Covered Entity Details

CH09157Z NEVADA HEALTH CENTERS, INC. (Terminated) - information as of 4/29/2025 2:52:39 AM

Main Details

Name

NEVADA HEALTH CENTERS, INC.

Subdivision Name

CRESCENT VALLEY MEDICAL CLINIC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-007277

340B ID

CH09157Z

Grant Number

H80CS00818

Additional Details

Current Program Status

Terminated

Registration Date

10/1/2000

Participating Start Date

10/1/2000

Participating Approval Date

1/21/2010

Last Recertification Date

2/1/2017

Termination Date
Termination Reason

10/1/2017
Site closure

Contacts

Authorizing Official

Nevada Health Centers, Inc.
Kathryn Triplett, CFO
(775) 888-6632

Primary Contact

Nevada Health Centers, Inc.
STEPHANIE INGREY, Pharmacy Director
(775) 887-1590 Ext: 1123

Addresses

Street Address

5043 TENABO AVENUE
CRESCENT VALLEY, NV 89821

Billing Address

Nevada Health Centers Inc.
3325 Research Way
Carson City, NV 89706-7913

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

Comments

Comment	Last Updated On
12/21/05 UPDATED ENTITY NAME	01/21/2010

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
NV	28-13000
		1366476210

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
CH091570	Active	BPS-H80-010586	NEVADA HEALTH CENTERS, INC.	Sierra Nevada Health Center & NVHC Administrative Offices	3325 Research Way	CARSON CITY	NV
CH09157AC	Active	BPS-H80-017340	NEVADA HEALTH CENTERS, INC.	JACKPOT COMMUNITY HEALTH CENTER	950 Lady Luck Drive	JACKPOT	NV
CH09157AD	Active	BPS-H80-002913	NEVADA HEALTH CENTERS, INC.	CAMBRIDGE FAMILY HLTH CTR	3900 Cambridge St STE 102	Las Vegas	NV
CH09157AE	Active	BPS-H80-003445	NEVADA HEALTH CENTERS, INC.	ELKO FAMILY MEDICAL & DENTAL CTR	762 14th St	Elko	NV
CH09157AF	Active	BPS-H80-010585	Nevada Health Centers, Inc.	Martin Luther King Health Center	1799 Mount Mariah Drive	Las Vegas	NV
CH09157AG	Active	BPS-H80-037105	NEVADA HEALTH CENTERS, INC.	LAS VEGAS OUTREACH CLINIC	1450 N Main St	LAS VEGAS	NV
CH09157AH	Active	BPS-H80-002200	NEVADA HEALTH CENTERS, INC.	Eastern Family Medical and Dental Center	2212 S. Eastern Ave.	Las Vegas	NV
CH09157AJ	Active	BPS-H80-012714	NEVADA HEALTH CENTERS, INC.	Nevada Health Centers at C.P. Squires	1312 E Tonopah Ave	North Las Vegas	NV
CH09157AK	Active	BPS-H80-015005	NEVADA HEALTH CENTERS, INC.	Henderson Family Health Center	98 E LAKE MEAD PKWY	HENDERSON	NV
CH09157AL	Active	BPS-H80-017406	NEVADA HEALTH CENTERS, INC.	Nevada Health Centers Carson City School Based	618 W. Musser St.	Carson City	NV
