Covered Entity Details

CH03070AD Central Virginia Health Services, Inc. (Active) - information as of 6/6/2025 4:24:49 AM

Main Details

Name

Central Virginia Health Services, Inc.

Subdivision Name

CVHS - Petersburg Recovery Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-034431

340B ID

CH03070AD

Grant Number

H80CS00479

Additional Details

Current Program Status

Active

Registration Date

7/22/2022

Participating Start Date

10/1/2022

Participating Approval Date

7/27/2022

Last Recertification Date

2/28/2025

Contacts

Authorizing Official

Central Virginia Health Services
Paula Anne Tomko, Chief Executive Officer
(434) 581-3276

Primary Contact

central Virginia Health Services, Inc.
DAVID CHRISTIAN, PHARMACIST DIRECTOR
(434) 581-3271 Ext: 10513

Addresses

Street Address

541 S. Sycamore St
Petersburg, VA 23803

Billing Address

Central Virginia Health Services, Inc.
P O Box 220
New Canton, VA 23123-0220

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
VA		1568106458

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
Contract Detail	WAL-MART PHARMACY 10-1486	1800 PERRY DR		FARMVILLE	VA	23901	10/17/2023	01/01/2024			01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH030700	Active	BPS-H80-000305	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS Buckingham	25892 N James Madison Hwy	New Canton	VA
CH03070AA	Active	BPS-H80-021402	Central Virginia Health Services, Inc.	CVHS Peterson	800 Preston Ave	Charlottesville	VA
CH03070AB	Active	BPS-H80-030830	Central Virginia Health Services, Inc.	CVHS-Crimson Clinic	3101 Johnson Rd	Petersburg	VA
CH03070AC	Active	BPS-H80-034048	Central Virginia Health Services, Inc.	CVHS- Blue Devils Health Center	400 S Mesa Drive	Hopewell	VA
CH03070AD	Active	BPS-H80-034431	Central Virginia Health Services, Inc.	CVHS - Petersburg Recovery Center	541 S. Sycamore St	Petersburg	VA
CH03070C	Active	BPS-H80-002126	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS Farmville	833 BUFFALO STREET STE 200	FARMVILLE	VA
CH03070D	Active	BPS-H80-001759	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS SOUTHERN ALBEMARLE	2256 IRISH RD	Esmont	VA
CH03070D1	Active	BPS-H80-000882	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS Petersburg	321 C POPLAR DRIVE	PETERSBURG	VA
CH03070F	Active	BPS-H80-003283	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS CHARLOTTE	165 LEGRANDE AVE	CHARLOTTE COURT HOUSE	VA
CH03070I	Active	BPS-H80-005341	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS KING WILLIAM	11814 KING WILLIAM RD	AYLETT	VA
CH03070J	Active	BPS-H80-003071	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS WESTMORELAND	18849 KINGS HIGHWAY	MONTROSS	VA
CH03070K	Active	BPS-H80-028160	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS - Downtown Petersburg	25 S Union St	Petersburg	VA
CH03070L	Active	BPS-H80-004757	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS BRUNSWICK	8380 BOYDTON PLANK RD	ALBERTA	VA
CH03070L1	Active	BPS-H80-014842	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS FREDERICKSBURG	1965 EMANCIPATION HIGHWAY SUITE 100	Fredericksburg	VA
CH03070M	Active	BPS-H80-003730	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS CHARLES CITY	9950 Courthouse Rd	Charles City	VA
CH03070P	Active	BPS-H80-004333	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS HOPEWELL - PRINCE GEORGE	4260 CROSSINGS BLVD SUITE 2	PRINCE GEORGE	VA
CH03070X	Active	BPS-H80-037636	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS LOUISA	410 Industrial Dr.	LOUISA	VA
CH03070Y	Active	BPS-H80-031519	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS CHARLOTTESVILLE	1101 E Jefferson St, Suite 1	Charlottesville	VA
