Covered Entity Details

CH05290N Community Action Committee of Pike County, The (Active) - information as of 4/25/2025 9:18:56 PM

Main Details

Name

Community Action Committee of Pike County, The

Subdivision Name

Valley View 23 North

Type

HRSA-Funded Health Center

Site ID

BPS-H80-032854

340B ID

CH05290N

Grant Number

H80CS00399

Additional Details

Current Program Status

Active

Registration Date

11/2/2021

Participating Start Date

11/3/2021

Participating Approval Date

11/3/2021

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

CAC of Pike County
Keith Pitts, President and Chief Executive Officer
(216) 770-3409 Ext: 7009

Primary Contact

Community Action Committee of Pike County
Angela Spangler, Vice President, Excellence
(740) 289-2371

Addresses

Street Address

13800 US Highway 23
Waverly, OH 45690-9402

Billing Address

Community Action Committee of Pike County
941 Market St
Piketon, OH 45661

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
OH	0474081	1932873049

Shipping Addresses

Shipping Address 1

Valley View Rx
229 Valley View Drive
Waverly, OH 45690

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	KROGER PHARMACY	220 WAVERLY PLAZA		WAVERLY	OH	45690	10/08/2024	01/01/2025			01/01/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH052900	Active	BPS-H80-000661	COMMUNITY ACTION COMMITTEE OF PIKE COUNTY	N/A	941 MARKET STREET	PIKETON	OH
CH05290A	Active	BPS-H80-005332	COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE	FAMILY HEALTH -WAVERLY	227 Valley View Dr	Waverly	OH
CH05290E	Active	BPS-H80-000269	COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE	WEST PORTSMOUTH FAMILY PRACTICE	23030 STATE ROUTE 73	PORTSMOUTH	OH
CH05290G	Active	BPS-H80-004453	COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE	PIKETON FAMILY HEALTH CENTER	7777 US HIGHWAY 23	PIKETON	OH
CH05290I	Active	BPS-H80-005185	COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE	JACKSON FAMILY HEALTH CENTER	14590 STATE ROUTE 93	JACKSON	OH
CH05290K	Active	BPS-H80-013155	COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE	Broadway Street Clinic	621 Broadway Street	Portsmouth	OH
CH05290L	Active	BPS-H80-013864	COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE	Manchester Family Health Center	130 WAYNE FRYE DR	MANCHESTER	OH
CH05290M	Terminated	BPS-H80-024761	COMMUNITY ACTION COMMITTEE OF PIKE COUNTY, THE	Valley View Health Center-Emmitt Ave	715 W Emmitt Avenue	Waverly	OH
CH05290N	Active	BPS-H80-032854	Community Action Committee of Pike County, The	Valley View 23 North	13800 US Highway 23	Waverly	OH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH052900	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2024
CH052900	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2024
CH052900	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2024
CH052900	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2024
CH052900	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2024
CH052900	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2024
CH052900	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2025
CH052900	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	07/01/2017	11/13/2023
CH052900	ALLEN'S MEDICAL PHARMACY INC	215 OLD EASTERN AVE		CHILLICOTHE	OH	45601-3462	01/05/2023	04/13/2023
CH052900	ALLEN'S MEDICAL PHARMACY, INC.	215 OLD EASTERN AVE		CHILLICOTHE	OH	45601	04/13/2023	01/09/2024
CH052900	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2018	10/21/2022
CH052900	AVELLA OF COLUMBUS	4830 KNIGHTSBRIDGE BLVD STE C		COLUMBUS	OH	43214-2300	10/01/2016	07/07/2020
CH052900	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	10/01/2016	07/07/2020
CH052900	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	04/01/2017	01/15/2021
CH052900	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	12/20/2024
CH052900	BREWSTER'S HOMETOWN PHARMACY LLC	104 THORNTON DR		PIKETON	OH	45661	01/01/2023
CH05290G	BREWSTER'S HOMETOWN PHARMACY LLC	104 THORNTON DR		PIKETON	OH	45661	01/01/2025
	BREWSTER'S HOMETOWN PHARMACY LLC	104 THORNTON DR		PIKETON	OH	45661	07/01/2025
CH052900	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2025
