Covered Entity Details

FQHCLA412 Lasante Health Center, Inc. (Active) - information as of 6/25/2025 12:50:54 AM

Main Details

Name

Lasante Health Center, Inc.

Subdivision Name

Lasante Health Center

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-021490

340B ID

FQHCLA412

Grant Number

LALCS31598

Additional Details

Current Program Status

Active

Registration Date

10/2/2020

Participating Start Date

1/1/2021

Participating Approval Date

10/7/2020

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

LaSante Health Center
Mordechai Heller, COO
(718) 246-5700 Ext: 120

Primary Contact

LaSante Health Center
Gedalya Blumenfrucht, CEO
(718) 246-5700 Ext: 121

Addresses

Street Address

672 Parkside Ave
Brooklyn, NY 11226-1506

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
Last Recertification Date: 03/22/2021	03/23/2021

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
NY	04644657	1740672732

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/08/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/08/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/08/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/08/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/08/2021	10/01/2021		10/01/2021
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/08/2021	10/01/2021		10/01/2021
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CAREWAY RX INC	CAREWAY PHARMACY	1174 FLATBUSH AVE	BROOKLYN	NY	11226-7005	10/15/2024	01/01/2025		01/01/2025
Contract Detail	CRYSTAL DRUGS INC	MICHAEL'S PHARMACY	163 LINDEN BLVD	BROOKLYN	NY	11226	04/13/2022	07/01/2022		07/01/2022
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02344	1249 NOSTRAND AVENUE	BROOKLYN	NY	11225	01/17/2023	04/01/2023		04/01/2023
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02431	4112 AVENUE U	BROOKLYN	NY	11234	01/17/2023	04/01/2023		04/01/2023
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02769	4901 KINGS HIGHWAY	BROOKLYN	NY	11234	01/17/2023	04/01/2023		04/01/2023
Contract Detail	CVS ALBANY, L.L.C.	CVS/PHARMACY # 10291	1601 KINGS HWY	BROOKLYN	NY	11229	01/17/2023	04/01/2023		04/01/2023
Contract Detail	CVS ALBANY, L.L.C.	CVS PHARMACY # 17290	1598 FLATBUSH AVE	BROOKLYN	NY	11210	01/17/2023	04/01/2023		04/01/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/03/2023	07/01/2023		07/01/2023
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/03/2023	07/01/2023		07/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/11/2024	04/01/2024		04/01/2024
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/03/2023	07/01/2023		07/01/2023
Contract Detail	DUANE READE	724 FLATBUSH AVENUE		BROOKLYN	NY	11226	04/03/2023	07/01/2023		07/01/2023
Contract Detail	DUANE READE	1517 CORTELYOU ROAD		BROOKLYN	NY	11226	04/03/2023	07/01/2023		07/01/2023
Contract Detail	DUANE READE	296 FLATBUSH AVE		BROOKLYN	NY	11217-2812	04/03/2023	07/01/2023		07/01/2023
Contract Detail	DUANE READE	2265 RALPH AVENUE		BROOKLYN	NY	11234	04/03/2023	07/01/2023		07/01/2023
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/14/2021	10/01/2021		10/01/2021
Contract Detail	ESTABLISHED DRUGS INC	D/B/A HEALTH-WISE PHARMACY	1233 NOSTRAND AVE	BROOKLYN	NY	11225	10/07/2020	01/01/2021		03/23/2021
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/14/2021	10/01/2021		10/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/14/2021	10/01/2021		10/01/2021
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/14/2021	10/01/2021		10/01/2021
Contract Detail	GOVIND PHARM INC.	DBA: PARKSIDE CHEMISTS	1274 NOSTRAND AVE	BROOKLYN	NY	11226-1122	10/07/2020	01/01/2021	04/30/2022	05/18/2022
Contract Detail	KALA PHARMACY INC	9311 CHURCH AVE		BROOKLYN	NY	11212-1645	07/01/2021	10/01/2021		10/01/2021
Contract Detail	MEDLY PHARMACY INC.	DBA MEDLY PHARMACY	31 DEBEVOISE ST	BROOKLYN	NY	11206-4196	01/14/2021	04/01/2021	01/10/2022	11/01/2022
Contract Detail	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	10/07/2020	01/01/2021	04/02/2024	07/31/2024
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/11/2024	04/01/2024		04/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/11/2024	04/01/2024		04/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/11/2024	04/01/2024		04/01/2024
Contract Detail	SIGNIO SPECIALTY PHARMACY	711 ANDERSON AVE		CLIFFSIDE PARK	NJ	07010	10/07/2020	01/01/2021	10/01/2024	10/01/2024
Contract Detail	WALGREEN EASTERN CO., INC	DBA: WALGREENS	1847 ROCKAWAY PKWY.	BROOKLYN	NY	11236-5307	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04565	12704 GUY R BREWER BLVD	JAMAICA	NY	11434	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10941	3000 CHURCH AVE.	BROOKLYN	NY	11226-4210	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11141	1366 BROADWAY	BROOKLYN	NY	11221	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	4915 FLATLANDS AVE.	BROOKLYN	NY	11234	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	5001 CHURCH AVE.	BROOKLYN	NY	11203-1320	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #15352	1281 FULTON ST.	BROOKLYN	NY	11216	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY #16511	306 CLARKSON AVE.	BROOKLYN	NY	11226	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17670	1559 FLATBUSH AVE	BROOKLYN	NY	11210	04/03/2023	07/01/2023	11/08/2023	04/16/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17802	506-528 UTICA AVENUE	BROOKLYN	NY	11203	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17979	78-14 LINDEN BLVD	HOWARD BEACH	NY	11414	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19158	1419 NEWKIRK AVE	BROOKLYN	NY	11226-6521	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19994	1040 SAINT JOHNS PL.	BROOKLYN	NY	11213-2533	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/03/2023	07/01/2023		07/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/03/2023	07/01/2023		07/01/2023