CH03070Z	Active	BPS-H80-012851	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS CHILDREN'S DENTAL	17202 Richmond Tpke	Milford	VA
CHC11414-01	Active	BPS-H80-008368	CENTRAL VIRGINIA HEALTH SERVICES, INC.	CVHS CAROLINE	102 West Broaddus Ave STE 200	Bowling Green	VA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH030700	A & N ASSOCIATES LLC DBA DILLWYN PHARMAC	1054 MAIN ST		DILLWYN	VA	23936	04/01/2024
CH030700	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2018
CH030700	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2018
CH030700	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2018
CH030700	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2018
CH030700	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2018
CH030700	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2018
CH030700	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2025
CH030700	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
CH030700	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	07/01/2017	07/31/2020
CH030700	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2025
CH030700	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	04/01/2025
CH03070J	AMBER ENTERPRISES, INC	DBA AMBER SPECIALTY PHARMACY	10004 S 152ND ST STE A	OMAHA	NE	68138-3931	07/01/2019	04/30/2020
CH030700	AMBER ENTERPRISES, INC	DBA AMBER SPECIALTY PHARMACY	10004 S 152ND ST STE A	OMAHA	NE	68138-3931	07/01/2019	11/07/2023
CH030700	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	04/01/2018	04/19/2021
CH030700	AVELLA OF ORLANDO	100 TECHNOLOGY PARK STE 155		LAKE MARY	FL	32746-6205	04/01/2018	04/19/2021
CH030700	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/01/2021
CH030700	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH030700	BACK HOME PHARMACY INC DBA HOPEWELL DRUG	2508 GRAY ST		HOPEWELL	VA	23860-5026	10/01/2021
CH030700	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	04/01/2025
CH030700	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/01/2021
CH030700	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	10/01/2021
CH030700	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	10/01/2024
CH030700	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	10/01/2024
CH030700	BIRDI, INC	8060 S KYRENE RD		TEMPE	AZ	85284	07/01/2025
CH030700	BIRDI, INC.	7835 FREEDOM AVE NW		NORTH CANTON	OH	44720	07/01/2025
CH030700	BIRDI, INC.	43811 PLYMOUTH OAKS BLVD		PLYMOUTH	MI	48170	07/01/2025
CH030700	BOWLING GREEN PHARMACY	121 TRAVIS STREET	PO BOX 796	BOWLING GREEN	VA	22427	06/16/2011	01/01/2021
CHC11414-01	BOWLING GREEN PHARMACY	121 TRAVIS STREET	PO BOX 796	BOWLING GREEN	VA	22427	03/09/2011	01/01/2021
CH030700	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CH030700	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CH030700	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CH030700	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CH030700	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CH030700	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CH030700	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CH03070L1	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2024
CH030700	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CH030700	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CH030700	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CH030700	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	10/01/2022
CH030700	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	01/01/2024
CH030700	CHARLOTTE DRUG COMPANY	P. O. BOX 728	120 DAVID BRUCE AVE.	CHARLOTTE COURT HOUSE	VA	23923-0728	03/17/2011	01/01/2021
