Covered Entity Details

CH03170R Centerville Clinics, Incorporated (Active) - information as of 5/19/2025 12:47:25 AM

Main Details

Name

Centerville Clinics, Incorporated

Subdivision Name

Connellsville Medical and Dental Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-031781

340B ID

CH03170R

Grant Number

H80CS00705

Additional Details

Current Program Status

Active

Registration Date

10/15/2021

Participating Start Date

1/1/2022

Participating Approval Date

10/19/2021

Last Recertification Date

2/20/2025

Contacts

Authorizing Official

Centerville Clinics, Inc
Barry R Niccolai, Executive Director
(724) 632-6801 Ext: 1100

Primary Contact

Centerville Clinics, Inc.
Brenda Workman, Administrative Assistant
(724) 632-6801 Ext: 1100

Addresses

Street Address

601 S Arch St
Connellsville, PA 15425-4000

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
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

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 10-1739	30 TRINITY POINT DRIVE		WASHINGTON	PA	15301	10/07/2024	01/01/2025			01/01/2025
Contract Detail	WAL-MART PHARMACY 10-5379	1450 MORRELL AVENUE		CONNELLSVILLE	PA	15425	10/07/2024	01/01/2025			01/01/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH031700	Active	BPS-H80-002820	CENTERVILLE CLINIC INC	CENTERVILLE CLINICS, INC.; Joseph Yablonski Memorial Clinic	1070 OLD NATIONAL PIKE	FREDERICKTOWN	PA
CH03170A	Active	BPS-H80-002957	CENTERVILLE CLINIC INC	CARMICHAELS CLINIC	601 W George St	Carmichaels	PA
CH03170B	Active	BPS-H80-001371	CENTERVILLE CLINIC INC	CALIFORNIA FAMILY PRACTICE	1152 Wood St	California	PA
CH03170E	Active	BPS-H80-001702	CENTERVILLE CLINIC INC	BENTLEYVILLE FAMILY PRACTICE CENTER	100 Wilson Rd	Bentleyville	PA
CH03170F	Active	BPS-H80-006804	CENTERVILLE CLINIC INC	WAYNESBURG CLINIC	1150 7th St	Waynesburg	PA
CH03170G	Active	BPS-H80-002448	CENTERVILLE CLINIC INC	REPUBLIC MEDICAL AND DENTAL CENTER	1006 MAIN STREET	REPUBLIC	PA
CH03170H	Active	BPS-H80-001529	CENTERVILLE CLINIC INC	UNIONTOWN FAMILY DOCTORS	86 Mcclellandtown Rd	Uniontown	PA
CH03170J	Terminated	BPS-H80-004156	CENTERVILLE CLINIC INC	CONNELLSVILLE MEDICAL &TAL CENTER	208 S ARCH ST	CONNELLSVILLE	PA
CH03170K	Active	BPS-H80-008815	CENTERVILLE CLINIC INC	Washington Family Doctors	37 Highland Ave	Washington	PA
CH03170L	Active	BPS-H80-011320	CENTERVILLE CLINIC INC	Charleroi Medical &tal Center	200 Chamber Plz	Charleroi	PA
CH03170M	Active	BPS-H80-002417	CENTERVILLE CLINIC INC	WAYNESBURG COMM MENTAL HLTH CTR	190 Bonar Ave	Waynesburg	PA
CH03170N	Active	BPS-H80-000396	CENTERVILLE CLINIC INC	FAIRCHANCE CLINIC	93 N Morgantown St	Fairchance	PA
CH03170P	Active	BPS-H80-029658	CENTERVILLE CLINIC INC	Donora Family Medicine	718 Mckean Ave	Donora	PA
CH03170Q	Active	BPS-H80-028285	CENTERVILLE CLINIC INC	Centerville Clinics - City Mission Site	84 W Wheeling St	Washington	PA
CH03170R	Active	BPS-H80-031781	Centerville Clinics, Incorporated	Connellsville Medical and Dental Center	601 S Arch St	Connellsville	PA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH031700	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2021
CH031700	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2021
CH031700	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2021