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
FQHCLA412	Active	BPS-LAL-021490	Lasante Health Center, Inc.	Lasante Health Center	672 Parkside Ave		Brooklyn	NY
FQHCLA412A	Active	BPS-LAL-036706	LASANTE HEALTH CENTER, INC.	BP Dental Center for Kids	5309 18th Ave		Brooklyn	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA412	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2021
FQHCLA412	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2021
FQHCLA412	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2021
FQHCLA412	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/01/2021
FQHCLA412	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2021
FQHCLA412	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2021
FQHCLA412	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
FQHCLA412	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2024
FQHCLA412	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2024
FQHCLA412	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2024
FQHCLA412	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2024
FQHCLA412	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2024
FQHCLA412	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2024
FQHCLA412	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2024
FQHCLA412	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2024
FQHCLA412	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2024
FQHCLA412	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2024
FQHCLA412	CAREWAY RX INC	CAREWAY PHARMACY	1174 FLATBUSH AVE	BROOKLYN	NY	11226-7005	01/01/2025
FQHCLA412	CRYSTAL DRUGS INC	MICHAEL'S PHARMACY	163 LINDEN BLVD	BROOKLYN	NY	11226	07/01/2022
FQHCLA412	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02344	1249 NOSTRAND AVENUE	BROOKLYN	NY	11225	04/01/2023
FQHCLA412	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02431	4112 AVENUE U	BROOKLYN	NY	11234	04/01/2023
FQHCLA412	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 02769	4901 KINGS HIGHWAY	BROOKLYN	NY	11234	04/01/2023
FQHCLA412	CVS ALBANY, L.L.C.	CVS/PHARMACY # 10291	1601 KINGS HWY	BROOKLYN	NY	11229	04/01/2023
FQHCLA412	CVS ALBANY, L.L.C.	CVS PHARMACY # 17290	1598 FLATBUSH AVE	BROOKLYN	NY	11210	04/01/2023
FQHCLA412	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2023
FQHCLA412	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2023
FQHCLA412	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2024
FQHCLA412	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2023
FQHCLA412	DUANE READE	724 FLATBUSH AVENUE		BROOKLYN	NY	11226	07/01/2023
FQHCLA412	DUANE READE	1517 CORTELYOU ROAD		BROOKLYN	NY	11226	07/01/2023
FQHCLA412	DUANE READE	296 FLATBUSH AVE		BROOKLYN	NY	11217-2812	07/01/2023
FQHCLA412	DUANE READE	2265 RALPH AVENUE		BROOKLYN	NY	11234	07/01/2023
FQHCLA412	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2021
FQHCLA412	ESTABLISHED DRUGS INC	D/B/A HEALTH-WISE PHARMACY	1233 NOSTRAND AVE	BROOKLYN	NY	11225	01/01/2021
FQHCLA412	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2021
FQHCLA412	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2021
FQHCLA412	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2021
FQHCLA412	GOVIND PHARM INC.	DBA: PARKSIDE CHEMISTS	1274 NOSTRAND AVE	BROOKLYN	NY	11226-1122	01/01/2021	04/30/2022