CH052900	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2025
CH052900	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2025
CH052900	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2025
CH052900	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2025
CH052900	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
CH052900	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2025
CH052900	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2025
CH052900	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2025
CH052900	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2025
CH052900	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2023
CH052900	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2023
CH052900	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2025
CH052900	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/01/2017	04/01/2021
CH052900	ENCORE PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	05/04/2022
CH052900	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2024	05/08/2024
CH052900	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2024	05/08/2024
CH052900	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2024	05/08/2024
CH052900	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2024	05/08/2024
CH052900	FRUTH PHARMACY #16	101 JAMES RD		WAVERLY	OH	45690-1017	10/01/2019
CH05290L	FRUTH PHARMACY #16	101 JAMES RD		WAVERLY	OH	45690-1017	01/01/2025
CH052900	FRUTH PHARMACY OF WELLSTON	FRUTH PHARMACY #4	120 W 2ND ST FRUTH PHARMACY	WELLSTON	OH	45692-1499	10/01/2019	01/15/2021
CH052900	GAHMS PHARMACY	50A CENTER ST		LUCASVILLE	OH	45648	01/17/2023
CH05290E	GAHMS PHARMACY	50A CENTER ST		LUCASVILLE	OH	45648	01/01/2025
CH052900	GENOA HEALTHCARE LLC	225 CARLTON DAVIDSON LN RM 1		COAL GROVE	OH	45638	04/01/2024
CH052900	GENOA HEALTHCARE LLC	4449 STATE ROUTE 159 STE P100		CHILLICOTHE	OH	45601	04/01/2024
CH052900	GENOA HEALTHCARE LLC	901 WASHINGTON STREET	ROOM 135	PORTSMOUTH	OH	45662	04/01/2024
CH052900	GENOA HEALTHCARE LLC	1550 SHERIDAN DRIVE	SUITE 202, ROOM P	LANCASTER	OH	43130	04/01/2024	03/21/2024
CH052900	GENOA HEALTHCARE LLC	3556 SULLIVANT AVE, ROOM 201		COLUMBUS	OH	43204	03/26/2024
CH052900	K MART PHARMACY #3420		225 WEST AVENUE	NEW BOSTON	OH	45662	10/01/2016	12/05/2016
CH052900	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	01/01/2020
CH052900	KROGER PHARMACY	220 WAVERLY PLAZA		WAVERLY	OH	45690	07/01/2014
CH052900	KROGER PHARMACY	530 E. MAIN STREET		JACKSON	OH	45640	07/01/2014
CH05290G	KROGER PHARMACY	220 WAVERLY PLAZA		WAVERLY	OH	45690	12/06/2005	10/02/2024
CH05290I	KROGER PHARMACY	530 E. MAIN STREET		JACKSON	OH	45640	12/06/2005	10/02/2024
CH05290K	KROGER PHARMACY	220 WAVERLY PLAZA		WAVERLY	OH	45690	10/01/2014	10/02/2024
CH05290K	KROGER PHARMACY	530 E. MAIN STREET		JACKSON	OH	45640	10/01/2014	10/02/2024
CH05290N	KROGER PHARMACY	220 WAVERLY PLAZA		WAVERLY	OH	45690	01/01/2025
	KROGER PHARMACY	220 WAVERLY PLAZA		WAVERLY	OH	45690	07/01/2025
CH052900	KROGER PHARMACY N-575	811 GAY STREET		PORTSMOUTH	OH	45662	07/01/2014
CH05290E	KROGER PHARMACY N-575	811 GAY STREET		PORTSMOUTH	OH	45662	12/06/2005	10/02/2024
CH05290K	KROGER PHARMACY N-575	811 GAY STREET		PORTSMOUTH	OH	45662	10/01/2014
CH052900	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2018	10/21/2022
CH052900	MORTON'S HILLTOP PHARMACY	1865 COLES BLVD		PORTSMOUTH	OH	45662	01/01/2023	01/09/2024
CH052900	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03416	802 11TH ST	PORTSMOUTH	OH	45662	01/01/2023
CH052900	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03498	4207 GALLIA ST.	NEW BOSTON	OH	45662	01/01/2023
CH052900	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03419	353 E. MAIN ST.	JACKSON	OH	45640	01/01/2023
CH052900	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06189	11 CENTENNIAL BLVD.	CHILLICOTHE	OH	45601	01/01/2023
CH052900	OHIO CVS STORES, L.L.C.	CVS/PHARMACY # 11086	210 EAST EMMITT AVE.	WAVERLY	OH	45690	01/01/2023
CH052900	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03612	407 NORTH FRONT ST	OAK HILL	OH	45656	01/01/2023
CH052900	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 07777	2812 SCIOTO TRAIL	PORTSMOUTH	OH	45662	01/01/2023