CH03070F	CHARLOTTE DRUG COMPANY	P. O. BOX 728	120 DAVID BRUCE AVE.	CHARLOTTE COURT HOUSE	VA	23923-0728	10/25/2010	01/01/2021
CH030700	CLARK'S PHARMACY INC		119-A NORTH MAIN ST	FARMVILLE	VA	23901	03/17/2011	08/11/2017
CH03070C	CLARK'S PHARMACY INC		119-A NORTH MAIN ST	FARMVILLE	VA	23901	03/17/2011	01/01/2021
CH030700	CUMBERLAND PHARMACY, INC	1756 ANDERSON HWY		CUMBERLAND	VA	23040	06/22/2012
CH030700	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	04/01/2021
CH030700	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	04/01/2021
CH030700	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2022
CH030700	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CH030700	CYRUS KIRKPATRICK PHARMACY	518 S. SYCAMORE ST		PETERSBURG	VA	23803	03/24/2011	02/22/2019
CH03070K	CYRUS KIRKPATRICK PHARMACY	518 S. SYCAMORE ST		PETERSBURG	VA	23803	01/13/2011	01/01/2021
CH030700	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2018
CH030700	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/01/2017	09/30/2019
CH030700	DILLWYN PHARMACY	1054 MAIN STREET		DILLWYN	VA	23936-0070	09/26/2012	10/30/2023
CH03070L	DILLWYN PHARMACY	1054 MAIN STREET		DILLWYN	VA	23936-0070	01/01/2024	10/30/2023
CH030700	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	10/01/2021
CH030700	ECKERD CORPORATION	RITE AID #11306	1401 SOUTH MAIN STREET	FARMVILLE	VA	23901	01/01/2015	11/17/2017
CH030700	ECKERD CORPORATION	RITE AID #11305	115 BRUNSWICK SQUARE COURT	LAWRENCEVILLE	VA	23868	01/01/2015
CH030700	ECKERD CORPORATION	RITE AID #11238	9100 POCAHONTAS TRAIL	PROVIDENCE FORGE	VA	23140	01/01/2015	10/17/2017
CH030700	ECKERD CORPORATION	RITE AID #11232	1840 TAPPAHANNOCK BLVD	TAPPAHANNOCK	VA	22560	01/01/2015	11/17/2017
CH030700	ECKERD CORPORATION	RITE AID #11300	4310 WESTGATE ROAD	NORTH DINWIDDIE	VA	23803-6571	01/01/2019	11/29/2023
CH030700	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2018
CH030700	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2018
CH030700	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	255 PHILLIPI ROAD	COLUMBUS	OH	43228	07/01/2018	07/01/2018
CH030700	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2018
CH030700	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2018
CH030700	FARMVILLE FAMILY PHARMACY, INC.	1538 S MAIN ST		FARMVILLE	VA	23901-2546	04/01/2025
CH030700	FARMVILLE PHARMACY,INC	308A SOUTH MAIN ST		FARMVILLE	VA	23901	07/01/2016	06/20/2019
CH030700	FOOD LION LLC DBA FOOD LION PHARMACY #22	253 NORTH WASHINGTON HIGHWAY		ASHLAND	VA	23005	04/01/2024
CH030700	FOOD LION PHARMACY #542	1020 BILL TUCK HIGHWAY #1000		SOUTH BOSTON	VA	24592	04/01/2024
CH030700	FOOD LION, LLC	DBA FOOD LION PHARMACY #2219	7300 MARKET PLACE DRIVE	QUINTON	VA	23141-1639	04/01/2024
CH030700	FORK UNION PHARMACY	4316-B JAMES MADISON HWY		FORK UNION	VA	23055	10/01/2013
CH030700	GENOA HEALTHCARE LLC	161 BUSH RIVER DR STE 2A		FARMVILLE	VA	23901	04/01/2022
CH030700	GENOA HEALTHCARE LLC	800 PRESTON AVENUE SUITE P		CHARLOTTESVILLE	VA	22903	04/01/2022
CH030700	GIANT OF MARYLAND LLC	35 TOWN & COUNTRY DRIVE		FALMOUTH	VA	22405	04/01/2024
CH030700	GIANT OF MARYLAND, LLC	GIANT PHARMACY #234	550 CELEBRATE VIRGINIA PARKWAY	FREDERICKSBURG	VA	22406	04/01/2024
CH030700	GIANT PHARMACY #235	5701 PLANK ROAD		FREDERICKSBURG	VA	22407	04/01/2024
CH030700	GIANT PHARMACY #243	317 WORTH AVENUE		STAFFORD	VA	22556	04/01/2024
CH030700	GIANT PHARMACY #251	1900 ABBEY RD		CHARLOTTESVILLE	VA	22911	04/01/2024
CH030700	GIANT PHARMACY #256	10346 COURTHOUSE ROAD		SPOTSYLVANIA	VA	22553	04/01/2024
CH030700	GIANT PHARMACY #770	1245 EMANCIPATION HIGHWAY		FREDERICKSBURG	VA	22401	03/28/2011	01/01/2021
