Covered Entity Details

CH051828T NORTHSHORE HEALTH CENTERS, INC (Active) - information as of 6/21/2025 12:10:43 AM

Main Details

Name

NORTHSHORE HEALTH CENTERS, INC

Subdivision Name

NorthShore Demotte Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033488

340B ID

CH051828T

Grant Number

H80CS02458

Additional Details

Current Program Status

Active

Registration Date

11/15/2021

Participating Start Date

11/16/2021

Participating Approval Date

11/16/2021

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

NorthShore Health Centers
David Hall, CEO
(219) 763-8112 Ext: 8002

Primary Contact

NorthShore Health Centers Inc.
Michael Wichlinski, Pharmacy Director
(219) 763-8112 Ext: 2301

Addresses

Street Address

200 3rd Ct SE
Demotte, IN 46310-7400

Billing Address

NorthShore Health Centers, Inc
PO Box 1430
Portage, IN 46368

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH0518280	Active	BPS-H80-003152	Stacy McKay Health & Education Center		6450 US HWY 6	PORTAGE	IN
CH051828A	Active	BPS-H80-008114	NORTHSHORE HEALTH CENTERS, INC	NorthShore Lake Station Health Center	2490 Central Avenue	Lake Station	IN
CH051828B	Active	BPS-H80-030360	NORTHSHORE HEALTH CENTERS, INC	NorthShore Portage Health Center	6050 Sterling Creek Rd.	Portage	IN
CH051828C	Active	BPS-H80-000916	NORTHSHORE HEALTH CENTERS, INC	NorthShore Dr. Fernando Rivera Dental Center	3099 Central Ave	Lake Station	IN
CH051828D	Active	BPS-H80-011202	NORTHSHORE HEALTH CENTERS, INC	NorthShore Health Center, Inc, Merrillville Health Center	6091 Broadway	Merrillville	IN
CH051828E	Terminated	BPS-H80-009337	NORTHSHORE HEALTH CENTERS, INC	NorthShore/Regional Health Center	8555 Taft Street	Merrillville	IN
CH051828F	Active	BPS-H80-010518	NORTHSHORE HEALTH CENTERS, INC	NorthShore Edison Senior High School	3304 Parkside Ave	Lake Station	IN
CH051828G	Active	BPS-H80-013451	NORTHSHORE HEALTH CENTERS, INC	NorthShore Merrillville High School Clinic	276 E 68th Pl	Merrillville	IN
CH051828H	Active	BPS-H80-031409	NORTHSHORE HEALTH CENTERS, INC	NorthShore Hammond Health Center	1828 165th Street STE A	Hammond	IN
CH051828J	Active	BPS-H80-033765	NORTHSHORE HEALTH CENTERS, INC	NorthShore Chesterton Health Center	801 Broadway	Chesterton	IN
CH051828K	Active	BPS-H80-032342	NORTHSHORE HEALTH CENTERS, INC	NorthShore LaPorte Health Center	504 Legacy Plaza W	Laporte	IN
CH051828L	Active	BPS-H80-032380	NORTHSHORE HEALTH CENTERS, INC	NorthShore LaPorte Health Center	508 Legacy Plz W	Laporte	IN
CH051828M	Terminated	BPS-H80-032741	NORTHSHORE HEALTH CENTERS, INC	NorthShore Schererville Health Center	1515 US Highway 41, Clinic Suite, West of Main Entrance	Schererville	IN
CH051828N	Terminated	BPS-H80-032445	NORTHSHORE HEALTH CENTERS, INC	NorthShore St. John Community Health Center	9825 Wicker Ave Side	Saint John	IN
CH051828P	Active	BPS-H80-032392	NORTHSHORE HEALTH CENTERS, INC	NorthShore Griffith School Based Health Clinic	600 N Wiggs St Rm A104B	Griffith	IN
CH051828Q	Active	BPS-H80-031410	NORTHSHORE HEALTH CENTERS, INC	NorthShore Chesterton Middle School Health Center	651 W Morgan Ave Rm F168	Chesterton	IN
CH051828R	Active	BPS-H80-032742	NORTHSHORE HEALTH CENTERS, INC	NorthShore LaPorte High School Health Center	602 F Street RM G.15	LaPorte	IN