CH052900	OHIO CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 06190	1021 NORTH BRIDGE ST.	CHILLICOTHE	OH	45601	01/01/2023
CH052900	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/01/2021	02/15/2023
CH052900	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/01/2021	02/15/2023
CH052900	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018	12/20/2024
CH052900	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2025
CH052900	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2025
CH052900	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2025
CH05290I	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/01/2022	10/07/2021
CH05290M	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/01/2022	10/07/2021
CH052900	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	10/07/2021	05/03/2022
CH05290A	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/01/2022	10/07/2021
CH05290L	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/01/2022	10/07/2021
CH05290G	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/01/2022	10/07/2021
CH05290E	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/01/2022	10/07/2021
CH05290K	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	01/01/2022	10/07/2021
	RECEPT PHARMACY #1	800 8TH AVE STE 130		FORT WORTH	TX	76104	07/01/2025
CH052900	RITE AID OF OHIO, INC.	RITE AID #4708	501 EAST EMMITT AVENUE	WAVERLY	OH	45690	01/19/2023	04/22/2024
CH052900	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2016
CH052900	WAL-MART PHARMACY 10-1519	100 WAL-MART DRIVE		JACKSON	OH	45640	07/01/2014
CH05290I	WAL-MART PHARMACY 10-1519	100 WAL-MART DRIVE		JACKSON	OH	45640	01/01/2025
CH052900	WAL-MART PHARMACY 10-1564	4490 GALLIA STREET		NEW BOSTON	OH	45662	01/01/2015	09/26/2016
CH052900	WAL-MART PHARMACY 10-2572	990 WEST EMMITT AVENUE		WAVERLY	OH	45690	04/01/2014
CH05290K	WAL-MART PHARMACY 10-2572	990 WEST EMMITT AVENUE		WAVERLY	OH	45690	10/01/2014	10/02/2024
CH05290A	WAL-MART PHARMACY 10-2572	990 WEST EMMITT AVENUE		WAVERLY	OH	45690	01/01/2025
CH052900	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2016
CH052900	WALGREEN CO.	DBA: WALGREENS # 07799	850 NORTH BRIDGE STREET	CHILLICOTHE	OH	45601	10/01/2016	10/07/2018
CH052900	WALGREEN CO.	DBA: WALGREENS #12476	521 EAST MAIN STREET	JACKSON	OH	45640	10/01/2016	10/07/2018
CH052900	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH052900	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03391	2901 FIFTH AVE	HUNTINGTON	WV	25702	01/01/2023	03/05/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Mercer, Michael Adair Director of Pharmacy Services Community Action Committee of Pike County 2163042462-7363	Spangler, Angela Vice President, Excellence Community Action Committee of Pike County 7402892371	2/13/2025 2:53 PM
Details	Last Recertification Date	Update	Recertification	1/31/2024 8:12:01 AM	2/13/2025 1:21:37 PM	2/13/2025 1:21 PM
Details	Last Recertification Date	Update	Recertification	1/30/2023 10:46:14 AM	1/31/2024 8:12:01 AM	1/31/2024 8:12 AM
Contacts	Authorizing Official	Update	Profile Change Request	Pitts, Keith Executive Director CAC of Pike County 2167703409-7009	Pitts, Keith President and Chief Executive Officer CAC of Pike County 2167703409-7009	1/30/2023 3:18 PM
Contacts	Signed By	Update	Profile Change Request	Pitts, Keith Executive Director CAC of Pike County 2167703409-7009	Pitts, Keith President and Chief Executive Officer CAC of Pike County 2167703409-7009	1/30/2023 3:18 PM
Details	Last Recertification Date	Update	Recertification	2/3/2022 8:16:30 AM	1/30/2023 10:46:14 AM	1/30/2023 10:46 AM
Contacts	Primary Contact	Update	Profile Change Request	Mercer, Michael Adair Director of Pharmacy Services Community Action Committee of Pike County 2165457027-7363	Mercer, Michael Adair Director of Pharmacy Services Community Action Committee of Pike County 2163042462-7363	1/5/2023 12:59 PM
Contacts	Primary Contact	Update	Profile Change Request	Mercer, Michael Adair Internal Contral/340B Manager Community Action Committee of Pike County 2165457027-7363	Mercer, Michael Adair Director of Pharmacy Services Community Action Committee of Pike County 2165457027-7363	5/24/2022 1:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/2/2022 1:26 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0474081	3/2/2022 1:26 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	3/2/2022 1:26 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932873049	3/2/2022 1:26 PM
