERSON RD		PETOSKEY	MI	49770	01/01/2013	01/08/2021
CH05198AC	WAL-MART PHARMACY 10-2417	1850 ANDERSON RD		PETOSKEY	MI	49770	07/01/2024
CH05198A	WAL-MART PHARMACY 10-2417	1850 ANDERSON RD		PETOSKEY	MI	49770	07/01/2024
CH051980	WAL-MART PHARMACY 10-5376	621 EAST LAKE STREET		TAWAS CITY	MI	48763	07/01/2014
CH05198A	WAL-MART PHARMACY 10-5376	621 EAST LAKE STREET		TAWAS CITY	MI	48763	01/01/2013	01/08/2021
CH05198K	WAL-MART PHARMACY 10-5376	621 EAST LAKE STREET		TAWAS CITY	MI	48763	07/01/2024
CH051980	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2015
CH051980	WALGREEN CO	DBA: WALGREENS #12534	1301 N US HWY 31	PETOSKEY	MI	49770	04/01/2014
CH051980	WALGREEN CO	DBA: WALGREENS #12508	1500 BRIDGE ST	CHARLEVOIX	MI	49720	04/01/2016
CH05198M	WALGREEN CO	DBA: WALGREENS #12534	1301 N US HWY 31	PETOSKEY	MI	49770	07/01/2024
CH05198Q	WALGREEN CO	DBA: WALGREENS #12508	1500 BRIDGE ST	CHARLEVOIX	MI	49720	10/01/2024
CH051980	WALGREEN CO.	DBA: WALGREENS # 05481	710 SPRING STREET	PETOSKEY	MI	49770	04/01/2014
CH051980	WALGREEN CO.	DBA: WALGREENS # 09148	1011 M 32 W	ALPENA	MI	49707-8169	04/01/2014
CH051980	WALGREEN CO.	DBA: WALGREENS # 10514	991 SOUTH MAIN ST	CHEBOYGAN	MI	49721-2219	04/01/2015
CH051980	WALGREEN CO.	DBA: WALGREENS # 10405	2101 ASHMUN ST	SAULT STE MARIE	MI	49783	01/01/2016
CH05198G	WALGREEN CO.	DBA: WALGREENS # 09148	1011 M 32 W	ALPENA	MI	49707-8169	07/01/2024
CH05198A	WALGREEN CO.	DBA: WALGREENS # 05481	710 SPRING STREET	PETOSKEY	MI	49770	07/01/2024
CH05198F	WALGREEN CO.	DBA: WALGREENS # 10514	991 SOUTH MAIN ST	CHEBOYGAN	MI	49721-2219	07/01/2024
CH05198AG	WALGREEN CO.	DBA: WALGREENS # 10405	2101 ASHMUN ST	SAULT STE MARIE	MI	49783	07/01/2024
CH051980	WALGREEN CO.	DBA: WALGREENS # 10406	2480 E HOUGHTON AVE	WEST BRANCH	MI	48661-1150	10/01/2024
CH05198AE	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21186	2284 S BALLENGER HWY STE F	FLINT	MI	48503	10/01/2024
CH05198AB	WALGREEN CO.	DBA: WALGREENS # 10406	2480 E HOUGHTON AVE	WEST BRANCH	MI	48661-1150	10/01/2024
CH051980	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21186	2284 S BALLENGER HWY STE F	FLINT	MI	48503	10/01/2024
CH051980	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CH051980	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2014	07/22/2015
CH051980	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2022
CH051980	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2022
CH051980	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2022
CH05198AE	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/01/2024
CH05198AR	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2025
CH051980	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH051980	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Delete	Recertification	Alcona Health Center Pharmacy 177 N BARLOW RD HARRISVILLE, MI 48740-9607		2/19/2025 1:26 PM
Addresses	Shipping Address	Delete	Recertification	Alcona Health Center Pharmacy 1185 Us HIGHWAY 23 N ALPENA, MI 49707-8018		2/19/2025 1:26 PM
Details	Last Recertification Date	Update	Recertification	2/8/2024 9:57:28 AM	2/19/2025 1:26:47 PM	2/19/2025 1:26 PM
Contacts	Primary Contact	Update	Group Change Request	Rumbles, Anna Pharmacy Director Alcona Citizens for Health, Inc. 9893583922	Kane, Katelyn Pharmacy Director Alcona Citizens for Health, Inc. 9893583922	5/1/2024 5:39 PM
Addresses	Main Address	Update	Recertification	3630 E River Rd Rm sw1 Oscoda, MI 48750-9026	3630 E River Rd Rm sw1 Oscoda, MI 48750	2/8/2024 9:57 AM