FQHCLA412	KALA PHARMACY INC	9311 CHURCH AVE		BROOKLYN	NY	11212-1645	10/01/2021
FQHCLA412	MEDLY PHARMACY INC.	DBA MEDLY PHARMACY	31 DEBEVOISE ST	BROOKLYN	NY	11206-4196	04/01/2021	01/10/2022
FQHCLA412	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	01/01/2021	04/02/2024
FQHCLA412	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2024
FQHCLA412	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2024
FQHCLA412	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2024
FQHCLA412	SIGNIO SPECIALTY PHARMACY	711 ANDERSON AVE		CLIFFSIDE PARK	NJ	07010	01/01/2021	10/01/2024
FQHCLA412	WALGREEN EASTERN CO., INC	DBA: WALGREENS	1847 ROCKAWAY PKWY.	BROOKLYN	NY	11236-5307	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04565	12704 GUY R BREWER BLVD	JAMAICA	NY	11434	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10941	3000 CHURCH AVE.	BROOKLYN	NY	11226-4210	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11141	1366 BROADWAY	BROOKLYN	NY	11221	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	4915 FLATLANDS AVE.	BROOKLYN	NY	11234	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	5001 CHURCH AVE.	BROOKLYN	NY	11203-1320	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	WALGREENS #15352	1281 FULTON ST.	BROOKLYN	NY	11216	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY #16511	306 CLARKSON AVE.	BROOKLYN	NY	11226	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17670	1559 FLATBUSH AVE	BROOKLYN	NY	11210	07/01/2023	11/08/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17802	506-528 UTICA AVENUE	BROOKLYN	NY	11203	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	WALGREENS #17979	78-14 LINDEN BLVD	HOWARD BEACH	NY	11414	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	WALGREENS #19158	1419 NEWKIRK AVE	BROOKLYN	NY	11226-6521	07/01/2023
FQHCLA412	WALGREEN EASTERN CO., INC.	WALGREENS #19994	1040 SAINT JOHNS PL.	BROOKLYN	NY	11213-2533	07/01/2023
FQHCLA412	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2023
FQHCLA412	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2023
FQHCLA412	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 7:35:50 AM	2/10/2025 8:30:25 AM	2/10/2025 8:30 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 2:14:08 PM	1/29/2024 7:35:50 AM	1/29/2024 7:35 AM
Details	Last Recertification Date	Update	Recertification	1/31/2022 11:01:24 AM	1/31/2023 2:14:08 PM	1/31/2023 2:14 PM
Details	Last Recertification Date	Update	Recertification		1/31/2022 11:01:24 AM	1/31/2022 11:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Cancel Termination Request	3/31/2021 12:00:00 AM		3/23/2021 7:36 AM
Details	State	Update	OPA Cancel Termination Request	To Be Terminated	Active	3/23/2021 7:36 AM
Terminations	Termination Date	Update	OPA Cancel Termination Request	4/1/2021 12:00:00 AM		3/23/2021 7:36 AM
Terminations	Termination Effective Date	Update	OPA Cancel Termination Request	3/31/2021 12:00:00 AM		3/23/2021 7:36 AM
Terminations	Termination Reason	Update	OPA Cancel Termination Request	Failure to recertify		3/23/2021 7:36 AM
Details	Comments Public	Insert	OPA Edit		Last Recertification Date: 03/22/2021	3/23/2021 7:36 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		3/31/2021 12:00:00 AM	3/11/2021 6:47 AM
