Covered Entity Details

CH057880 WILL COUNTY COMMUNITY HEALTH CENTER (Active) - information as of 5/2/2025 10:28:30 PM

Main Details

Name

WILL COUNTY COMMUNITY HEALTH CENTER

Subdivision Name

WILL COUNTY COMMUNITY HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-001557

340B ID

CH057880

Grant Number

H80CS00476

Additional Details

Current Program Status

Active

Registration Date

7/1/2001

Participating Start Date

7/1/2001

Participating Approval Date

1/8/2010

Last Recertification Date

3/7/2025

Contacts

Authorizing Official

Will County Community Health Center
Stacy Baumgartner, Chief Executive Officer
(815) 740-7635

Primary Contact

Will County Community Health Center
Phil Jass, Quality Risk Management Program Coordinator
(815) 774-7355

Addresses

Street Address

1106 Neal Ave
Joliet, IL 60433-2548

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
01/20/06 UPDATED ADDR (WAS 501 ELLA AVENUE)	01/08/2010

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
IL	363971168001	1346772373,1053870204
WI	363971168001	1902811714

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	BASINGER'S MADISON PHARMACY	330 N. MADISON STREET	SUITE 102	JOLIET	IL	60435	10/03/2016	01/01/2017	01/20/2023	03/22/2023
Contract Detail	BASINGER'S PHARMACY	2130 W JEFFERSON ST		JOLIET	IL	60435-6622	10/03/2016	01/01/2017	01/20/2023	03/22/2023
Contract Detail	BASINGER'S PHARMACY INC	DBA BASINGERS CITY CENTER PHARMACY	300 N OTTAWA ST	JOLIET	IL	60432-4009	10/03/2016	01/01/2017	01/20/2023	03/22/2023
Contract Detail	BASINGER'S PHARMACY, INC	DBA BASINGER'S WILL COUNTY PHARMACY	1106 NEAL AVE STE A	JOLIET	IL	60433	04/07/2017	07/01/2017	01/20/2023	03/22/2023
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03929	1801 INGALLS AVE	JOLIET	IL	60435	04/11/2013	07/01/2013		04/11/2013
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04032	466 NELSON ROAD	NEW LENOX	IL	60451	04/11/2013	07/01/2013		04/11/2013
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04948	101 LILY CACHE LANE	BOLINGBROOK	IL	60440	04/11/2013	07/01/2013		04/11/2013
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05386	358 E CASS STREET	JOLIET	IL	60432	04/11/2013	07/01/2013		04/11/2013
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 10772	1163 W. JEFFERSON ST.	JOLIET	IL	60435	10/03/2016	01/01/2017		10/03/2016
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04460	1295 LILY CACHE LANE	BOLINGBROOK	IL	60490	04/05/2017	07/01/2017		04/05/2017
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03651	20950 GOVERNORS HWY.	OLYMPIA FIELDS	IL	60461	01/09/2019	04/01/2019		04/01/2019
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04532	15 S. ORCHARD DR.	PARK FOREST	IL	60466	01/09/2019	04/01/2019	03/07/2024	03/07/2024
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04949	7209 W. LINCOLN HWY.	FRANKFORT	IL	60423	01/09/2019	04/01/2019		04/01/2019
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05086	3120 CHICAGO RD	SOUTH CHICAGO HEIGHTS	IL	60411	01/09/2019	04/01/2019		04/01/2019
Contract Detail	BUBBLEPACK PHARMACY	2202 ESSINGTON RD	SUITE 104	JOLIET	IL	60435-1634	10/09/2018	01/01/2019	01/20/2023	03/22/2023
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/15/2019	04/01/2019		04/01/2019
Contract Detail	GENOA HEALTHCARE LLC	1106 NEAL AVE STE 1211		JOLIET	IL	60433	01/11/2024	04/01/2024		04/01/2024
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01170	3200 CATON FARM	JOLIET	IL	60431	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04977	2050 NELSON RD.	NEW LENOX	IL	60451	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 00921	1155 W. JEFFERSON ST.	SHOREWOOD	IL	60404	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02936	809 PLAINFIELD RD.	JOLIET	IL	60435	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01773	9551 W. 171ST ST.	TINLEY PARK	IL	60487	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05421	2375 DRAUDEN RD	PLAINFIELD	IL	60586	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05449	11840 S. STATE RTE 59	PLAINFIELD	IL	60585	10/01/2019	01/01/2020	04/02/2025	04/03/2025
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05822	11200 LINCOLN HWY	MOKENA	IL	60448	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07142	16760 W. DIVISION ST.	LOCKPORT	IL	60441	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07168	1725 WEST BOUGHTON RD.	BOLINGBROOK	IL	60490	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07760	19900 S LA GRANGE RD	MOKENA	IL	60448	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08512	1 MAIN STREET	PARK FOREST	IL	60466	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBS: CVS/PHARMACY #10553	230 S COMET DR.	BRAIDWOOD	IL	60408	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY #10761	1101 S WATER ST	WILMINGTON	IL	60481	10/01/2019	01/01/2020		01/01/2020