CH09157AM	Active	BPS-H80-017405	NEVADA HEALTH CENTERS, INC.	Nevada Health Centers at Virginia City	175 E. Carson Street STE A	Virginia City	NV
CH09157AN	Active	BPS-H80-021868	NEVADA HEALTH CENTERS, INC.	Nevada Health Centers - Bower School Based at Basic Academy	400 Palo Verde Dr.	Henderson	NV
CH09157AP	Active	BPS-H80-024497	NEVADA HEALTH CENTERS, INC.	Nevada Children's Health Project	1799 Mount Mariah Dr,	Las Vegas	NV
CH09157AQ	Active	BPS-H80-027612	NEVADA HEALTH CENTERS, INC.	Nevada Health Centers at Enterprise	1700 Wheeler Peak Dr.	Las Vegas	NV
CH09157AR	Active	BPS-H80-003687	Nevada Health Centers, Inc.	MILES FOR SMILES	1802 N CARSON ST	CARSON CITY	NV
CH09157AS	Active	BPS-H80-005302	NEVADA HEALTH CENTERS, INC.	NEVADA HEALTH CTRS MAMMOVAN	1799 Mount Mariah Dr	Las Vegas	NV
CH09157AT	Active	BPS-H80-037106	NEVADA HEALTH CENTERS, INC.	Willow Street Health Center	790 Willow Street BLDG	Reno	NV
CH09157AU	Active	BPS-H80-038029	NEVADA HEALTH CENTERS, INC.	Nevada Health Centers Mobile Medical Services 1	3325 Research Way	Carson City	NV
CH09157AV	Active	BPS-H80-037699	NEVADA HEALTH CENTERS, INC.	Mobile Dental Services 1	762 14th St	Elko	NV
CH09157AW	Active	BPS-H80-039309	NEVADA HEALTH CENTERS, INC.	Pahrump Family Health Center	1430 E Calvada Blvd	Pahrump	NV
CH09157AX	Active	BPS-H80-039310	NEVADA HEALTH CENTERS, INC.	Nellis Family Medical and Dental Center	691 N Nellis Blvd	Las Vegas	NV
CH09157C	Terminated	BPS-H80-004822	NEVADA HEALTH CENTERS, INC.	BEATTY MEDICAL CLINIC	702 IRVING STREET	BEATTY	NV
CH09157D	Terminated	BPS-H80-004036	NEVADA HEALTH CENTERS, INC.	EUREKA MEDICAL CLINIC	250 S. MAIN STREET	EUREKA	NV
CH09157M	Active	BPS-H80-005003	NEVADA HEALTH CENTERS, INC.	AMARGOSA VALLEY MEDICAL CLINIC	1690 E Amargosa Farm Rd	AMARGOSA VALLEY	NV
CH09157N	Active	BPS-H80-006469	NEVADA HEALTH CENTERS, INC.	AUSTIN MEDICAL CLINIC	121 MAIN STREET	AUSTIN	NV
CH09157O	Active	BPS-H80-012562	NEVADA HEALTH CENTERS, INC.	CARLIN COMMUNITY HEALTH CENTER	310 MEMORY LANE	CARLIN	NV
CH09157R	Active	BPS-H80-001717	NEVADA HEALTH CENTERS, INC.	WENDOVER COMMUNITY HEALTH CENTER	925 WELLS AVENUE	WEST WENDOVER	NV
CH09157S	Terminated	BPS-H80-010586	NEVADA HEALTH CENTERS, INC.	SIERRA FAMILY HEALTH CENTER	3325 Research Way	CARSON CITY	NV
CH09157T	Active	BPS-H80-012563	NEVADA HEALTH CENTERS, INC.	North Las Vegas Family Health Center	2225 Civic Center Drive STE 224	North Las Vegas	NV
CH09157Z	Terminated	BPS-H80-007277	NEVADA HEALTH CENTERS, INC.	CRESCENT VALLEY MEDICAL CLINIC	5043 TENABO AVENUE	CRESCENT VALLEY	NV