CH051828S	Active	BPS-H80-038280	NORTHSHORE HEALTH CENTERS, INC	NorthShore Crown Point Health Center	310 W. 112th Ave	Crown Point	IN
CH051828T	Active	BPS-H80-033488	NORTHSHORE HEALTH CENTERS, INC	NorthShore Demotte Health Center	200 3rd Ct SE	Demotte	IN
CH051828U	Active	BPS-H80-037803	NORTHSHORE HEALTH CENTERS, INC	NorthShore Gary Health Center	2200 Grant St	Gary	IN
CH051828V	Active	BPS-H80-038281	NORTHSHORE HEALTH CENTERS, INC	NorthShore Valparaiso Health Center	85 E US Highway 6, Ste 330	Valparaiso	IN
CH051828W	Active	BPS-H80-033026	NORTHSHORE HEALTH CENTERS, INC	NorthShore River Forest High School Health Center	3300 Indiana St Rm 1	Hobart	IN
CH051828X	Active	BPS-H80-037944	NORTHSHORE HEALTH CENTERS, INC	NorthShore Mobile Clinic	6050 Sterling Creek Rd	Portage	IN
CH051828Y	Active	BPS-H80-038444	NORTHSHORE HEALTH CENTERS, INC	NorthShore Michigan City	817 Pine St.	Michigan City	IN
CH051828Z	Active	BPS-H80-038442	NORTHSHORE HEALTH CENTERS, INC	NorthShore East Chicago	2121 E Columbus Dr.	East Chicago	IN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0518280	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2018	10/25/2023
CH0518280	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	07/01/2018	10/25/2023
CH0518280	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	01/01/2018	10/25/2023
CH0518280	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH051828A	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH051828B	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH051828C	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH051828D	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH051828E	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	04/01/2020
CH051828F	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH051828G	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH051828H	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH051828J	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	10/25/2023
CH0518280	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05127	18133 TORRENCE AVE	LANSING	IL	60438	04/01/2022
CH0518280	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	10/01/2017	10/25/2023
CH0518280	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	07/01/2018	10/25/2023
CH0518280	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	07/01/2018	10/25/2023
CH0518280	WALGREEN CO.	DBA: WALGREENS #13949	6001 CENTRAL AVE	PORTAGE	IN	46368-3506	10/19/2011
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04560	5995 US HWY. 6	PORTAGE	IN	46368	10/19/2011
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04581	1605 E 37TH AVENUE	HOBART	IN	46342	10/19/2011	04/23/2018
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04750	400 W LINCOLN HWY	MERRILLVILLE	IN	46410	10/19/2011
CH0518280	WALGREEN CO.	DBA: WALGREENS # 06216	732 W OLD RIDGE RD	HOBART	IN	46342	10/19/2011
CH0518280	WALGREEN CO.	DBA: WALGREENS # 06733	3500 CENTRAL AVENUE	LAKE STATION	IN	46405-2271	10/19/2011
CH0518280	WALGREEN CO.	DBA: WALGREENS # 06906	6097 BROADWAY	MERRILLVILLE	IN	46410	10/19/2011
CH0518280	WALGREEN CO.	DBA: WALGREENS # 03680	1903 CALUMET AVE.	VALPARAISO	IN	46383	07/01/2013
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04241	1225 E. RIDGE RD.	GRIFFITH	IN	46319	07/01/2013
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04668	1003 N MAIN STREET	CROWN POINT	IN	46307	07/01/2013