Contract Detail	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17121	2370 E LINCOLN HWY	NEW LENOX	IL	60451	10/12/2021	01/01/2022		01/01/2022
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06789	8645 WOODWARD AVE.	WOODRIDGE	IL	60517	01/06/2022	04/01/2022		04/01/2022
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #10599	245 S BROADWAY ST.	COAL CITY	IL	60416	01/06/2022	04/01/2022		04/01/2022
Contract Detail	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16326	2701 PLAINFIELD RD	JOLIET	IL	60435	01/06/2022	04/01/2022		04/01/2022
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08750	4801 N CENTRAL	CHICAGO	IL	60630	01/18/2022	04/01/2022		04/01/2022
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04262	2211 S. EOLA RD.	AURORA	IL	60503	01/18/2022	04/01/2022		04/01/2022
Contract Detail	J D BROWN & CO	837 PLAINFIELD RD		JOLIET	IL	60435-4660	10/03/2016	01/01/2017	01/02/2017	09/18/2018
Contract Detail	JOLIET PROFESSIONAL PHARMACY CORP	2401 W JEFFERSON ST	SUITE 200	JOLIET	IL	60435	10/03/2016	01/01/2017		10/03/2016
Contract Detail	KODO CARE, INC.	2401 W JEFFERSON ST STE 100		JOLIET	IL	60435	06/09/2020	07/01/2020		07/01/2020
Contract Detail	KODO PHARMACY, INC.		1522 E. WASHINGTON STREET	JOLIET	IL	60433-1365	07/14/2015	10/01/2015	10/30/2016	10/03/2016
Contract Detail	KODO PHARMACY, INC.		1522 E. WASHINGTON STREET	JOLIET	IL	60433-1365	04/14/2020	07/01/2020	06/09/2020	06/09/2020
Contract Detail	PRIMARY PHARMACY INC	DBA BASINGER'S PRIMARY CARE PHARMACY	2025 S. CHICAGO STREET	JOLIET	IL	60436-6043	10/09/2018	01/01/2019	01/20/2023	03/22/2023
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/15/2019	04/01/2019	07/12/2023	07/12/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/09/2020	04/01/2020	09/07/2021	09/07/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/13/2021	01/01/2022	07/05/2022	03/22/2023
Contract Detail	WAL-MART PHARMACY 10-1256	2424 W JEFFERSON		JOLIET	IL	60436	07/06/2018	10/01/2018	02/25/2019	02/27/2019
Contract Detail	WAL-MART PHARMACY 10-1256	2424 W JEFFERSON		JOLIET	IL	60436	10/13/2021	01/01/2022	07/05/2022	03/22/2023
Contract Detail	WAL-MART PHARMACY 10-3790	16241 S FARREL RD		LOCKPORT	IL	60441	07/06/2018	10/01/2018	02/25/2019	02/27/2019
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/13/2021	01/01/2022	07/05/2022	03/22/2023
Contract Detail	WALGREEN CO	DBA: WALGREENS #10374	680 E. BOUGHTON RD	BOLINGBROOK	IL	60440	04/05/2017	07/01/2017		04/05/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #11195	347 N INDEPENDENCE BLVD	ROMEOVILLE	IL	60446-1558	04/05/2017	07/01/2017		04/05/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #10605	1160 W JEFFERSON ST	SHOREWOOD	IL	60404-0703	01/03/2018	04/01/2018		01/03/2018
Contract Detail	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	01/04/2023	04/01/2023		04/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15031	1106 NEAL AVENUE	JOLIET	IL	60433	04/18/2013	07/01/2013	08/25/2016	09/08/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07866	2101 W JEFFERSON ST	JOLIET	IL	60435-6621	10/03/2016	01/01/2017		10/03/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04828	4822 CATON FARM RD	PLAINFIELD	IL	60586	01/04/2017	04/01/2017		01/04/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06563	498 N WEBER ROAD	ROMEOVILLE	IL	60446	01/04/2017	04/01/2017		01/04/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09919	695 W BOUGHTON RD	BOLINGBROOK	IL	60440-1752	04/05/2017	07/01/2017	11/13/2019	01/21/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07362	2379 PLAINFIELD RD	CREST HILL	IL	60403	10/05/2017	01/01/2018	04/10/2024	05/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06703	16750 W 159TH STREET	LOCKPORT	IL	60441-7968	10/05/2017	01/01/2018		10/05/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07829	680 S WEBER RD	ROMEOVILLE	IL	60446	10/05/2017	01/01/2018		10/05/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07411	3200 VOLLMER ROAD	OLYMPIA FIELDS	IL	60461-1122	01/09/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09326	9554 E LINCOLN HWY	FRANKFORT	IL	60423	01/09/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06180	450 S SCHOOLHOUSE RD	NEW LENOX	IL	60451	01/15/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13923	1890 SILVER CROSS BLVD STE 120	NEW LENOX	IL	60451	01/15/2019	04/01/2019	08/19/2021	08/20/2021
Contract Detail	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15305	912 W BELMONT AVE	CHICAGO	IL	60657	07/11/2023	10/01/2023		10/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/15/2019	04/01/2019	11/05/2021	01/21/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/15/2019	04/01/2019		04/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/15/2019	04/01/2019		04/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/15/2019	04/01/2019		04/01/2019