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH091570	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
CH091570	ASPCARES	501 S RANCHO DR STE G46		LAS VEGAS	NV	89106-4835	01/01/2019	01/01/2021
CH091570	ASPCARES	501 S RANCHO DR STE G46		LAS VEGAS	NV	89106-4835	01/01/2019	10/17/2018
CH091570	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2024
CH091570	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	04/01/2024
CH091570	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/01/2024
CH091570	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2024
CH091570	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2024
CH091570	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2024
CH091570	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2024
CH091570	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2024
CH091570	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2024
CH091570	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2024
CH091570	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2024
CH091570	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2024
CH091570	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2024
CH091570	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2024
CH091570	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2024
CH091570	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	04/01/2024
CH091570	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09981	3240 US HIGHWAY 50 E	CARSON CITY	NV	89701	01/01/2020
CH091570	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09842	1980 N CARSON ST	CARSON CITY	NV	89701	01/01/2020
CH09157AG	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09842	1980 N CARSON ST	CARSON CITY	NV	89701	04/01/2023
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08789	100 S. NEVADA HIGHWAY 160	PAHRUMP	NV	89048	01/01/2020
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08808	2011 E. LAKE MEAD BLVD	NORTH LAS VEGAS	NV	89030	01/01/2020
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08788	1812 E. CHARLESTON BLVD.	LAS VEGAS	NV	89104	01/01/2020	08/01/2023
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08804	1408 W. CRAIG RD	NORTH LAS VEGAS	NV	89032	01/01/2020
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08799	1360 E. FLAMINGO RD.	LAS VEGAS	NV	89119	01/01/2020	02/08/2021
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08779	220 FAIRVIEW LANE	CARSON CITY	NV	89701	01/01/2020
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08824	4411 E. BONANZA RD	LAS VEGAS	NV	89110	01/01/2020
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08807	5681 BOULDER HIGHWAY	LAS VEGAS	NV	89122	01/01/2020
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08801	550 W. IDAHO ST	ELKO	NV	89801	01/01/2020
CH091570	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08821	8320 W CHEYENNE AVE	LAS VEGAS	NV	89129	10/01/2020
CH09157AH	NEVADA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08801	550 W. IDAHO ST	ELKO	NV	89801	04/01/2023
CH091570	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2024
CH091570	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2024
CH091570	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2024
CH091570	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY	1010 UNIVERSITY AVENUE	SAN DIEGO	CA	92103	04/01/2024
CH091570	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/01/2024
CH091570	REFILL PHARMACY 1, LLC	986 PHARMACY #8026	8536 DEL WEBB BLVD	LAS VEGAS	NV	89134	10/01/2020	08/19/2021
CH091570	REFILL PHARMACY, LLC		8536 DEL WEBB BLVD	LAS VEGAS	NV	89134	10/01/2020	10/01/2020