CH031700	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2021
CH031700	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2021
CH031700	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/01/2021
CH031700	BENTLEYVILLE MEDICINE SHOPPE	808 MAIN ST		BENTLEYVILLE	PA	15314-1214	01/01/2022
CH03170M	BENTLEYVILLE MEDICINE SHOPPE	808 MAIN ST		BENTLEYVILLE	PA	15314-1214	01/01/2025
CH031700	BROWNSVILLE FAMILY PHARMACY	27 MARKET ST		BROWNSVILLE	PA	15417	01/01/2022
CH031700	CURTIS PHARMACY	305 MAIN ST	BOX K	CLAYSVILLE	PA	15323-3300	07/01/2022
CH031700	CURTIS PHARMACY	802 VANDERBILT RD		CONNELLSVILLE	PA	15425	07/01/2022
CH031700	CURTIS PHARMACY	575 HENDERSON AVE STE 1		WASHINGTON	PA	15301-1901	07/01/2022
CH031700	CURTIS PHARMACY	555 ROUTE 88		CARMICHAELS	PA	15320	06/08/2023
CH03170A	CURTIS PHARMACY	555 ROUTE 88		CARMICHAELS	PA	15320	01/01/2025
CH03170H	CURTIS PHARMACY	575 HENDERSON AVE STE 1		WASHINGTON	PA	15301-1901	01/01/2025
CH031700	DONORA UNION PHARMACY	601 MCKEAN AVE		DONORA	PA	15033-1020	01/01/2022
CH03170B	DONORA UNION PHARMACY	601 MCKEAN AVE		DONORA	PA	15033-1020	01/01/2025
CH031700	ECKERD CORPORATION	RITE AID #10960	601 WEST PIKE STREET	CANONSBURG	PA	15317	01/01/2025
CH031700	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2021
CH031700	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2021
CH031700	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2021
CH031700	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2021
CH031700	GENOA HEALTHCARE LLC	378 WEST CHESTNUT STREET	SUITE 205	WASHINGTON	PA	15301	01/01/2025
CH031700	GIANT EAGLE PHARMACY #0012	1300 COUNTRY CLUB ROAD		MONONGAHELA	PA	15063	10/01/2021
CH031700	GIANT EAGLE PHARMACY #0039	331 WASHINGTON ROAD		WASHINGTON	PA	15301	10/01/2021
CH03170Q	GIANT EAGLE PHARMACY #0039	331 WASHINGTON ROAD		WASHINGTON	PA	15301	01/01/2025
CH031700	GIANT EAGLE PHARMACY #0053	300 TRI-COUNTY LANE		BELLE VERNON	PA	15012	10/01/2021
CH03170N	GIANT EAGLE PHARMACY #0053	300 TRI-COUNTY LANE		BELLE VERNON	PA	15012	01/01/2025
CH031700	GIANT EAGLE PHARMACY #0070	4007 WASHINGTON ROAD		MCMURRAY	PA	15317	10/01/2021
CH031700	GIANT EAGLE PHARMACY #0098	581 PITTSBURGH RD		UNIONTOWN	PA	15401	10/01/2021
CH03170N	GIANT EAGLE PHARMACY #0098	581 PITTSBURGH RD		UNIONTOWN	PA	15401	01/01/2025
CH031700	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	10/01/2021	09/29/2024
CH031700	GIANT EAGLE PHARMACY #0487	100 SUGAR RUN ROAD		WAYNESBURG	PA	15370	10/01/2021
CH031700	GIANT EAGLE PHARMACY #1689	999 N EIGHTY EIGHT RD		RICES LANDING	PA	15357	10/01/2021
CH03170F	GIANT EAGLE PHARMACY #1689	999 N EIGHTY EIGHT RD		RICES LANDING	PA	15357	01/01/2025
CH031700	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	10/01/2021
CH031700	GIANT EAGLE SPECIALTY PHARMACY	2500 LOVI RD	ROOM #101	FREEDOM	PA	15042	01/01/2025
CH031700	LIZZAS APOTHECARE PHARMACY	173 MORGANTOWN STREET		UNIONTOWN	PA	15401	01/01/2022
CH031700	MON VALLEY PHARMACY AND COMPOUNDING	600 WILLOWBROOK PLAZA		ROSTRAVER TWP	PA	15012	01/01/2022
CH031700	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	10/01/2021
CH031700	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2021
CH031700	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	10/01/2021
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1147	175 WILSON ROAD	BENTLEYVILLE	PA	15314	10/01/2021