Details	Last Recertification Date	Update	Recertification	2/16/2023 1:58:20 PM	2/8/2024 9:57:28 AM	2/8/2024 9:57 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1487164257	6/16/2023 7:20 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	6/16/2023 7:20 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1326055450	6/16/2023 7:20 AM
Medicaid Billing	NPI: State	Insert	Change Request		MI	6/16/2023 7:20 AM
Details	Last Recertification Date	Update	Recertification	2/9/2022 9:25:40 AM	2/16/2023 1:58:20 PM	2/16/2023 1:58 PM
Details	Last Recertification Date	Update	Recertification	2/3/2021 11:30:00 AM	2/9/2022 9:25:40 AM	2/9/2022 9:25 AM
Details	Last Recertification Date	Update	Recertification		2/3/2021 11:30:00 AM	2/3/2021 11:30 AM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		Spencer, Nancy CEO ALCONA CITIZENS FOR HEALTH, INC 9893583916	8/26/2020 5:42 PM
Details	340B ID	Update	New Registration		CH05198AN	8/26/2020 5:42 PM
Dates	Participating Approval Date	Update	New Registration		8/26/2020 5:42:58 PM	8/26/2020 5:42 PM
Details	State	Update	New Registration	Pending	Approved	8/26/2020 5:42 PM
Dates	Signed By Date	Update	New Registration		8/25/2020 2:27:08 PM	8/26/2020 5:42 PM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	8/26/2020 5:42 PM
Addresses	Main Address	Insert	New Registration		3630 E River Rd Rm sw1 Oscoda, MI 48750-9026	8/25/2020 1:00 PM
Addresses	Billing Address	Insert	New Registration		ALCONA CITIZENS FOR HEALTH, INC. P.O. BOX 655 ALPENA, MI 49707	8/25/2020 1:00 PM
Addresses	Shipping Address	Insert	New Registration		Alcona Health Center Pharmacy 177 N BARLOW RD HARRISVILLE, MI 48740-9607	8/25/2020 1:00 PM
Addresses	Shipping Address	Insert	New Registration		Alcona Health Center Pharmacy 1185 Us HIGHWAY 23 N ALPENA, MI 49707-8018	8/25/2020 1:00 PM
Contacts	Authorizing Official	Insert	New Registration		Spencer, Nancy CEO ALCONA CITIZENS FOR HEALTH, INC 9893583916	8/25/2020 1:00 PM
Contacts	Primary Contact	Insert	New Registration		Rumbles, Anna Pharmacy Director Alcona Citizens for Health, Inc. 9893583922	8/25/2020 1:00 PM
Details	Assistance Received From Date	Insert	New Registration			8/25/2020 1:00 PM
Details	Assistance Received To Date	Insert	New Registration			8/25/2020 1:00 PM
Details	Last Recertification Date	Insert	New Registration			8/25/2020 1:00 PM
Details	Grant Number	Insert	New Registration		H80CS00679	8/25/2020 1:00 PM
Details	340B ID	Insert	New Registration			8/25/2020 1:00 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			8/25/2020 1:00 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			8/25/2020 1:00 PM
Details	Medicare Provider Number	Insert	New Registration			8/25/2020 1:00 PM
Details	Entity Name	Insert	New Registration		Alcona Citizens For Health, Inc.	8/25/2020 1:00 PM
Details	NOFO Number	Insert	New Registration			8/25/2020 1:00 PM
Details	Program Code	Insert	New Registration		CH	8/25/2020 1:00 PM
Details	Entity Subname	Insert	New Registration		AHC Richardson Elementary School SBHC	8/25/2020 1:00 PM
Dates	Participating Approval Date	Insert	New Registration			8/25/2020 1:00 PM
Details	State	Insert	New Registration		Pending	8/25/2020 1:00 PM
Dates	Registration Date	Insert	New Registration		8/25/2020 1:00:07 PM	8/25/2020 1:00 PM
Dates	Signed By Date	Insert	New Registration			8/25/2020 1:00 PM
Dates	Start Date	Insert	New Registration			8/25/2020 1:00 PM
Terminations	Termination Comments	Insert	New Registration			8/25/2020 1:00 PM
Terminations	Termination Date	Insert	New Registration			8/25/2020 1:00 PM
Terminations	Termination Effective Date	Insert	New Registration			8/25/2020 1:00 PM
Terminations	Termination Reason	Insert	New Registration			8/25/2020 1:00 PM

340B Drug Pricing Program Database