CH091570	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/01/2024
CH091570	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	04/01/2024
CH091570	SMITH MANAGEMENT CORP	DBA SMITHS FOOD & DRUG #356	599 EAST WILLIAMS STREET	CARSON CITY	NV	89702	10/01/2014
CH09157AL	SMITH MANAGEMENT CORP	DBA SMITHS FOOD & DRUG #356	599 EAST WILLIAMS STREET	CARSON CITY	NV	89702	04/01/2023
CH091570	SMITH'S FOOD & DRUG #388	1740 MOUNTAIN CITY HWY		ELKO	NV	89801	10/01/2014
CH09157AE	SMITH'S FOOD & DRUG #388	1740 MOUNTAIN CITY HWY		ELKO	NV	89801	04/01/2023
CH091570	SMITH'S FOOD & DRUG CTRS	SMITHS FOOD & DRUG #390	1855 WEST WENDOVER BLVD PO BOX 5190	WEST WENDOVER	NV	89883	10/01/2014
CH09157R	SMITH'S FOOD & DRUG CTRS	SMITHS FOOD & DRUG #390	1855 WEST WENDOVER BLVD PO BOX 5190	WEST WENDOVER	NV	89883	04/01/2023
CH091570	SMITHS FOOD & DRUG CENTERS	SMITHS FOOD & DRUG #392	2200 HWY 50 E	DAYTON	NV	89403	10/01/2014
CH09157AM	SMITHS FOOD & DRUG CENTERS	SMITHS FOOD & DRUG #392	2200 HWY 50 E	DAYTON	NV	89403	04/01/2023
CH091570	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019
CH091570	WAL-MART PHARMACY 10-1559	201 NORTH NELLIS BLVD		LAS VEGAS (NE)	NV	89110	04/01/2019
CH091570	WAL-MART PHARMACY 10-1648	3770 NORTH HWY 395		CARSON CITY	NV	89705	04/01/2019
CH091570	WAL-MART PHARMACY 10-2402	2944 MOUNTAIN CITY HWY		ELKO	NV	89801	04/01/2019
CH09157AC	WAL-MART PHARMACY 10-2402	2944 MOUNTAIN CITY HWY		ELKO	NV	89801	04/01/2023
CH091570	WAL-MART PHARMACY 10-2592	1807 WEST CRAIG ROAD		NORTH LAS VEGAS	NV	89032	04/01/2019
CH091570	WAL-MART PHARMACY 10-3408	3200 MARKET STREET		CARSON CITY	NV	89706	04/01/2019
CH09157N	WAL-MART PHARMACY 10-3408	3200 MARKET STREET		CARSON CITY	NV	89706	04/01/2023
CH091570	WAL-MART PHARMACY 10-3728	3950 WEST LAKE MEAD BLVD		NORTH LAS VEGAS	NV	89032	04/01/2019
CH091570	WAL-MART PHARMACY 10-5101	300 SOUTH HWY 160		PAHRUMP	NV	89048	04/01/2019
CH091570	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019
CH091570	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	10/01/2021
CH091570	WALGREEN CO.	DBA: WALGREENS # 03844	5011 E. SAHARA AVE.	LAS VEGAS	NV	89142	04/01/2014
CH091570	WALGREEN CO.	DBA: WALGREENS # 03845	2280 N LAS VEGAS BLVD	NORTH LAS VEGAS	NV	89030	04/01/2014
CH091570	WALGREEN CO.	DBA: WALGREENS # 04788	1465 E WILLIAM ST	CARSON CITY	NV	89701	04/01/2014
CH091570	WALGREEN CO.	DBA: WALGREENS #10862	2421 E BONANZA RD	LAS VEGAS	NV	89101	04/01/2014
CH091570	WALGREEN CO.	DBA: WALGREENS # 04086	4470 E. BONANZA ROAD	LAS VEGAS	NV	89110	04/01/2015
CH091570	WALGREEN CO.	DBA: WALGREENS # 04433	4895 BOULDER HWY STE 100	LAS VEGAS	NV	89121	04/01/2015	11/12/2024
CH091570	WALGREEN CO.	DBA: WALGREENS # 05311	1180 E FLAMINGO RD	LAS VEGAS	NV	89119	04/01/2015
CH091570	WALGREEN CO.	DBA: WALGREENS # 05570	6650 E LAKE MEAD BLVD	LAS VEGAS	NV	89156	07/01/2017
CH091570	WALGREEN CO.	DBA: WALGREENS # 05814	1445 W CRAIG RD STE 100	NORTH LAS VEGAS	NV	89032	07/01/2017
CH091570	WALGREEN CO.	DBA: WALGREENS # 03841	6101 W LAKE MEAD	LAS VEGAS	NV	89108	07/01/2017
CH091570	WALGREEN CO.	DBA: WALGREENS # 05646	770 S HWY 160	PAHRUMP	NV	89048	07/01/2017
CH091570	WALGREEN CO.	DBA: WALGREENS # 07164	101 E LAKE MEAD PKWY STE 100	HENDERSON	NV	89015	07/01/2017
CH091570	WALGREEN CO.	DBA: WALGREENS # 06545	11001 S EASTERN AVE	HENDERSON	NV	89052	07/01/2017
CH091570	WALGREEN CO.	DBA: WALGREENS # 05862	401 N ARROYO GRANDE BLVD	HENDERSON	NV	89014	07/01/2017
CH091570	WALGREEN CO.	DBA: WALGREENS # 03871	1701 N GREEN VALLEY PKWY STE 14	HENDERSON	NV	89074	07/01/2017
CH091570	WALGREEN CO.	DBA: WALGREENS # 06424	1360 W HORIZON RIDGE PKWY	HENDERSON	NV	89012	07/01/2017