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #926	1440 EAST HIGH STREET	WAYNESBURG	PA	15370	10/01/2021
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #4083	101 5TH STREET	CHARLEROI	PA	15022	10/01/2021
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2545	1001 JEFFERSON AVENUE	WASHINGTON	PA	15301	10/01/2021
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #3443	6039 NATIONAL PIKE	GRINDSTONE	PA	15442	10/01/2021
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1963	262 CONNELLSVILLE STREET	UNIONTOWN	PA	15401	04/01/2022
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1197	446 WEST MAIN STREET	MONONGAHELA	PA	15063	04/01/2022
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2466	10 DONNER AVENUE	MONESSEN	PA	15062	04/01/2022
CH031700	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1514	404 THIRD STREET	CALIFORNIA	PA	15419	04/01/2022
CH03170B	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1514	404 THIRD STREET	CALIFORNIA	PA	15419	01/01/2025
CH03170P	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2466	10 DONNER AVENUE	MONESSEN	PA	15062	01/01/2025
CH03170E	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1147	175 WILSON ROAD	BENTLEYVILLE	PA	15314	01/01/2025
CH03170L	RITE AID OF PENNSYLVANIA, LLC	RITE AID #4083	101 5TH STREET	CHARLEROI	PA	15022	01/01/2025
CH03170M	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2545	1001 JEFFERSON AVENUE	WASHINGTON	PA	15301	01/01/2025
CH03170G	RITE AID OF PENNSYLVANIA, LLC	RITE AID #3443	6039 NATIONAL PIKE	GRINDSTONE	PA	15442	01/01/2025
CH031700	SPAN AND TAYLOR DRUG CO	175 W MAIN ST		MONONGAHELA	PA	15063	01/01/2022
CH031700	THE MEDICINE MINE INC	555 ROUTE 88		CARMICHAELS	PA	15320	04/01/2023
CH031700	THRIFT DRUG, INC.	RITE AID #10958	1396 WEST CHESTNUT ST.	WASHINGTON	PA	15301	10/01/2021
CH031700	THRIFT DRUG, INC.	RITE AID #10964	200 MEMORIAL BLVD.	CONNELLSVILLE	PA	15425	04/01/2022
CH031700	THRIFT DRUG, INC.	RITE AID #10962	575 MORGANTOWN ROAD	UNIONTOWN	PA	15401	04/01/2022
CH03170P	THRIFT DRUG, INC.	RITE AID #10962	575 MORGANTOWN ROAD	UNIONTOWN	PA	15401	01/01/2025
CH03170N	THRIFT DRUG, INC.	RITE AID #10958	1396 WEST CHESTNUT ST.	WASHINGTON	PA	15301	01/01/2025
CH031700	THRIFT DRUG, INC.	RITE AID #10961	4185 WASHINGTON ROAD	MCMURRAY	PA	15317	01/01/2025
CH031700	THRIFT DRUG, INC.	RITE AID #10892	417 CHARTIERS STREET	BRIDGEVILLE	PA	15017	01/01/2025
CH031700	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2021
CH031700	WAL-MART PHARMACY 10-1739	30 TRINITY POINT DRIVE		WASHINGTON	PA	15301	10/01/2021
CH03170R	WAL-MART PHARMACY 10-1739	30 TRINITY POINT DRIVE		WASHINGTON	PA	15301	01/01/2025
CH031700	WAL-MART PHARMACY 10-2019	355 WAL-MART DR		UNIONTOWN	PA	15401	10/01/2021
CH03170H	WAL-MART PHARMACY 10-2019	355 WAL-MART DR		UNIONTOWN	PA	15401	01/01/2025
CH031700	WAL-MART PHARMACY 10-2420	100 SARA WAY/ ROSTRAVER SQUARE		BELLE VERNON	PA	15012	04/01/2022
CH031700	WAL-MART PHARMACY 10-4501	134 DANIEL KENDALL DR		WEST BROWNSVILLE	PA	15417	10/01/2021
CH03170M	WAL-MART PHARMACY 10-4501	134 DANIEL KENDALL DR		WEST BROWNSVILLE	PA	15417	01/01/2025
CH031700	WAL-MART PHARMACY 10-5379	1450 MORRELL AVENUE		CONNELLSVILLE	PA	15425	04/01/2022
CH03170R	WAL-MART PHARMACY 10-5379	1450 MORRELL AVENUE		CONNELLSVILLE	PA	15425	01/01/2025
