Covered Entity Details

FQHCLA416B EHS, INC. (Active) - information as of 6/14/2025 10:09:17 AM

Main Details

Name

EHS, INC.

Subdivision Name

Evergreen Health - Hertel Ave.

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-033019

340B ID

FQHCLA416B

Grant Number

LALCS40178

Additional Details

Current Program Status

Active

Registration Date

1/12/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/13/2022

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

EHS, Inc.
Raymond Ganoe, President/CEO
(716) 847-0212

Primary Contact

EHS, INC.
PATRICK HILDENBRANDT, VP Pharmacy Services
(716) 541-0656

Addresses

Street Address

800 Hertel Ave Ste 100
Buffalo, NY 14207-1906

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?
Yes

State	Medicaid Number	NPI Number
NY	03370596	1043508179

Shipping Addresses

Shipping Address 1

EHS, Inc., dba The Pharmacy at Evergreen
800 Hertel Ave
Ste 105
Buffalo, NY 14207

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
FQHCLA416	Active	BPS-LAL-031687	EHS, INC.	Evergreen Health - Bailey Ave.	3297 Bailey Ave	Buffalo	NY
FQHCLA416A	Active	BPS-LAL-031685	EHS, INC.	Evergreen Health - Elmwood Ave.	206 S Elmwood Ave	Buffalo	NY
FQHCLA416B	Active	BPS-LAL-033019	EHS, INC.	Evergreen Health - Hertel Ave.	800 Hertel Ave Ste 100	Buffalo	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
FQHCLA416	PARKVIEW HEALTH SERVICES OF NEW YORK LLC	PARKVIEW	1770 COLVIN BLVD	BUFFALO	NY	14223	10/01/2021
FQHCLA416A	PARKVIEW HEALTH SERVICES OF NEW YORK LLC	PARKVIEW	1770 COLVIN BLVD	BUFFALO	NY	14223	10/01/2021
FQHCLA416	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	10/01/2021
FQHCLA416A	PARKVIEW NIAGARA STREET, LLC	DBA RIVERVIEW PROFESSIONAL PHARMACY	3920 MAIN ST STE 150	AMHERST	NY	14226	10/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/31/2024 11:09:47 AM	2/12/2025 1:48:09 PM	2/12/2025 1:48 PM
Details	Last Recertification Date	Update	Recertification	1/31/2023 3:40:08 PM	1/31/2024 11:09:47 AM	1/31/2024 11:09 AM
Details	Last Recertification Date	Update	Recertification		1/31/2023 3:40:08 PM	1/31/2023 3:40 PM
Addresses	Shipping Address	Update	Change Request	EHS, Inc., dba The Pharmacy at Evergreen 800 Hertel 105 Buffalo, NY 14207	EHS, Inc., dba The Pharmacy at Evergreen 800 Hertel Ave Ste 105 Buffalo, NY 14207	12/30/2022 9:48 AM
Addresses	Shipping Address	Insert	Change Request		EHS, Inc., dba The Pharmacy at Evergreen 800 Hertel 105 Buffalo, NY 14207	12/21/2022 12:06 PM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Ganoe, Raymond President/CEO EHS, Inc. 7168470212	1/13/2022 8:32 AM
Details	340B ID	Update	New Registration		FQHCLA416B	1/13/2022 8:32 AM
Dates	Participating Approval Date	Update	New Registration		1/13/2022 8:32:43 AM	1/13/2022 8:32 AM
Details	State	Update	New Registration	Pending	Approved	1/13/2022 8:32 AM
Dates	Signed By Date	Update	New Registration		1/12/2022 1:22:07 PM	1/13/2022 8:32 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/13/2022 8:32 AM
Addresses	Main Address	Insert	New Registration		800 Hertel Ave Ste 100 Buffalo, NY 14207-1906	1/12/2022 1:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2022 1:22 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		03370596	1/12/2022 1:22 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NY	1/12/2022 1:22 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1043508179	1/12/2022 1:22 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	1/12/2022 1:22 PM
Contacts	Primary Contact	Insert	New Registration		HILDENBRANDT, PATRICK VP Pharmacy Services EHS, INC. 7165410656	1/12/2022 1:22 PM
Contacts	Authorizing Official	Insert	New Registration		Ganoe, Raymond President/CEO EHS, Inc. 7168470212	1/12/2022 1:22 PM
Details	Assistance Received From Date	Insert	New Registration			1/12/2022 1:22 PM
Details	Assistance Received To Date	Insert	New Registration			1/12/2022 1:22 PM
Details	Last Recertification Date	Insert	New Registration			1/12/2022 1:22 PM
Details	Grant Number	Insert	New Registration		LALCS40178	1/12/2022 1:22 PM
Details	340B ID	Insert	New Registration			1/12/2022 1:22 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2022 1:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2022 1:22 PM
Details	Medicare Provider Number	Insert	New Registration			1/12/2022 1:22 PM
Details	Entity Name	Insert	New Registration		EHS, INC.	1/12/2022 1:22 PM
Details	NOFO Number	Insert	New Registration			1/12/2022 1:22 PM
Details	Program Code	Insert	New Registration		FQHCLA	1/12/2022 1:22 PM
Details	Entity Subname	Insert	New Registration		Evergreen Health - Hertel Ave.	1/12/2022 1:22 PM
Dates	Participating Approval Date	Insert	New Registration			1/12/2022 1:22 PM
Details	State	Insert	New Registration		Pending	1/12/2022 1:22 PM
Dates	Registration Date	Insert	New Registration		1/12/2022 1:22:04 PM	1/12/2022 1:22 PM
Dates	Signed By Date	Insert	New Registration			1/12/2022 1:22 PM
Dates	Start Date	Insert	New Registration			1/12/2022 1:22 PM
Terminations	Termination Comments	Insert	New Registration			1/12/2022 1:22 PM
Terminations	Termination Date	Insert	New Registration			1/12/2022 1:22 PM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2022 1:22 PM
Terminations	Termination Reason	Insert	New Registration			1/12/2022 1:22 PM

340B Drug Pricing Program Database