Details	State	Update	Recertification	Active	To Be Terminated	3/11/2021 6:47 AM
Terminations	Termination Date	Update	Recertification		4/1/2021 12:00:00 AM	3/11/2021 6:47 AM
Terminations	Termination Effective Date	Update	Recertification		3/31/2021 12:00:00 AM	3/11/2021 6:47 AM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	3/11/2021 6:47 AM
Details	State	Update		Approved	Active	1/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Heller, Mordechai COO LaSante Health Center 7182465700-120	10/7/2020 2:52 PM
Details	340B ID	Update	New Registration		FQHCLA412	10/7/2020 2:52 PM
Dates	Participating Approval Date	Update	New Registration		10/7/2020 2:52:59 PM	10/7/2020 2:52 PM
Details	State	Update	New Registration	Pending	Approved	10/7/2020 2:52 PM
Dates	Signed By Date	Update	New Registration		10/2/2020 11:47:43 AM	10/7/2020 2:52 PM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	10/7/2020 2:52 PM
Addresses	Main Address	Insert	New Registration		672 Parkside Ave Brooklyn, NY 11226-1506	10/2/2020 11:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/2/2020 11:47 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		04644657	10/2/2020 11:47 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	10/2/2020 11:47 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1740672732	10/2/2020 11:47 AM
Medicaid Billing	NPI: State	Insert	New Registration		NY	10/2/2020 11:47 AM
Contacts	Authorizing Official	Insert	New Registration		Heller, Mordechai COO LaSante Health Center 7182465700-120	10/2/2020 11:47 AM
Contacts	Primary Contact	Insert	New Registration		Blumenfrucht, Gedalya CEO LaSante Health Center 7182465700-121	10/2/2020 11:47 AM
Details	Assistance Received From Date	Insert	New Registration			10/2/2020 11:47 AM
Details	Assistance Received To Date	Insert	New Registration			10/2/2020 11:47 AM
Details	Last Recertification Date	Insert	New Registration			10/2/2020 11:47 AM
Details	Grant Number	Insert	New Registration		LALCS31598	10/2/2020 11:47 AM
Details	340B ID	Insert	New Registration			10/2/2020 11:47 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/2/2020 11:47 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/2/2020 11:47 AM
Details	Medicare Provider Number	Insert	New Registration			10/2/2020 11:47 AM
Details	Entity Name	Insert	New Registration		Lasante Health Center, Inc.	10/2/2020 11:47 AM
Details	NOFO Number	Insert	New Registration			10/2/2020 11:47 AM
Details	Program Code	Insert	New Registration		FQHCLA	10/2/2020 11:47 AM
Details	Entity Subname	Insert	New Registration		Lasante Health Center	10/2/2020 11:47 AM
Dates	Participating Approval Date	Insert	New Registration			10/2/2020 11:47 AM
Details	State	Insert	New Registration		Pending	10/2/2020 11:47 AM
Dates	Registration Date	Insert	New Registration		10/2/2020 11:47:39 AM	10/2/2020 11:47 AM
Dates	Signed By Date	Insert	New Registration			10/2/2020 11:47 AM
Dates	Start Date	Insert	New Registration			10/2/2020 11:47 AM
Terminations	Termination Comments	Insert	New Registration			10/2/2020 11:47 AM
Terminations	Termination Date	Insert	New Registration			10/2/2020 11:47 AM
Terminations	Termination Effective Date	Insert	New Registration			10/2/2020 11:47 AM
Terminations	Termination Reason	Insert	New Registration			10/2/2020 11:47 AM

340B Drug Pricing Program Database