CH03070L1	GIANT PHARMACY #770	1245 EMANCIPATION HIGHWAY		FREDERICKSBURG	VA	22401	03/28/2011	01/01/2021
CH030700	HOMETOWN DRUG INC	2508 GRAY STREET		HOPEWELL	VA	23860-2386	01/01/2017	04/27/2021
CH030700	KING WILLIAM PHARMACY	7890-B-RICHMOND TAPPAHANNOCK	PO BOX 29	AYLETT	VA	23009	03/17/2011	03/26/2020
CH03070I	KING WILLIAM PHARMACY	7890-B-RICHMOND TAPPAHANNOCK	PO BOX 29	AYLETT	VA	23009	03/17/2011	01/01/2021
CH030700	KROGER PHARMACY #406	7789 RICHMOND HWY		APPOMATTOX	VA	24522	04/01/2024
CH030700	KROGER PHARMACY #510	6335 MERCHANICSVILLE TURNPIKE		MECHANICSVILLE	VA	23111	04/01/2024
CH030700	KROGER PHARMACY #515	9351 ATLEE ROAD, RUTLAND COMMONS		MECHANICSVILLE	VA	23116	04/01/2024
CH030700	KROGER PHARMACY #523	14101 MIDLOTHIAN TURNPIKE		MIDLOTHIAN	VA	23113	04/01/2024
CH030700	LA PHARMACY LLC	1048 S GARFIELD AVE	STE 101	ALHAMBRA	CA	91801	04/01/2022	01/17/2023
CH030700	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	07/01/2021
CH030700	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2018
CH030700	ONCOMED PHARMACEUTICAL SERVICES OF MA, L	D/B/A ONCO360	335 BEAR HILL RD STE 2100	WALTHAM	MA	02451	10/01/2018	01/22/2025
CH030700	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	10/01/2018	01/22/2025
CH030700	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/01/2024
CH030700	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	04/01/2022
CH030700	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	04/01/2025
CH030700	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/01/2024
CH030700	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/01/2024
CH030700	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/01/2024
CH030700	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	04/01/2024
CH030700	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2022
CH03070AB	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/01/2024
CH030700	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	04/01/2022	01/17/2023
CH030700	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	07/01/2021
CH030700	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018
CH030700	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2018	01/11/2023
CH030700	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CH030700	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CH030700	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/01/2022
CH030700	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CH030700	PUBLIX NORTH CAROLINA, LP	PUBLIX PHARMACY #1643	7200 COSBY VILLAGE RD	CHESTERFIELD	VA	23832	04/01/2024
CH030700	PUBLIX NORTH CAROLINA, LP	PUBLIX PHARMACY #1632	9601 PATRIOT HWY	FREDERICKSBURG	VA	22407	04/01/2024
CH030700	PUBLIX NORTH CAROLINA, LP	PUBLIX PHARMACY #1594	3007 BOULEVARD	COLONIAL HEIGHTS	VA	23834	04/01/2024
CH030700	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	04/01/2024
CH030700	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	04/01/2024
CH030700	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/01/2021
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #7763	17422 RICHMOND ROAD PO BOX 1059	CALLAO	VA	22435	01/01/2015	11/17/2017
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #7762	15748 KINGS HIGHWAY PO BOX 429	MONTROSS	VA	22520	01/01/2015	11/17/2017
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #3772	4671 RICHMOND ROAD P.O. BOX 1298	WARSAW	VA	22572	01/01/2015	11/17/2017
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #3705	2305 OAKLAWN BOULEVARD	HOPEWELL	VA	23860	01/01/2015
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #3352	104 WEST BROADDUS AVENUE	BOWLING GREEN	VA	22427	01/01/2015	10/17/2017
