Covered Entity Details

CH05302AB West Side Community Health Services, Inc. (Terminated) - information as of 5/13/2025 10:56:09 PM

Main Details

Name

West Side Community Health Services, Inc.

Subdivision Name

MN Community Care-Farmington Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033698

340B ID

CH05302AB

Grant Number

H80CS00790

Additional Details

Current Program Status

Terminated

Registration Date

1/4/2022

Participating Start Date

1/14/2022

Participating Approval Date

1/14/2022

Last Recertification Date

2/1/2024

Termination Date
Termination Reason

1/1/2025
Business decision by the Covered Entity

Contacts

Authorizing Official

West Side Community Health Services
Reuben Moore, President and Executive Officer
(651) 602-7536

Primary Contact

West Side Community Health Services
Kenneth Scott Nelson, Director of Pharmacy
(715) 566-0729

Addresses

Street Address

19685 Pilot Knob Rd Ste 100
Farmington, MN 55024-7238

Billing Address

West Side Community Health Services
153 Cesar Chavez St.
Attn Pharmacy Department
St. Paul, MN 55107

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
MN	955353300	1174284699,1114069911,1871755975

Shipping Addresses

Shipping Address 1

West Side Community Health Services, Inc.
153 Cesar Chavez Street
St. Paul, MN 55107