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH057880	Active	BPS-H80-001557	WILL COUNTY COMMUNITY HEALTH CENTER	WILL COUNTY COMMUNITY HEALTH CENTER	1106 Neal Ave	Joliet	IL
CH05788A	Active	BPS-H80-010960	WILL COUNTY COMMUNITY HEALTH CENTER	Mobile Medical and Dental Unit	1106 Neal Avenue	Joliet	IL
CH05788B	Active	BPS-H80-019321	WILL COUNTY COMMUNITY HEALTH CENTER	Will County Community Health Center - North	323 Quadrangle Drive	Bolingbrook	IL
CH05788C	Active	BPS-H80-027626	WILL COUNTY COMMUNITY HEALTH CENTER	Will County Community Health Center - East	5601 W. Monee-Manhattan Road STE 109	Monee	IL
CH05788D	Active	BPS-H80-035423	WILL COUNTY COMMUNITY HEALTH CENTER	Will County Community Health Center Brooks Middle School	350 Blair Ln	Bolingbrook	IL
CH05788E	Active	BPS-H80-038181	WILL CO COMM HEALTH CENTER	Will County Community Health Center at Will County Health Department	501 Ella Ave	Joliet	IL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH057880	BASINGER'S MADISON PHARMACY	330 N. MADISON STREET	SUITE 102	JOLIET	IL	60435	01/01/2017	01/20/2023
CH057880	BASINGER'S PHARMACY	2130 W JEFFERSON ST		JOLIET	IL	60435-6622	01/01/2017	01/20/2023
CH057880	BASINGER'S PHARMACY INC	DBA BASINGERS CITY CENTER PHARMACY	300 N OTTAWA ST	JOLIET	IL	60432-4009	01/01/2017	01/20/2023
CH057880	BASINGER'S PHARMACY, INC	DBA BASINGER'S WILL COUNTY PHARMACY	1106 NEAL AVE STE A	JOLIET	IL	60433	07/01/2017	01/20/2023
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03929	1801 INGALLS AVE	JOLIET	IL	60435	07/01/2013
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04032	466 NELSON ROAD	NEW LENOX	IL	60451	07/01/2013
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04948	101 LILY CACHE LANE	BOLINGBROOK	IL	60440	07/01/2013
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05386	358 E CASS STREET	JOLIET	IL	60432	07/01/2013
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 10772	1163 W. JEFFERSON ST.	JOLIET	IL	60435	01/01/2017
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04460	1295 LILY CACHE LANE	BOLINGBROOK	IL	60490	07/01/2017
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03651	20950 GOVERNORS HWY.	OLYMPIA FIELDS	IL	60461	04/01/2019
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04532	15 S. ORCHARD DR.	PARK FOREST	IL	60466	04/01/2019	03/07/2024
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04949	7209 W. LINCOLN HWY.	FRANKFORT	IL	60423	04/01/2019
CH057880	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05086	3120 CHICAGO RD	SOUTH CHICAGO HEIGHTS	IL	60411	04/01/2019
CH057880	BUBBLEPACK PHARMACY	2202 ESSINGTON RD	SUITE 104	JOLIET	IL	60435-1634	01/01/2019	01/20/2023
CH057880	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2019
CH057880	GENOA HEALTHCARE LLC	1106 NEAL AVE STE 1211		JOLIET	IL	60433	04/01/2024
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01170	3200 CATON FARM	JOLIET	IL	60431	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04977	2050 NELSON RD.	NEW LENOX	IL	60451	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 00921	1155 W. JEFFERSON ST.	SHOREWOOD	IL	60404	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02936	809 PLAINFIELD RD.	JOLIET	IL	60435	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01773	9551 W. 171ST ST.	TINLEY PARK	IL	60487	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05421	2375 DRAUDEN RD	PLAINFIELD	IL	60586	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05449	11840 S. STATE RTE 59	PLAINFIELD	IL	60585	01/01/2020	04/02/2025