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04829	10920 RANDOLPH ST.	CROWN POINT	IN	46307	07/01/2013
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04946	580 INDIAN BOUNDARY RD	CHESTERTON	IN	46304	07/01/2013
CH0518280	WALGREEN CO.	DBA: WALGREENS # 05194	1704 EAST COMMERCIAL AVENUE	LOWELL	IN	46356	07/01/2013
CH0518280	WALGREEN CO.	DBA: WALGREENS # 05241	252 MORTHLAND DRIVE	VALPARAISO	IN	46383	07/01/2013
CH0518280	WALGREEN CO.	DBA: WALGREENS # 09290	2500 GRANT ST	GARY	IN	46404-3508	07/01/2013
CH0518280	WALGREEN CO.	DBA: WALGREENS # 10719	801 S LAKE STREET	GARY	IN	46403-2918	07/01/2013	04/23/2018
CH0518280	WALGREEN CO.	DBA: STEEL FAMILY HEALTH CARE PHARMACY	2022 KELLE DRIVE	CHESTERTON	IN	46304	07/01/2013	02/25/2016
CH0518280	WALGREEN CO.	DBA: WALGREENS # 03352	6905 KENNEDY AVE	HAMMOND	IN	46323	07/01/2014
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04462	6510 COLUMBIA AVE.	HAMMOND	IN	46320	07/01/2014
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04486	5520 US HWY 30	SCHERERVILLE	IN	46375	07/01/2014
CH0518280	WALGREEN CO.	DBA: WALGREENS # 05628	4445 CALUMET AVE	HAMMOND	IN	46327	07/01/2014	11/04/2019
CH0518280	WALGREEN CO.	DBA: WALGREENS # 12109	7236 CALUMET AVE	HAMMOND	IN	46324	07/01/2014
CH0518280	WALGREEN CO.	DBA: WALGREENS # 12556	2801 W 5TH AVE	GARY	IN	46404-1244	07/01/2014	08/24/2016
CH0518280	WALGREEN CO.	DBA: WALGREENS # 06691	2401 RIDGE ROAD	HIGHLAND	IN	46322	10/01/2014
CH0518280	WALGREEN CO.	DBA: WALGREENS # 07631	720 W CHICAGO AVE	EAST CHICAGO	IN	46312-3222	07/01/2016	11/07/2019
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04635	101 W HWY 20	MICHIGAN CITY	IN	46360	01/01/2020
CH0518280	WALGREEN CO.	DBA: WALGREENS # 09318	525 E LINCOLNWAY	LAPORTE	IN	46350-3833	01/01/2020
CH0518280	WALGREEN CO.	DBA: WALGREENS #11084	1816 FRANKLIN ST	MICHIGAN CITY	IN	46360	01/01/2020
CH0518280	WALGREEN CO.	DBA: WALGREENS #12788	407 W. GLEN PARK AVENUE	GRIFFITH	IN	46319	10/01/2020
CH0518280	WALGREEN CO.	DBA: WALGREENS # 07708	8930 CALUMET AVENUE	MUNSTER	IN	46321	10/01/2020
CH0518280	WALGREEN CO.	DBA: WALGREENS # 06106	770 JOLIET ST	DYER	IN	46311	01/01/2021
CH0518280	WALGREEN CO.	DBA: WALGREENS #12640	226 N HALLECK STREET	DEMOTTE	IN	46310	04/01/2022
CH0518280	WALGREEN CO.	DBA: WALGREENS # 04276	9280 WICKER AVE.	ST JOHN	IN	46373	04/01/2022
CH0518280	WALGREEN CO.	DBA: WALGREENS # 06000	22 US HWY 41	SCHERERVILLE	IN	46375	04/01/2022
CH0518280	WALGREEN CO.	DBA: WALGREENS # 05141	1302 W SR 2	LAPORTE	IN	46350	04/01/2022
CH0518280	WALGREEN CO.	DBA: WALGREENS # 05787	651 W. US HWY 30	SCHERERVILLE	IN	46375	04/01/2022
CH0518280	WALGREEN CO.	DBA: WALGREENS # 10529	2123 E COLUMBUS DR.	EAST CHICAGO	IN	46312	04/01/2022
CH0518280	WALGREEN CO.	DBA: WALGREENS # 10123	10795 BROADWAY	CROWN POINT	IN	46307-8834	04/01/2022
CH0518280	WALGREEN CO.	DBA: WALGREENS # 12074	308 NORTH MAIN STREET	HEBRON	IN	46341	04/01/2022
CH0518280	WALGREEN CO.	DBA: WALGREENS # 10534	1939 INDIANAPOLIS BLVD.	WHITING	IN	46394	04/01/2022
CH0518280	Walgreens Central Fill #21399	4132Plainfield Rd	Ste 110	Indianapolis	IN	46231-7021	04/01/2023
CH0518280	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2014	07/22/2015
CH0518280	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2014	07/22/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/2/2024 11:51:17 AM	2/13/2025 10:44:51 AM	2/13/2025 10:44 AM