Shipping Address 2

West Side Community Health Services, Inc.
895 7th St. E.
St. Paul, MN 55106

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
CH053020	Active	BPS-H80-000234	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	WESTSIDE COMMUNITY HEALTH SERVICES, INC.	153 Cesar Chavez St	Saint Paul	MN
CH05302AA	Active	BPS-H80-029985	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	MN Community Care - Downtown Clinic	424 Dorothy Day Pl	Saint Paul	MN
CH05302AB	Terminated	BPS-H80-033698	West Side Community Health Services, Inc.	MN Community Care-Farmington Clinic	19685 Pilot Knob Rd Ste 100	Farmington	MN
CH05302AC	Active	BPS-H80-024768	West Side Community Health Services, Inc.	MN Community Care - Creative Arts SBC	65 Kellogg Blvd E, School-Based Clinic Suite	Saint Paul	MN
CH05302AD	Active	BPS-H80-034433	West Side Community Health Services, Inc.	MN Community Care - St. Paul Wellness Center	45 10th St W	Saint Paul	MN
CH05302K	Active	BPS-H80-011405	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	East Side Family Clinic	895 7th St E	St Paul	MN
CH05302L	Active	BPS-H80-006982	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	HUMBOLDT JR/SR HIGH CLINIC	30 Baker St E	Saint Paul	MN
CH05302M	Active	BPS-H80-006449	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	Gordon Parks Area Learning Center	1212 University Ave W	Saint Paul	MN
CH05302N	Active	BPS-H80-006496	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	COMO HIGH SCHOOL CLINIC	740 Rose Ave W	Saint Paul	MN
CH05302P	Active	BPS-H80-000472	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	JOHNSON HIGH SCHOOL CLINIC	1349 ARCADE ST	ST. PAUL	MN
CH05302Q	Active	BPS-H80-002335	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	Washington Technology Magnet School	1495 Rice St	Saint Paul	MN
CH05302R	Active	BPS-H80-011314	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	AGAPE CLINIC	1037 University Ave W	Saint Paul	MN
CH05302S	Active	BPS-H80-000926	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	HARDING HIGH SCHOOL CLINIC	1540 6th St E	Saint Paul	MN
CH05302T	Active	BPS-H80-005775	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	UNION GOSPEL MISSION	435 UNIVERSITY AVE	ST. PAUL	MN
CH05302U	Active	BPS-H80-000917	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	HIGHLAND PARK JR/SR HIGH CLINIC	1015 Snelling Ave S	Saint Paul	MN
CH05302V	Terminated	BPS-H80-006051	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	DOROTHY DAY CLINIC	183 Old 6th St W	Saint Paul	MN
CH05302W	Terminated	BPS-H80-005824	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	FAMILY SERVICES CENTER	2001 Van Dyke St	Saint Paul	MN
CH05302X	Active	BPS-H80-006198	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	CENTRAL HIGH SCHOOL CLINIC	275 Lexington Pkwy N	Saint Paul	MN
CH05302Y	Active	BPS-H80-000730	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	MCDONOUGH HOMES CLINIC	1544 Timberlake Rd	Saint Paul	MN
CH05302Z	Active	BPS-H80-005247	WEST SIDE COMMUNITY HEALTH SERVICES, INC.	WEST SIDE DENTAL CLINIC	478 Robert St S	Saint Paul	MN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH053020	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2023
CH053020	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2023
CH053020	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2023
CH053020	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2023
CH053020	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2023
CH053020	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2023
CH053020	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2023
CH053020	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2023
CH053020	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2023
CH053020	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2023
CH053020	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2023
CH053020	EQUITY CONSULTING PARTNERS LLC	DBA WELLNESS PHARMACY	45 10TH ST W STE 1045	SAINT PAUL	MN	55102	07/01/2023
CH053020	FAIRVIEW SPECIALTY SERVICES PHARMACY	711 KASOTA AVENUE SE, SUITE A		MINNEAPOLIS	MN	55414	10/01/2024
CH053020	GENOA HEALTHCARE LLC	1155 FORD RD	STE C	SAINT LOUIS PARK	MN	55426	07/01/2025
CH053020	GENOA HEALTHCARE LLC	166 4TH STREET E, STE 244		SAINT PAUL	MN	55101	07/01/2025
CH053020	GENOA HEALTHCARE LLC	1600 UNIVERSITY AVE W # 12	ROOM P	SAINT PAUL	MN	55104	07/01/2025
CH053020	GENOA HEALTHCARE LLC	800 TRANSFER RD STE 1A		SAINT PAUL	MN	55114	07/01/2025
CH053020	GENOA HEALTHCARE LLC	317 YORK AVENUE		SAINT PAUL	MN	55130	07/01/2025
CH053020	GENOA HEALTHCARE LLC	1900 SILVER LAKE ROAD	STE 111	NEW BRIGHTON	MN	55112	07/01/2025
CH053020	GENOA HEALTHCARE LLC	3101 OLD HIGHWAY 8	STE 203-B	ROSEVILLE	MN	55113	07/01/2025
CH053020	GENOA HEALTHCARE LLC	1811 WEIR DRIVE	SUITE 275	WOODBURY	MN	55125	07/01/2025