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #3318	670 KING STREET	KEYSVILLE	VA	23947	01/01/2015	11/17/2017
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #2592	700 MCKINNEY BOULEVARD #700	COLONIAL BEACH	VA	22443	01/01/2015	11/17/2017
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #764	THE CROSSINGS 5210 OAKLAWN BLVD.	HOPEWELL	VA	23860	07/01/2017
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #588	2141 SOUTH CRATER ROAD	PETERSBURG	VA	23805	01/01/2019	02/01/2019
CH030700	RITE AID OF VIRGINIA, INC.	RITE AID #7510	144 SCOTTSVILLE CTR	SCOTTSVILLE	VA	24590	07/01/2023
CH030700	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/01/2021
CH030700	SCOTTSVILLE PHARMACY	295B E MAIN ST		SCOTTSVILLE	VA	24590	10/01/2013	05/25/2023
CH030700	SERVE YOU RX	10201 W INNOVATION DR STE 600		MILWAUKEE	WI	53226	04/01/2024
CH030700	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	10/01/2018	01/22/2025
CH030700	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/01/2018	01/22/2025
CH030700	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	10/01/2018	01/22/2025
CH030700	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	04/01/2022	01/17/2023
CH030700	TRUEPILL NY LLC	850 3RD AVE STE 404		BROOKLYN	NY	11232-1523	04/01/2022	01/17/2023
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01559	919 SOUTH MAIN ST	FARMVILLE	VA	23901	07/01/2016
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03915	610 N MAIN ST	CHASE CITY	VA	23924	10/01/2018
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05729	3231 HALIFAX ROAD	SOUTH BOSTON	VA	24592	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01542	629 BOULEVARD	COLONIAL HEIGHTS	VA	23834	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01985	133 JUNCTION DRIVE	ASHLAND	VA	23005	01/01/2019	12/15/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07561	503 MAIN ST.	LOUISA	VA	23093	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01978	2100 S. CRATER RD.	PETERSBURG	VA	23805	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10769	18048 US ROUTE 1 HWY	RUTHER GLEN	VA	22546	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01565	591 EMANCIPATION HWY	FREDERICKSBURG	VA	22401	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 392	11458 KINGS HIGHWAY	KING GEORGE	VA	22485	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01555	1133 5TH STREET SW	CHARLOTTESVILLE	VA	22902	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07352	240-B LUSARDI DR	BROOKNEAL	VA	24528	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01980	7048 MECHANICSVILLE TPKE	MECHANICSVILLE	VA	23111	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05507	807 E ATLANTIC ST	SOUTH HILL	VA	23970	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00947	28 ABBY RD.	PALMYRA	VA	22963	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01551	1341 LONG STREET	CHARLOTTESVILLE	VA	22901	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03515	7738 RICHMOND HIGHWAY	APPOMATTOX	VA	24522	01/01/2019
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07589	4201 PLANK RD.	FREDERICKSBURG	VA	22407	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01569	450 CHATHAM HEIGHTS RD.	FREDERICKSBURG	VA	22405	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04242	151 PIKE VIEW DR.	MIDLOTHIAN	VA	23113	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10251	2704 OAKLAWN BLVD	HOPEWELL	VA	23860	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16978	312 CONNOR DR	CHARLOTTESVILLE	VA	22911	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01986	1007 EAST MAIN STREET	RICHMOND	VA	23219	07/01/2021	11/12/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04335	1 MCWHIRT LOOP	FREDERICKSBURG	VA	22406	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01393	8041 SUDLEY ROAD	MANASSAS	VA	20109	07/01/2021	04/25/2023