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05822	11200 LINCOLN HWY	MOKENA	IL	60448	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07142	16760 W. DIVISION ST.	LOCKPORT	IL	60441	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07168	1725 WEST BOUGHTON RD.	BOLINGBROOK	IL	60490	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07760	19900 S LA GRANGE RD	MOKENA	IL	60448	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08512	1 MAIN STREET	PARK FOREST	IL	60466	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBS: CVS/PHARMACY #10553	230 S COMET DR.	BRAIDWOOD	IL	60408	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY #10761	1101 S WATER ST	WILMINGTON	IL	60481	01/01/2020
CH057880	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17121	2370 E LINCOLN HWY	NEW LENOX	IL	60451	01/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06789	8645 WOODWARD AVE.	WOODRIDGE	IL	60517	04/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #10599	245 S BROADWAY ST.	COAL CITY	IL	60416	04/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16326	2701 PLAINFIELD RD	JOLIET	IL	60435	04/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08750	4801 N CENTRAL	CHICAGO	IL	60630	04/01/2022
CH057880	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04262	2211 S. EOLA RD.	AURORA	IL	60503	04/01/2022
CH057880	J D BROWN & CO	837 PLAINFIELD RD		JOLIET	IL	60435-4660	01/01/2017	01/02/2017
CH057880	JOLIET PROFESSIONAL PHARMACY CORP	2401 W JEFFERSON ST	SUITE 200	JOLIET	IL	60435	01/01/2017
CH057880	KODO CARE, INC.	2401 W JEFFERSON ST STE 100		JOLIET	IL	60435	07/01/2020
CH057880	KODO PHARMACY, INC.		1522 E. WASHINGTON STREET	JOLIET	IL	60433-1365	10/01/2015	10/30/2016
CH057880	KODO PHARMACY, INC.		1522 E. WASHINGTON STREET	JOLIET	IL	60433-1365	07/01/2020	06/09/2020
CH057880	PRIMARY PHARMACY INC	DBA BASINGER'S PRIMARY CARE PHARMACY	2025 S. CHICAGO STREET	JOLIET	IL	60436-6043	01/01/2019	01/20/2023
CH057880	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2019	07/12/2023
CH057880	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2020	09/07/2021
CH057880	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2022	07/05/2022
CH057880	WAL-MART PHARMACY 10-1256	2424 W JEFFERSON		JOLIET	IL	60436	10/01/2018	02/25/2019
CH057880	WAL-MART PHARMACY 10-1256	2424 W JEFFERSON		JOLIET	IL	60436	01/01/2022	07/05/2022
CH057880	WAL-MART PHARMACY 10-3790	16241 S FARREL RD		LOCKPORT	IL	60441	10/01/2018	02/25/2019
CH057880	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2022	07/05/2022
CH057880	WALGREEN CO	DBA: WALGREENS #10374	680 E. BOUGHTON RD	BOLINGBROOK	IL	60440	07/01/2017
CH057880	WALGREEN CO	DBA: WALGREENS #11195	347 N INDEPENDENCE BLVD	ROMEOVILLE	IL	60446-1558	07/01/2017
CH057880	WALGREEN CO	DBA: WALGREENS #10605	1160 W JEFFERSON ST	SHOREWOOD	IL	60404-0703	04/01/2018
CH057880	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	04/01/2023
CH057880	WALGREEN CO.	DBA: WALGREENS #15031	1106 NEAL AVENUE	JOLIET	IL	60433	07/01/2013	08/25/2016
CH057880	WALGREEN CO.	DBA: WALGREENS # 07866	2101 W JEFFERSON ST	JOLIET	IL	60435-6621	01/01/2017
CH057880	WALGREEN CO.	DBA: WALGREENS # 04828	4822 CATON FARM RD	PLAINFIELD	IL	60586	04/01/2017
CH057880	WALGREEN CO.	DBA: WALGREENS # 06563	498 N WEBER ROAD	ROMEOVILLE	IL	60446	04/01/2017
CH057880	WALGREEN CO.	DBA: WALGREENS # 09919	695 W BOUGHTON RD	BOLINGBROOK	IL	60440-1752	07/01/2017	11/13/2019
CH057880	WALGREEN CO.	DBA: WALGREENS # 07362	2379 PLAINFIELD RD	CREST HILL	IL	60403	01/01/2018	04/10/2024