CH053020	GENOA HEALTHCARE LLC	149 THOMPSON AVE E STE 150		WEST ST PAUL	MN	55118	07/01/2025
CH053020	GENOA HEALTHCARE LLC	122 WABASHA ST S STE 110		SAINT PAUL	MN	55107	07/01/2025
CH053020	GRAND ST. PAUL CVS, L.L.C.	DBA: CVS/PHARMACY # 05998	499 SNELLING AVE. N.	ST PAUL	MN	55104	01/01/2020	04/01/2022
CH053020	GRAND ST. PAUL CVS, L.L.C.	DBA: CVS/PHARMACY # 07060	810 MARYLAND AVENUE EAST	ST PAUL	MN	55106	01/01/2020	07/08/2022
CH053020	GRAND ST. PAUL CVS, L.L.C.	DBA: CVS/PHARMACY # 03313	1471 ROBERT STREET S	WEST SAINT PAUL	MN	55118	01/01/2020
CH053020	GRAND ST. PAUL CVS, L.L.C.	DBA: CVS/PHARMACY # 00241	19605 PILOT KNOB RD.	FARMINGTON	MN	55024	01/01/2022
CH053020	GRAND ST. PAUL CVS, L.L.C.	DBA: CVS/PHARMACY # 05992	7901 BASS LAKE RD.	NEW HOPE	MN	55428	01/01/2023
CH053020	GRAND ST. PAUL CVS, L.L.C.	CVS PHARMACY # 17218	7900 32ND ST N	OAKDALE	MN	55128	01/01/2023
CH053020	GRAND ST. PAUL CVS, L.L.C.	CVS PHARMACY # 16508	3300 124TH AVE NW	COON RAPIDS	MN	55433	01/01/2023
CH053020	GRAND ST. PAUL CVS, L.L.C.	CVS PHARMACY # 16015	1744 SUBURBAN AVE	SAINT PAUL	MN	55106	01/01/2023
CH053020	LLOYD'S PHARMACY	ALCHEMIST GENERAL INC.	720 SNELLING AVE N	SAINT PAUL	MN	55104	11/08/2022
CH053020	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2025
CH053020	PHALEN FAMILY PHARMACY, LTD	1001 JOHNSON PKWY STE B23		SAINT PAUL	MN	55106-3474	07/01/2019
CH053020	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2023
CH053020	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2023
CH053020	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2023
CH053020	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2023
CH053020	SETZER PHARMACY	1685 RICE ST		ROSEVILLE	MN	55113	11/08/2022
CH053020	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2019	10/26/2023
CH053020	WAL-MART PHARMACY 10-3364	1644 SOUTH ROBERT STREET SOUTH		WEST ST.PAUL	MN	55118	07/01/2019	10/26/2023
CH053020	WAL-MART PHARMACY 10-5437	1450 UNIVERSITY AVE W		ST PAUL (MIDWAY)	MN	55104	07/01/2019	09/13/2019
CH053020	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2019	10/26/2023
CH053020	WALGREEN CO	DBA: WALGREENS #1751	2920 WHITE BEAR AVE N	MAPLEWOOD	MN	55109	12/29/2011
CH053020	WALGREEN CO	DBA: WALGREENS #10473	1700 RICE ST	SAINT PAUL	MN	55113-6812	12/29/2011
CH053020	WALGREEN CO	DBA: WALGREENS #11421	1180 ARCADE ST	SAINT PAUL	MN	55106-2629	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 16476	398 WABASHA ST N	ST PAUL	MN	55102	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS #15272	1110 LARPENTEUR AVE W	ST PAUL	MN	55113	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 02142	734 GRAND AVE	ST PAUL	MN	55105	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 02355	1550 UNIVERSITY AVE W	ST PAUL	MN	55104	12/29/2011	08/16/2018
CH053020	WALGREEN CO.	DBA: WALGREENS # 02805	1133 S ROBERT ST	WEST ST PAUL	MN	55118	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 03122	985 GENEVA AVENUE N	OAKDALE	MN	55128	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 03187	1075 HIGHWAY 96 E	WHITE BEAR LAKE	MN	55127	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 03665	1401 MARYLAND AVE E	ST PAUL	MN	55106	12/29/2011	11/30/2023
CH053020	WALGREEN CO.	DBA: WALGREENS # 04882	5825 CAHILL AVE.	INVER GROVE HEIGHTS	MN	55076	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 06995	1788 OLD HUDSON ROAD	ST PAUL	MN	55119-4307	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 07388	1665 WHITE BEAR AVENUE N	ST PAUL	MN	55106-1611	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS # 09795	1585 RANDOLPH AVE	ST PAUL	MN	55105-2149	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS #13685	2635 RICE ST	ROSEVILLE	MN	55113	12/29/2011
CH053020	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #11916	1221 W LAKE ST, STE 200	MINNEAPOLIS	MN	55408	07/01/2013
CH053020	WALGREEN CO.	DBA: WALGREENS # 06943	4560 S ROBERT TRAIL	INVER GROVE HEIGHTS	MN	55077	10/01/2013
CH053020	WALGREEN CO.	DBA: WALGREENS # 10188	1615 QUEENS DR	WOODBURY	MN	55125	04/01/2015
CH053020	WALGREEN CO.	DBA: WALGREENS # 05634	7560 160TH STREET WEST	LAKEVILLE	MN	55044	04/01/2015
CH053020	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15309	2100 LYNDALE AVE S STE A	MINNEAPOLIS	MN	55405	07/01/2019
CH053020	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #16522	360 SHERMAN ST. SUITE 100	SAINT PAUL	MN	55102	07/01/2019	08/24/2023
CH053020	WALGREEN CO.	DBA: WALGREENS # 06057	7135 E POINT DOUGLAS RD SOUTH	COTTAGE GROVE	MN	55016	01/01/2023
CH053020	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2024
CH053020	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/1/2024 12:00:00 AM	10/31/2024 8:33 AM
Details	State	Update	Termination Request	Active	To Be Terminated	10/31/2024 8:33 AM