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01976	5100 S LABURNUM AVE	RICHMOND	VA	23231	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02150	8185 ATLEE ROAD	MECHANICSVILLE	VA	23116	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01556	1170 EMMET ST N	CHARLOTTESVILLE	VA	22903	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01539	10805 TIDEWATER TRAIL	FREDERICKSBURG	VA	22408	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10746	1700 SEMINOLE TRAIL	CHARLOTTESVILLE	VA	22901	07/01/2021
CH030700	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01406	9200 CENTREVILLE RD.	MANASSAS	VA	20110	07/01/2023
CH03070J	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01559	919 SOUTH MAIN ST	FARMVILLE	VA	23901	01/01/2024
CH030700	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH030700	WAL-MART PHARMACY 10-1345	3471 OLD HALIFAX ROAD		SOUTH BOSTON	VA	24592	01/01/2019	03/10/2021
CH030700	WAL-MART PHARMACY 10-1345	3471 OLD HALIFAX ROAD		SOUTH BOSTON	VA	24592	01/01/2019
CH030700	WAL-MART PHARMACY 10-1424	671 SOUTHPARK BLVD		COLONIAL HEIGHTS	VA	23834	01/01/2019
CH030700	WAL-MART PHARMACY 10-1486	1800 PERRY DR		FARMVILLE	VA	23901	07/06/2012
CH03070AD	WAL-MART PHARMACY 10-1486	1800 PERRY DR		FARMVILLE	VA	23901	01/01/2024
CH030700	WAL-MART PHARMACY 10-1525	7430 BELL CREEK RD		MECHANICSVILLE	VA	23111	01/01/2019
CH030700	WAL-MART PHARMACY 10-1730	BOX 520	1660 TAPPAHANNOCK BLVD	TAPPAHANNOCK	VA	22560	04/01/2013
CH03070AB	WAL-MART PHARMACY 10-1730	BOX 520	1660 TAPPAHANNOCK BLVD	TAPPAHANNOCK	VA	22560	01/01/2024
CH030700	WAL-MART PHARMACY 10-1833	1800 CARL D SILVER PKWY		FREDERICKSBURG	VA	22401	01/01/2019
CH030700	WAL-MART PHARMACY 10-1934	315 FURR ST		SOUTH HILL	VA	23970	04/01/2013
CH03070I	WAL-MART PHARMACY 10-1934	315 FURR ST		SOUTH HILL	VA	23970	01/01/2024
CH030700	WAL-MART PHARMACY 10-2160	3500 SO. CRATER ROAD		PETERSBURG	VA	23805	01/01/2019
CH030700	WAL-MART PHARMACY 10-2645	1451 SO MAIN STREET		BLACKSTONE	VA	23824	01/01/2019
CH030700	WAL-MART PHARMACY 10-2795	145 HILL CARTER PKWY		ASHLAND	VA	23005	01/01/2019
CH030700	WAL-MART PHARMACY 10-4636	505 OAKVILLE ROAD		APPOMATTOX	VA	24522	01/01/2019
CH03070K	WAL-MART PHARMACY 10-4636	505 OAKVILLE ROAD		APPOMATTOX	VA	24522	01/01/2024
CH030700	WAL-MART PHARMACY 10-4682	164 CAMP CREEK PARKWAY		GORDONSVILLE	VA	22942	04/01/2022
CH030700	WAL-MART PHARMACY 10-5343	10001 SOUTH POINT PARKWAY		FREDERICKSBURG	VA	22407	01/01/2019
CH030700	WAL-MART PHARMACY 10-5779	16375 MERCHANT LANE		KING GEORGE	VA	22485	01/01/2019
CH030700	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH030700	WALGREEN CO	DBA WALGREENS #17493	665 KING ST	KEYSVILLE	VA	23947	07/01/2023
CH030700	WALGREEN CO.	DBA: WALGREENS # 03684	4201 MEADOWDALE BLVD.	NORTH CHESTERFIELD	VA	23234	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS # 04921	3201 BOULEVARD	COLONIAL HEIGHTS	VA	23834	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS # 09270	3298 S CRATER RD	PETERSBURG	VA	23805-9217	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS # 09226	4238 W HUNDRED RD	CHESTER	VA	23831-1733	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS # 09779	4845 S LABURNUM AVE	RICHMOND	VA	23231-2713	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS #10923	412 EAST MAIN ST.	LOUISA	VA	23093-6518	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS #10713	26036 COX RD.	NORTH DINWIDDIE	VA	23803-6566	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS #12360	3901 OAKLAWN BLVD.	HOPEWELL	VA	23860	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS #11571	5650 PLANK RD.	FREDERICKSBURG	VA	22407	10/01/2013