CH09157AH	WALGREEN CO.	DBA: WALGREENS # 03844	5011 E. SAHARA AVE.	LAS VEGAS	NV	89142	04/01/2023
CH09157AN	WALGREEN CO.	DBA: WALGREENS # 05311	1180 E FLAMINGO RD	LAS VEGAS	NV	89119	04/01/2023
CH09157AQ	WALGREEN CO.	DBA: WALGREENS # 03841	6101 W LAKE MEAD	LAS VEGAS	NV	89108	04/01/2023
CH09157AG	WALGREEN CO.	DBA: WALGREENS # 04433	4895 BOULDER HWY STE 100	LAS VEGAS	NV	89121	04/01/2023	11/12/2024
CH09157AJ	WALGREEN CO.	DBA: WALGREENS # 05814	1445 W CRAIG RD STE 100	NORTH LAS VEGAS	NV	89032	04/01/2023
CH09157AP	WALGREEN CO.	DBA: WALGREENS # 04086	4470 E. BONANZA ROAD	LAS VEGAS	NV	89110	04/01/2023
CH09157AD	WALGREEN CO.	DBA: WALGREENS # 05570	6650 E LAKE MEAD BLVD	LAS VEGAS	NV	89156	04/01/2023
CH09157AK	WALGREEN CO.	DBA: WALGREENS # 07164	101 E LAKE MEAD PKWY STE 100	HENDERSON	NV	89015	04/01/2023
CH09157O	WALGREEN CO.	DBA: WALGREENS # 04788	1465 E WILLIAM ST	CARSON CITY	NV	89701	04/01/2023
CH09157T	WALGREEN CO.	DBA: WALGREENS # 03845	2280 N LAS VEGAS BLVD	NORTH LAS VEGAS	NV	89030	04/01/2023
CH09157AM	WALGREEN CO.	DBA: WALGREENS #10862	2421 E BONANZA RD	LAS VEGAS	NV	89101	04/01/2023
CH09157AD	WALGREEN CO.	DBA: WALGREENS # 05619	3030 LAS VEGAS BLVD N	NORTH LAS VEGAS	NV	89030	01/01/2024
CH091570	WALGREEN CO.	DBA: WALGREENS # 05619	3030 LAS VEGAS BLVD N	NORTH LAS VEGAS	NV	89030	01/01/2024
CH09157AG	WALGREEN CO.	DBA: WALGREENS # 06425	900 N RANCHO DRIVE	LAS VEGAS	NV	89106	01/01/2024
CH091570	WALGREEN CO.	DBA: WALGREENS # 06425	900 N RANCHO DRIVE	LAS VEGAS	NV	89106	01/01/2024
CH09157AW	WALGREEN CO.	DBA: WALGREENS # 05646	770 S HWY 160	PAHRUMP	NV	89048	01/01/2025
CH09157AX	WALGREEN CO.	DBA: WALGREENS # 06545	11001 S EASTERN AVE	HENDERSON	NV	89052	01/01/2025
CH091570	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2014	07/02/2015
CH091570	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/01/2015	07/02/2015
CH091570	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024
CH091570	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	CVS PHARMACY # 16079	4001 S MARYLAND PKWY	LAS VEGAS	NV	89119	01/01/2020
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 06867	4490 PARADISE RD.	LAS VEGAS	NV	89169	01/01/2020
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 05043	9695 S. MARYLAND PKWY.	LAS VEGAS	NV	89123	01/01/2020
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 05286	21 W. HORIZON RIDGE PARKWAY	HENDERSON	NV	89012	01/01/2020
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 05144	1425 W. LAKE MEAD BLVD.	LAS VEGAS	NV	89106	01/01/2020	12/03/2021
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 02990	6391 W. LAKE MEAD BLVD.	LAS VEGAS	NV	89108	10/01/2020
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 04786	2735 S. MARYLAND PARKWAY	LAS VEGAS	NV	89109	10/01/2020	05/07/2024
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 02929	7190 W. CRAIG RD.	LAS VEGAS	NV	89129	10/01/2020
CH09157M	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 04786	2735 S. MARYLAND PARKWAY	LAS VEGAS	NV	89109	04/01/2023	05/07/2024
CH091570	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 05792	2425 E. DESERT INN RD.	LAS VEGAS	NV	89121	10/01/2024
CH09157M	WARM SPRINGS ROAD CVS, L.L.C.	DBA: CVS/PHARMACY # 05792	2425 E. DESERT INN RD.	LAS VEGAS	NV	89121	10/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	INGREY, STEPHANIE LEAD PHARMACIST Nevada Health Centers, Inc. 7758871590-1123	INGREY, STEPHANIE Pharmacy Director Nevada Health Centers, Inc. 7758871590-1123	5/30/2019 1:54 PM
Contacts	Primary Contact	Update	Recertification	INGREY, STEPHANIE LEAD PHARMACIST 7758871590-1123	INGREY, STEPHANIE LEAD PHARMACIST Nevada Health Centers, Inc. 7758871590-1123	2/7/2018 4:11 PM