Details	Last Recertification Date	Update	Recertification	2/3/2023 1:46:20 PM	2/2/2024 11:51:17 AM	2/2/2024 11:51 AM
Details	Last Recertification Date	Update	Recertification	2/8/2022 4:08:36 PM	2/3/2023 1:46:20 PM	2/3/2023 1:46 PM
Addresses	Billing Address	Insert	Recertification		NorthShore Health Centers, Inc PO Box 1430 Portage, IN 46368	2/8/2022 4:08 PM
Details	Last Recertification Date	Update	Recertification		2/8/2022 4:08:36 PM	2/8/2022 4:08 PM
Details	State	Update	OPA Edit	Approved	Active	11/16/2021 11:40 AM
Dates	Start Date	Update	OPA Edit	1/1/2022 12:00:00 AM	11/16/2021 12:00:00 AM	11/16/2021 11:40 AM
Contacts	Signed By	Insert	New Registration		Hall, David CEO NorthShore Health Centers 2197638112-8002	11/16/2021 11:34 AM
Details	340B ID	Update	New Registration		CH051828T	11/16/2021 11:34 AM
Dates	Participating Approval Date	Update	New Registration		11/16/2021 11:34:31 AM	11/16/2021 11:34 AM
Details	State	Update	New Registration	Pending	Approved	11/16/2021 11:34 AM
Dates	Signed By Date	Update	New Registration		11/15/2021 11:35:20 AM	11/16/2021 11:34 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	11/16/2021 11:34 AM
Addresses	Main Address	Insert	New Registration		200 3rd Ct SE Demotte, IN 46310-7400	11/15/2021 10:11 AM
Contacts	Primary Contact	Insert	New Registration		Wichlinski, Michael Pharmacy Director NorthShore Health Centers Inc. 2197638112-2301	11/15/2021 10:11 AM
Contacts	Authorizing Official	Insert	New Registration		Hall, David CEO NorthShore Health Centers 2197638112-8002	11/15/2021 10:11 AM
Details	Assistance Received From Date	Insert	New Registration			11/15/2021 10:11 AM
Details	Assistance Received To Date	Insert	New Registration			11/15/2021 10:11 AM
Details	Last Recertification Date	Insert	New Registration			11/15/2021 10:11 AM
Details	Grant Number	Insert	New Registration		H80CS02458	11/15/2021 10:11 AM
Details	340B ID	Insert	New Registration			11/15/2021 10:11 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			11/15/2021 10:11 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			11/15/2021 10:11 AM
Details	Medicare Provider Number	Insert	New Registration			11/15/2021 10:11 AM
Details	Entity Name	Insert	New Registration		NORTHSHORE HEALTH CENTERS, INC	11/15/2021 10:11 AM
Details	NOFO Number	Insert	New Registration			11/15/2021 10:11 AM
Details	Program Code	Insert	New Registration		CH	11/15/2021 10:11 AM
Details	Entity Subname	Insert	New Registration		NorthShore Demotte Health Center	11/15/2021 10:11 AM
Dates	Participating Approval Date	Insert	New Registration			11/15/2021 10:11 AM
Details	State	Insert	New Registration		Pending	11/15/2021 10:11 AM
Dates	Registration Date	Insert	New Registration		11/15/2021 10:11:00 AM	11/15/2021 10:11 AM
Dates	Signed By Date	Insert	New Registration			11/15/2021 10:11 AM
Dates	Start Date	Insert	New Registration			11/15/2021 10:11 AM
Terminations	Termination Comments	Insert	New Registration			11/15/2021 10:11 AM
Terminations	Termination Date	Insert	New Registration			11/15/2021 10:11 AM
Terminations	Termination Effective Date	Insert	New Registration			11/15/2021 10:11 AM
Terminations	Termination Reason	Insert	New Registration			11/15/2021 10:11 AM

340B Drug Pricing Program Database