CH030700	WALGREEN CO.	DBA: WALGREENS #13830	7039 MECHANICSVILLE TURNPIKE	MECHANICSVILLE	VA	23111	10/01/2013
CH030700	WALGREEN CO.	WALGREENS #17487	9125 POCAHONTAS TRL	PROVIDENCE FORGE	VA	23140	12/04/2017
CH030700	WALGREEN CO.	WALGREENS #17843	670 KING ST	KEYSVILLE	VA	23947-3500	12/04/2017	09/01/2023
CH030700	WALGREEN CO.	WALGREENS #17922	4671 RICHMOND RD P.O. BOX 1298	WARSAW	VA	22572-3137	12/04/2017
CH030700	WALGREEN CO.	WALGREENS #18087	17422 RICHMOND RD P.O. BOX 1059	CALLAO	VA	22435	12/04/2017
CH030700	WALGREEN CO.	WALGREENS #18193	700 MCKINNEY BLVD STE 700	COLONIAL BEACH	VA	22443-1925	12/04/2017
CH030700	WALGREEN CO.	WALGREENS #17997	15748 KINGS HWY PO BOX 429	MONTROSS	VA	22520	12/04/2017
CH030700	WALGREEN CO.	WALGREENS #19365	1840 TAPPAHANNOCK BLVD P. O. BOX 1429	TAPPAHANNOCK	VA	22560-9350	12/04/2017
CH030700	WALGREEN CO.	WALGREENS #17429	1401 S. MAIN STREET	FARMVILLE	VA	23901	12/04/2017
CH030700	WALGREEN CO.	WALGREENS #18200	104 W BROADDUS AVE PO BOX 1157	BOWLING GREEN	VA	22427	12/04/2017
CH030700	WALGREEN CO.	DBA: WALGREENS #09417	3489 SEMINOLE TRAIL	CHARLOTTESVILLE	VA	22911-5637	07/01/2018	02/17/2025
CH030700	WALGREEN CO.	DBA: WALGREENS #12496	9268 CHAMBERLAYNE RD.	MECHANICSVILLE	VA	23116	07/01/2018
CH030700	WALGREEN CO.	WALGREENS #18211	11129 GORDON RD	FREDERICKSBURG	VA	22407-1714	10/01/2018	03/20/2025
CH030700	WALGREEN CO.	WALGREEN #17759	10100 JEFFERSON DAVIS HWY	FREDERICKSBURG	VA	22407-9419	10/01/2018	11/09/2021
CH030700	WALGREEN CO.	WALGREENS #17626	314 ROLKIN RD	CHARLOTTESVILLE	VA	22911-3556	10/01/2018
CH030700	WALGREEN CO.	WALGREENS #18196	2207 POCAHONTAS TRL	QUINTON	VA	23141-1633	07/01/2019
CH030700	WALGREEN CO.	WALGREENS #17550	345 14TH ST P.O. BOX 1501	WEST POINT	VA	23181	10/01/2019
CH03070C	WALGREEN CO.	WALGREENS #17429	1401 S. MAIN STREET	FARMVILLE	VA	23901	01/01/2024
CH03070F	WALGREEN CO.	WALGREENS #17922	4671 RICHMOND RD P.O. BOX 1298	WARSAW	VA	22572-3137	01/01/2024
CH03070D	WALGREEN CO.	DBA: WALGREENS #10713	26036 COX RD.	NORTH DINWIDDIE	VA	23803-6566	01/01/2024
CH03070AA	WALGREEN CO.	WALGREENS #17997	15748 KINGS HWY PO BOX 429	MONTROSS	VA	22520	01/01/2024
CH03070AC	WALGREEN CO.	WALGREENS #17487	9125 POCAHONTAS TRL	PROVIDENCE FORGE	VA	23140	01/01/2024
CH03070M	WALGREEN CO.	DBA: WALGREENS #10923	412 EAST MAIN ST.	LOUISA	VA	23093-6518	01/01/2024
CH030700	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	10/01/2023
CH030700	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	07/27/2015
CH030700	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2018
CH030700	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2018
CH030700	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2018	10/01/2021
CH030700	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2018	08/22/2024
CH030700	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH030700	WEST POINT PHARMACY	1302-A LEE STREET	P.O. BOX 1463	WEST POINT	VA	23181-1463	10/01/2016	02/19/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/6/2024 3:36:55 PM	2/28/2025 11:58:09 AM	2/28/2025 11:58 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1467413880 (VA)		1/29/2025 3:00 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1356302988 (VA)		1/29/2025 3:00 PM
Addresses	Shipping Address	Delete	Change Request	Healthcare Alliance Pharmacy 321 C Poplar Drive Petersburg, VA 23805		1/27/2025 2:30 PM
Details	Last Recertification Date	Update	Recertification	2/9/2023 2:24:04 PM	2/6/2024 3:36:55 PM	2/6/2024 3:36 PM