Contacts	Authorizing Official	Update		Triplett, Kathryn CFO 7758886632	Triplett, Kathryn CFO Nevada Health Centers, Inc. 7758886632	2/7/2018 3:49 PM
Addresses	Main Address	Insert			5043 TENABO AVENUE CRESCENT VALLEY, NV 89821	7/12/2017 11:13 AM
Addresses	Billing Address	Insert			Nevada Health Centers Inc. 3325 Research Way Carson City, NV 89706-7913	7/12/2017 11:13 AM
Contacts	Authorizing Official	Update		Duffrin, Elizabeth M. CFO 7758886632	Triplett, Kathryn CFO 7758886632	7/12/2017 11:13 AM
Contacts	Primary Contact	Insert			INGREY, STEPHANIE LEAD PHARMACIST 7758871590-1123	7/12/2017 11:13 AM
Details	State	Update		To Be Terminated	Terminated	7/12/2017 11:13 AM
Dates	Last Date That 340B Drugs Purchased	Update			6/30/2017 12:00:00 AM	7/12/2017 11:13 AM
Details	State	Update		Active	To Be Terminated	7/12/2017 11:13 AM
Terminations	Termination Comments	Update			The Eureka County Commissioners awarded the contract for operation of this location to another entity so we will no longer be providing primary care services at this site.	7/12/2017 11:13 AM
Terminations	Termination Date	Update			10/1/2017 12:00:00 AM	7/12/2017 11:13 AM
Terminations	Termination Effective Date	Update			6/30/2017 12:00:00 AM	7/12/2017 11:13 AM
Terminations	Termination Reason	Update			Site closure	7/12/2017 11:13 AM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 8:56 AM
Contacts	Authorizing Official	Update		CHASE, THOMAS G. CHIEF EXECUTIVE OFFICER 7758871590-1114	Duffrin, Elizabeth M. CFO 7758886632	3/29/2016 8:54 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/23/2016 1:35 PM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 1:35 PM
Details	Last Recertification Date	Update		2/12/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 2:14 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/12/2014 12:00:00 AM	2/12/2014 12:33 PM
Medicaid Billing	NPI: Number	Insert			1366476210	2/13/2013 12:06 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/13/2013 12:06 PM
Contacts	Authorizing Official	Insert			CHASE, THOMAS G. CHIEF EXECUTIVE OFFICER 7758871590-1114	5/24/2012 4:04 PM
Details	Last Recertification Date	Insert				1/21/2010 2:27 PM
Details	Grant Number	Insert			H80CS00818	1/21/2010 2:27 PM
Details	340B ID	Insert			CH09157Z	1/21/2010 2:27 PM
Details	Is Authorizing Official EHB Data	Insert				1/21/2010 2:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/21/2010 2:27 PM
Details	Medicare Provider Number	Insert				1/21/2010 2:27 PM
Details	Entity Name	Insert			NEVADA HEALTH CENTERS, INC.	1/21/2010 2:27 PM
Details	Program Code	Insert			CH	1/21/2010 2:27 PM
Details	Entity Subname	Insert			CRESCENT VALLEY MEDICAL CLINIC	1/21/2010 2:27 PM
Dates	Participating Approval Date	Insert			1/21/2010 12:00:00 AM	1/21/2010 2:27 PM
Details	State	Insert			Active	1/21/2010 2:27 PM
Dates	Registration Date	Insert			10/1/2000 12:00:00 AM	1/21/2010 2:27 PM
Dates	Signed By Date	Insert				1/21/2010 2:27 PM
Dates	Start Date	Insert			10/1/2000 12:00:00 AM	1/21/2010 2:27 PM
Terminations	Termination Comments	Insert				1/21/2010 2:27 PM
Terminations	Termination Date	Insert				1/21/2010 2:27 PM
Terminations	Termination Effective Date	Insert				1/21/2010 2:27 PM
Terminations	Termination Reason	Insert				1/21/2010 2:27 PM
Details	Comments Public	Insert			12/21/05 UPDATED ENTITY NAME	1/21/2010 2:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	10/1/2000 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			28-13000	10/1/2000 12:00 AM
Medicaid Billing	Medicaid: State	Insert			NV	10/1/2000 12:00 AM

340B Drug Pricing Program Database