Terminations	Termination Comments	Update	Termination Request		Farmington Clinic site closed due to financial pressure and unsustainability	10/31/2024 8:33 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	10/31/2024 8:33 AM
Terminations	Termination Effective Date	Update	Termination Request		1/1/2024 12:00:00 AM	10/31/2024 8:33 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	10/31/2024 8:33 AM
Details	Last Recertification Date	Update	Recertification	2/2/2023 2:52:18 PM	2/1/2024 8:21:31 AM	2/1/2024 8:21 AM
Details	Last Recertification Date	Update	Recertification	2/3/2022 9:35:52 AM	2/2/2023 2:52:18 PM	2/2/2023 2:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/29/2022 2:56 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		955353300	7/29/2022 2:56 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	7/29/2022 2:56 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1114069911	7/29/2022 2:56 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	7/29/2022 2:56 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1871755975	7/29/2022 2:56 PM
Medicaid Billing	NPI: State	Insert	Change Request		MN	7/29/2022 2:56 PM
Addresses	Shipping Address	Insert	Change Request		West Side Community Health Services, Inc. 153 Cesar Chavez Street St. Paul, MN 55107	7/26/2022 1:35 PM
Addresses	Shipping Address	Insert	Change Request		West Side Community Health Services, Inc. 895 7th St. E. St. Paul, MN 55106	7/26/2022 1:35 PM
Addresses	Billing Address	Update	Recertification	West Side Community Health Services attn: pharmacy 153 Cesar Chavez St. St. Paul, MN 55107	West Side Community Health Services 153 Cesar Chavez St. Attn Pharmacy Department St. Paul, MN 55107	2/3/2022 9:35 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1174284699	2/3/2022 9:35 AM
Medicaid Billing	NPI: State	Insert	Recertification		MN	2/3/2022 9:35 AM
Details	Last Recertification Date	Update	Recertification		2/3/2022 9:35:52 AM	2/3/2022 9:35 AM
Details	State	Update	OPA Edit	Approved	Active	1/14/2022 2:01 PM
Dates	Start Date	Update	OPA Edit	4/1/2022 12:00:00 AM	1/14/2022 12:00:00 AM	1/14/2022 2:01 PM
Contacts	Signed By	Insert	New Registration		Moore, Reuben President and Executive Officer West Side Community Health Services 6516027536	1/14/2022 1:59 PM
Details	340B ID	Update	New Registration		CH05302AB	1/14/2022 1:59 PM
Dates	Participating Approval Date	Update	New Registration		1/14/2022 1:59:29 PM	1/14/2022 1:59 PM
Details	State	Update	New Registration	Pending	Approved	1/14/2022 1:59 PM
Dates	Signed By Date	Update	New Registration		1/6/2022 10:30:23 AM	1/14/2022 1:59 PM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/14/2022 1:59 PM
Addresses	Main Address	Insert	New Registration		19685 Pilot Knob Rd Ste 100 Farmington, MN 55024-7238	1/4/2022 1:49 PM
Addresses	Billing Address	Insert	New Registration		West Side Community Health Services attn: pharmacy 153 Cesar Chavez St. St. Paul, MN 55107	1/4/2022 1:49 PM
Contacts	Primary Contact	Insert	New Registration		Nelson, Kenneth Scott Director of Pharmacy West Side Community Health Services 7155660729	1/4/2022 1:49 PM
Contacts	Authorizing Official	Insert	New Registration		Moore, Reuben President and Executive Officer West Side Community Health Services 6516027536	1/4/2022 1:49 PM
Details	Assistance Received From Date	Insert	New Registration			1/4/2022 1:49 PM
Details	Assistance Received To Date	Insert	New Registration			1/4/2022 1:49 PM
Details	Last Recertification Date	Insert	New Registration			1/4/2022 1:49 PM
Details	Grant Number	Insert	New Registration		H80CS00790	1/4/2022 1:49 PM
Details	340B ID	Insert	New Registration			1/4/2022 1:49 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/4/2022 1:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/4/2022 1:49 PM
Details	Medicare Provider Number	Insert	New Registration			1/4/2022 1:49 PM
Details	Entity Name	Insert	New Registration		West Side Community Health Services, Inc.	1/4/2022 1:49 PM
Details	NOFO Number	Insert	New Registration			1/4/2022 1:49 PM
Details	Program Code	Insert	New Registration		CH	1/4/2022 1:49 PM
Details	Entity Subname	Insert	New Registration		MN Community Care-Farmington Clinic	1/4/2022 1:49 PM
Dates	Participating Approval Date	Insert	New Registration			1/4/2022 1:49 PM
Details	State	Insert	New Registration		Pending	1/4/2022 1:49 PM
Dates	Registration Date	Insert	New Registration		1/4/2022 1:49:07 PM	1/4/2022 1:49 PM
Dates	Signed By Date	Insert	New Registration			1/4/2022 1:49 PM
Dates	Start Date	Insert	New Registration			1/4/2022 1:49 PM
Terminations	Termination Comments	Insert	New Registration			1/4/2022 1:49 PM
Terminations	Termination Date	Insert	New Registration			1/4/2022 1:49 PM
Terminations	Termination Effective Date	Insert	New Registration			1/4/2022 1:49 PM
Terminations	Termination Reason	Insert	New Registration			1/4/2022 1:49 PM

340B Drug Pricing Program Database