CH057880	WALGREEN CO.	DBA: WALGREENS # 06703	16750 W 159TH STREET	LOCKPORT	IL	60441-7968	01/01/2018
CH057880	WALGREEN CO.	DBA: WALGREENS # 07829	680 S WEBER RD	ROMEOVILLE	IL	60446	01/01/2018
CH057880	WALGREEN CO.	DBA: WALGREENS # 07411	3200 VOLLMER ROAD	OLYMPIA FIELDS	IL	60461-1122	04/01/2019
CH057880	WALGREEN CO.	DBA: WALGREENS # 09326	9554 E LINCOLN HWY	FRANKFORT	IL	60423	04/01/2019
CH057880	WALGREEN CO.	DBA: WALGREENS # 06180	450 S SCHOOLHOUSE RD	NEW LENOX	IL	60451	04/01/2019
CH057880	WALGREEN CO.	DBA: WALGREENS #13923	1890 SILVER CROSS BLVD STE 120	NEW LENOX	IL	60451	04/01/2019	08/19/2021
CH057880	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15305	912 W BELMONT AVE	CHICAGO	IL	60657	10/01/2023
CH057880	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2019	11/05/2021
CH057880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2019
CH057880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2019
CH057880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/6/2024 10:53:26 AM	3/7/2025 2:16:29 PM	3/7/2025 2:16 PM
Contacts	Authorizing Official	Update	Change Request	Maragos, Mary Chief Executive Officer Will County Community Health Center 8157407635	Baumgartner, Stacy Chief Executive Officer Will County Community Health Center 8157407635	3/11/2024 9:33 AM
Details	Last Recertification Date	Update	Recertification	2/8/2023 9:22:28 AM	2/6/2024 10:53:26 AM	2/6/2024 10:53 AM
Details	Last Recertification Date	Update	Recertification	2/16/2022 6:56:17 AM	2/8/2023 9:22:28 AM	2/8/2023 9:22 AM
Contacts	Primary Contact	Update	Recertification	Baumgartner, Stacy Director of Operations Will County Community Health Center 8157747375	Jass, Phil Quality Risk Management Program Coordinator Will County Community Health Center 8157747355	2/16/2022 6:56 AM
Details	Last Recertification Date	Update	Recertification	2/22/2021 10:24:07 AM	2/16/2022 6:56:17 AM	2/16/2022 6:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2021 10:24 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		363971168001	2/22/2021 10:24 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		WI	2/22/2021 10:24 AM
Medicaid Billing	NPI: State	Update	Recertification		WI	2/22/2021 10:24 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1346772373	2/22/2021 10:24 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	2/22/2021 10:24 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1053870204	2/22/2021 10:24 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	2/22/2021 10:24 AM
Details	Last Recertification Date	Update	Recertification	1/27/2020 10:55:27 AM	2/22/2021 10:24:07 AM	2/22/2021 10:24 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 5:54:34 PM	1/27/2020 10:55:27 AM	1/27/2020 10:55 AM
Contacts	Primary Contact	Update	Change Request	Byrd, Jennifer Chief Medical Officer Will County Community Health Center 8157408985	Baumgartner, Stacy Director of Operations Will County Community Health Center 8157747375	4/2/2019 1:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/7/2019 2:11 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		363971168001	3/7/2019 2:11 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	3/7/2019 2:11 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1902811714	3/7/2019 2:11 PM
Details	Last Recertification Date	Update	Recertification	2/9/2018 11:11:15 AM	1/29/2019 5:54:34 PM	1/29/2019 5:54 PM
Contacts	Primary Contact	Update	Change Request	Edwards, Thomas Director of Operations Will County Community Health Center 8157747375	Byrd, Jennifer Chief Medical Officer Will County Community Health Center 8157408985	7/13/2018 3:36 PM