Addresses	Main Address	Update	Recertification	541 S Sycamore St Petersburg, VA 23803-5039	541 S. Sycamore St Petersburg, VA 23803	2/9/2023 2:24 PM
Addresses	Billing Address	Insert	Recertification		Central Virginia Health Services, Inc. P O Box 220 New Canton, VA 23123-0220	2/9/2023 2:24 PM
Addresses	Shipping Address	Insert	Recertification		Healthcare Alliance Pharmacy 321 C Poplar Drive Petersburg, VA 23805	2/9/2023 2:24 PM
Details	Last Recertification Date	Update	Recertification		2/9/2023 2:24:04 PM	2/9/2023 2:24 PM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Tomko, Paula Anne Chief Executive Officer Central Virginia Health Services 4345813276	7/27/2022 2:37 PM
Details	340B ID	Update	New Registration		CH03070AD	7/27/2022 2:37 PM
Dates	Participating Approval Date	Update	New Registration		7/27/2022 2:37:24 PM	7/27/2022 2:37 PM
Details	State	Update	New Registration	Pending	Approved	7/27/2022 2:37 PM
Dates	Signed By Date	Update	New Registration		7/22/2022 12:30:56 PM	7/27/2022 2:37 PM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	7/27/2022 2:37 PM
Addresses	Main Address	Insert	New Registration		541 S Sycamore St Petersburg, VA 23803-5039	7/22/2022 11:32 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1568106458	7/22/2022 11:32 AM
Medicaid Billing	NPI: State	Insert	New Registration		VA	7/22/2022 11:32 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1467413880	7/22/2022 11:32 AM
Medicaid Billing	NPI: State	Insert	New Registration		VA	7/22/2022 11:32 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1356302988	7/22/2022 11:32 AM
Medicaid Billing	NPI: State	Insert	New Registration		VA	7/22/2022 11:32 AM
Contacts	Authorizing Official	Insert	New Registration		Tomko, Paula Anne Chief Executive Officer Central Virginia Health Services 4345813276	7/22/2022 11:32 AM
Contacts	Primary Contact	Insert	New Registration		CHRISTIAN, DAVID PHARMACIST DIRECTOR central Virginia Health Services, Inc. 4345813271-10513	7/22/2022 11:32 AM
Details	Assistance Received From Date	Insert	New Registration			7/22/2022 11:32 AM
Details	Assistance Received To Date	Insert	New Registration			7/22/2022 11:32 AM
Details	Last Recertification Date	Insert	New Registration			7/22/2022 11:32 AM
Details	Grant Number	Insert	New Registration		H80CS00479	7/22/2022 11:32 AM
Details	340B ID	Insert	New Registration			7/22/2022 11:32 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/22/2022 11:32 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/22/2022 11:32 AM
Details	Medicare Provider Number	Insert	New Registration			7/22/2022 11:32 AM
Details	Entity Name	Insert	New Registration		Central Virginia Health Services, Inc.	7/22/2022 11:32 AM
Details	NOFO Number	Insert	New Registration			7/22/2022 11:32 AM
Details	Program Code	Insert	New Registration		CH	7/22/2022 11:32 AM
Details	Entity Subname	Insert	New Registration		CVHS - Petersburg Recovery Center	7/22/2022 11:32 AM
Dates	Participating Approval Date	Insert	New Registration			7/22/2022 11:32 AM
Details	State	Insert	New Registration		Pending	7/22/2022 11:32 AM
Dates	Registration Date	Insert	New Registration		7/22/2022 11:32:44 AM	7/22/2022 11:32 AM
Dates	Signed By Date	Insert	New Registration			7/22/2022 11:32 AM
Dates	Start Date	Insert	New Registration			7/22/2022 11:32 AM
Terminations	Termination Comments	Insert	New Registration			7/22/2022 11:32 AM
Terminations	Termination Date	Insert	New Registration			7/22/2022 11:32 AM
Terminations	Termination Effective Date	Insert	New Registration			7/22/2022 11:32 AM
Terminations	Termination Reason	Insert	New Registration			7/22/2022 11:32 AM

340B Drug Pricing Program Database