Medicaid Billing	NPI: State	Insert	Change Request		OH	3/2/2022 1:26 PM
Details	Last Recertification Date	Update	Recertification		2/3/2022 8:16:30 AM	2/3/2022 8:16 AM
Contacts	Authorizing Official	Update	Profile Change Request	Pitts, Keith Executive Director CAC of Pike County 7402892371-7009	Pitts, Keith Executive Director CAC of Pike County 2167703409-7009	1/27/2022 10:13 AM
Contacts	Signed By	Update	Profile Change Request	Pitts, Keith Executive Director CAC of Pike County 7402892371-7009	Pitts, Keith Executive Director CAC of Pike County 2167703409-7009	1/27/2022 10:13 AM
Contacts	Primary Contact	Update	Profile Change Request	Mercer, Michael Adair Internal Contral/340B Manager Community Action Committee of Pike County 7402892371-7363	Mercer, Michael Adair Internal Contral/340B Manager Community Action Committee of Pike County 2165457027-7363	1/27/2022 8:36 AM
Details	State	Update	OPA Edit	Approved	Active	11/3/2021 2:55 PM
Dates	Start Date	Update	OPA Edit	1/1/2022 12:00:00 AM	11/3/2021 12:00:00 AM	11/3/2021 2:55 PM
Contacts	Signed By	Insert	New Registration		Pitts, Keith Executive Director CAC of Pike County 7402892371-7009	11/3/2021 2:48 PM
Details	340B ID	Update	New Registration		CH05290N	11/3/2021 2:48 PM
Dates	Participating Approval Date	Update	New Registration		11/3/2021 2:48:51 PM	11/3/2021 2:48 PM
Details	State	Update	New Registration	Pending	Approved	11/3/2021 2:48 PM
Dates	Signed By Date	Update	New Registration		11/3/2021 8:33:49 AM	11/3/2021 2:48 PM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	11/3/2021 2:48 PM
Addresses	Main Address	Insert	New Registration		13800 US Highway 23 Waverly, OH 45690-9402	11/2/2021 8:14 AM
Addresses	Billing Address	Insert	New Registration		Community Action Committee of Pike County 941 Market St Piketon, OH 45661	11/2/2021 8:14 AM
Addresses	Shipping Address	Insert	New Registration		Valley View Rx 229 Valley View Drive Waverly, OH 45690	11/2/2021 8:14 AM
Contacts	Authorizing Official	Insert	New Registration		Pitts, Keith Executive Director CAC of Pike County 7402892371-7009	11/2/2021 8:14 AM
Contacts	Primary Contact	Insert	New Registration		Mercer, Michael Adair Internal Contral/340B Manager Community Action Committee of Pike County 7402892371-7363	11/2/2021 8:14 AM
Details	Assistance Received From Date	Insert	New Registration			11/2/2021 8:14 AM
Details	Assistance Received To Date	Insert	New Registration			11/2/2021 8:14 AM
Details	Last Recertification Date	Insert	New Registration			11/2/2021 8:14 AM
Details	Grant Number	Insert	New Registration		H80CS00399	11/2/2021 8:14 AM
Details	340B ID	Insert	New Registration			11/2/2021 8:14 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			11/2/2021 8:14 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			11/2/2021 8:14 AM
Details	Medicare Provider Number	Insert	New Registration			11/2/2021 8:14 AM
Details	Entity Name	Insert	New Registration		Community Action Committee of Pike County, The	11/2/2021 8:14 AM
Details	NOFO Number	Insert	New Registration			11/2/2021 8:14 AM
Details	Program Code	Insert	New Registration		CH	11/2/2021 8:14 AM
Details	Entity Subname	Insert	New Registration		Valley View 23 North	11/2/2021 8:14 AM
Dates	Participating Approval Date	Insert	New Registration			11/2/2021 8:14 AM
Details	State	Insert	New Registration		Pending	11/2/2021 8:14 AM
Dates	Registration Date	Insert	New Registration		11/2/2021 8:14:01 AM	11/2/2021 8:14 AM
Dates	Signed By Date	Insert	New Registration			11/2/2021 8:14 AM
Dates	Start Date	Insert	New Registration			11/2/2021 8:14 AM
Terminations	Termination Comments	Insert	New Registration			11/2/2021 8:14 AM
Terminations	Termination Date	Insert	New Registration			11/2/2021 8:14 AM
Terminations	Termination Effective Date	Insert	New Registration			11/2/2021 8:14 AM
Terminations	Termination Reason	Insert	New Registration			11/2/2021 8:14 AM

340B Drug Pricing Program Database