Contacts	Primary Contact	Update	Recertification	Edwards, Thomas Director of Operations 8157747375	Edwards, Thomas Director of Operations Will County Community Health Center 8157747375	2/9/2018 11:11 AM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/9/2018 11:11:15 AM	2/9/2018 11:11 AM
Contacts	Authorizing Official	Update		Maragos, Mary Chief Executive Officer 8157407635	Maragos, Mary Chief Executive Officer Will County Community Health Center 8157407635	9/29/2017 10:07 AM
Contacts	Authorizing Official	Update		Coffey, Mary CEO 8157407635	Maragos, Mary Chief Executive Officer 8157407635	8/7/2017 9:51 AM
Contacts	Primary Contact	Update		Zanelli, Nola Administration Clerk/Purchasing 8157747301	Edwards, Thomas Director of Operations 8157747375	4/28/2017 12:47 PM
Addresses	Main Address	Insert			1106 Neal Ave Joliet, IL 60433-2548	2/1/2017 2:56 PM
Details	Last Recertification Date	Update		2/24/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 2:56 PM
Addresses	Billing Address	Insert			Will County Health Department 501 Ella Avenue Joliet, IL 60433	2/24/2016 5:15 PM
Details	Last Recertification Date	Update		1/28/2015 12:00:00 AM	2/24/2016 12:00:00 AM	2/24/2016 5:15 PM
Contacts	Primary Contact	Update		SEMETULSKIS, ANDREA ADMINISTRATION CLERK 8157278670	Zanelli, Nola Administration Clerk/Purchasing 8157747301	5/18/2015 9:45 AM
Details	Last Recertification Date	Update		3/17/2014 12:00:00 AM	1/28/2015 12:00:00 AM	1/28/2015 12:35 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/17/2014 12:00:00 AM	3/17/2014 7:05 AM
Details	Entity Name	Update		WILL COUNTY HEALTH DEPARTMENT/WILL COUNTY CHC	WILL COUNTY COMMUNITY HEALTH CENTER	3/17/2014 7:05 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/11/2013 12:29 PM
Contacts	Authorizing Official	Update		ALBERT, YOLANDA SHANNON CEO 8157278869	Coffey, Mary CEO 8157407635	3/27/2012 10:07 AM
Details	Entity Name	Update		WILL COUNTY HEALTH DEPARTMENT	WILL COUNTY HEALTH DEPARTMENT/WILL COUNTY CHC	2/24/2012 1:21 PM
Contacts	Primary Contact	Insert			SEMETULSKIS, ANDREA ADMINISTRATION CLERK 8157278670	1/8/2010 2:05 PM
Contacts	Authorizing Official	Insert			ALBERT, YOLANDA SHANNON CEO 8157278869	1/8/2010 2:05 PM
Details	Last Recertification Date	Insert				1/8/2010 2:05 PM
Details	Grant Number	Insert			H80CS00476	1/8/2010 2:05 PM
Details	340B ID	Insert			CH057880	1/8/2010 2:05 PM
Details	Is Authorizing Official EHB Data	Insert				1/8/2010 2:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/8/2010 2:05 PM
Details	Medicare Provider Number	Insert				1/8/2010 2:05 PM
Details	Entity Name	Insert			WILL COUNTY HEALTH DEPARTMENT	1/8/2010 2:05 PM
Details	Program Code	Insert			CH	1/8/2010 2:05 PM
Details	Entity Subname	Insert			WILL COUNTY COMMUNITY HEALTH CENTER	1/8/2010 2:05 PM
Dates	Participating Approval Date	Insert			1/8/2010 12:00:00 AM	1/8/2010 2:05 PM
Details	State	Insert			Active	1/8/2010 2:05 PM
Dates	Registration Date	Insert			7/1/2001 12:00:00 AM	1/8/2010 2:05 PM
Dates	Signed By Date	Insert				1/8/2010 2:05 PM
Dates	Start Date	Insert			7/1/2001 12:00:00 AM	1/8/2010 2:05 PM
Terminations	Termination Comments	Insert				1/8/2010 2:05 PM
Terminations	Termination Date	Insert				1/8/2010 2:05 PM
Terminations	Termination Effective Date	Insert				1/8/2010 2:05 PM
Terminations	Termination Reason	Insert				1/8/2010 2:05 PM
Details	Comments Public	Insert			01/20/06 UPDATED ADDR (WAS 501 ELLA AVENUE)	1/8/2010 2:05 PM

340B Drug Pricing Program Database