CH031700	WAL-MART PHARMACY 10-5446	405 MURTHA DRIVE		WAYNESBURG	PA	15370	04/01/2022
CH031700	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2021
CH031700	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH031700	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/26/2024 8:34:00 AM	2/20/2025 12:53:35 PM	2/20/2025 12:53 PM
Details	Last Recertification Date	Update	Recertification	2/20/2023 9:22:52 AM	2/26/2024 8:34:00 AM	2/26/2024 8:34 AM
Details	Last Recertification Date	Update	Recertification	2/25/2022 8:27:07 AM	2/20/2023 9:22:52 AM	2/20/2023 9:22 AM
Details	Last Recertification Date	Update	Recertification		2/25/2022 8:27:07 AM	2/25/2022 8:27 AM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Niccolai, Barry R Executive Director Centerville Clinics, Inc 7246326801-1100	10/19/2021 11:44 AM
Details	340B ID	Update	New Registration		CH03170R	10/19/2021 11:44 AM
Dates	Participating Approval Date	Update	New Registration		10/19/2021 11:44:41 AM	10/19/2021 11:44 AM
Details	State	Update	New Registration	Pending	Approved	10/19/2021 11:44 AM
Dates	Signed By Date	Update	New Registration		10/15/2021 4:23:02 PM	10/19/2021 11:44 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	10/19/2021 11:44 AM
Addresses	Main Address	Insert	New Registration		601 S Arch St Connellsville, PA 15425-4000	10/15/2021 1:23 PM
Contacts	Authorizing Official	Insert	New Registration		Niccolai, Barry R Executive Director Centerville Clinics, Inc 7246326801-1100	10/15/2021 1:23 PM
Contacts	Primary Contact	Insert	New Registration		Workman, Brenda Administrative Assistant Centerville Clinics, Inc. 7246326801-1100	10/15/2021 1:23 PM
Details	Assistance Received From Date	Insert	New Registration			10/15/2021 1:23 PM
Details	Assistance Received To Date	Insert	New Registration			10/15/2021 1:23 PM
Details	Last Recertification Date	Insert	New Registration			10/15/2021 1:23 PM
Details	Grant Number	Insert	New Registration		H80CS00705	10/15/2021 1:23 PM
Details	340B ID	Insert	New Registration			10/15/2021 1:23 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/15/2021 1:23 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/15/2021 1:23 PM
Details	Medicare Provider Number	Insert	New Registration			10/15/2021 1:23 PM
Details	Entity Name	Insert	New Registration		Centerville Clinics, Incorporated	10/15/2021 1:23 PM
Details	NOFO Number	Insert	New Registration			10/15/2021 1:23 PM
Details	Program Code	Insert	New Registration		CH	10/15/2021 1:23 PM
Details	Entity Subname	Insert	New Registration		Connellsville Medical and Dental Center	10/15/2021 1:23 PM
Dates	Participating Approval Date	Insert	New Registration			10/15/2021 1:23 PM
Details	State	Insert	New Registration		Pending	10/15/2021 1:23 PM
Dates	Registration Date	Insert	New Registration		10/15/2021 1:23:30 PM	10/15/2021 1:23 PM
Dates	Signed By Date	Insert	New Registration			10/15/2021 1:23 PM
Dates	Start Date	Insert	New Registration			10/15/2021 1:23 PM
Terminations	Termination Comments	Insert	New Registration			10/15/2021 1:23 PM
Terminations	Termination Date	Insert	New Registration			10/15/2021 1:23 PM
Terminations	Termination Effective Date	Insert	New Registration			10/15/2021 1:23 PM
Terminations	Termination Reason	Insert	New Registration			10/15/2021 1:23 PM

340B Drug Pricing Program Database