Covered Entity Details

CHC29016-01 APICHA COMMUNITY HEALTH CENTER (Active) - information as of 6/16/2025 1:02:08 AM

Main Details

Name

APICHA COMMUNITY HEALTH CENTER

Subdivision Name

Apicha Community Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-034764

340B ID

CHC29016-01

Grant Number

H80CS29016

Additional Details

Current Program Status

Active

Registration Date

7/25/2022

Participating Start Date

10/1/2022

Participating Approval Date

7/27/2022

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Apicha Community Health Center
Yumiko Sano, COO
(646) 744-0980

Primary Contact

Apicha Community Health Center
Mihaela Mihai, Director of Administration
(646) 884-5373

Addresses

Street Address

82-11 37th Ave
Jackson Heights, NY 11372-7003

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	07502821,04658348	1396238283,1699123216

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	Address Cont.	City	State
CHC29016-00	Active	BPS-H80-015546	APICHA COMMUNITY HEALTH CENTER	Apicha Community Health Center	400 Broadway		New York	NY
CHC29016-01	Active	BPS-H80-034764	APICHA COMMUNITY HEALTH CENTER	Apicha Community Health Center	82-11 37th Ave		Jackson Heights	NY

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC29016-00	DUANE READE	2683 BROADWAY # 7		NEW YORK	NY	10025	01/01/2016	01/13/2017
CHC29016-00	DUANE READE	84-32 JAMAICA AVENUE		WOODHAVEN	NY	11421	01/01/2016
CHC29016-00	DUANE READE	2409 BROADWAY		NEW YORK	NY	10024-1711	01/01/2016	06/02/2020
CHC29016-00	DUANE READE	455 WEST 37TH ST		NEW YORK	NY	10018	01/01/2016
CHC29016-00	DUANE READE	401 PARK AVENUE SOUTH		NEW YORK	NY	10016	01/01/2016
CHC29016-00	DUANE READE	40 WALL STREET		NEW YORK	NY	10005	01/01/2016	01/13/2017
CHC29016-00	DUANE READE		415 BROADWAY FRONT A	NEW YORK	NY	10013	04/01/2017	07/31/2017
CHC29016-00	JAC PHARMACY INC	.	93-15 ROOSEVELT AVE	JACKSON HEIGHTS	NY	11372	01/01/2016	11/25/2017
CHC29016-00	JMC PHARMACY INC	3875 BROADWAY	UNIT A	NEW YORK	NY	10032	01/01/2016	11/25/2017
CHC29016-00	RITE AID OF NEW YORK, INC.	RITE AID #7759	1033 ST NICHOLAS AVENUE	NEW YORK	NY	10032	07/01/2020	05/05/2022
CHC29016-00	RITE AID OF NEW YORK, INC.	RITE AID #7808	4188 BROADWAY	NEW YORK	NY	10033	07/01/2020	04/24/2023
CHC29016-00	RITE AID OF NEW YORK, INC.	RITE AID #4205	81 1ST AVENUE	NEW YORK	NY	10003	07/01/2020	07/17/2023
CHC29016-00	RITE AID OF NEW YORK, INC.	RITE AID #3984	82-13 37TH AVENUE	JACKSON HEIGHTS	NY	11372	07/01/2020	09/06/2022
CHC29016-00	RITE AID OF NEW YORK, INC.	RITE AID #4865	32-87 STEINWAY STREET	ASTORIA	NY	11103	07/01/2020	12/15/2021
CHC29016-00	TOWN TOTAL HEALTH, LLC	D/B/A MEIJER SPECIALTY PHARMACY	415 CROSSWAYS PARK DRIVE SUITE A	WOODBURY	NY	11797	01/01/2016	11/25/2017
CHC29016-00	WALGREEN EASTERN CO INC	DBA: WALGREENS # 06159	145 FOURTH AVE	NEW YORK	NY	10003	01/01/2016	12/10/2021
CHC29016-00	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #09731	20 ASTOR PL.	NEW YORK	NY	10003-6903	01/01/2016	08/31/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 10:42:33 AM	2/12/2025 6:45:17 PM	2/12/2025 6:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	1/30/2024 10:42 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		07502821	1/30/2024 10:42 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	1/30/2024 10:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	1/30/2024 10:42 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		04658348	1/30/2024 10:42 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	1/30/2024 10:42 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1396238283	1/30/2024 10:42 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	1/30/2024 10:42 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1699123216	1/30/2024 10:42 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	1/30/2024 10:42 AM
Details	Last Recertification Date	Update	Recertification	2/9/2023 12:37:39 PM	1/30/2024 10:42:33 AM	1/30/2024 10:42 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1396238283 (NY)		2/9/2023 12:37 PM
Details	Last Recertification Date	Update	Recertification		2/9/2023 12:37:39 PM	2/9/2023 12:37 PM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Sano, Yumiko COO Apicha Community Health Center 6467440980	7/27/2022 8:20 AM
Details	340B ID	Update	New Registration		CHC29016-01	7/27/2022 8:20 AM
Dates	Participating Approval Date	Update	New Registration		7/27/2022 8:20:22 AM	7/27/2022 8:20 AM
Details	State	Update	New Registration	Pending	Approved	7/27/2022 8:20 AM
Dates	Signed By Date	Update	New Registration		7/25/2022 4:23:30 PM	7/27/2022 8:20 AM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	7/27/2022 8:20 AM
Addresses	Main Address	Insert	New Registration		82-11 37th Ave Jackson Heights, NY 11372-7003	7/25/2022 3:46 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1396238283	7/25/2022 3:46 PM
Medicaid Billing	NPI: State	Insert	New Registration		NY	7/25/2022 3:46 PM
Contacts	Primary Contact	Insert	New Registration		Mihai, Mihaela Director of Administration Apicha Community Health Center 6468845373	7/25/2022 3:46 PM
Contacts	Authorizing Official	Insert	New Registration		Sano, Yumiko COO Apicha Community Health Center 6467440980	7/25/2022 3:46 PM
Details	Assistance Received From Date	Insert	New Registration			7/25/2022 3:46 PM
Details	Assistance Received To Date	Insert	New Registration			7/25/2022 3:46 PM
Details	Last Recertification Date	Insert	New Registration			7/25/2022 3:46 PM
Details	Grant Number	Insert	New Registration		H80CS29016	7/25/2022 3:46 PM
Details	340B ID	Insert	New Registration			7/25/2022 3:46 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/25/2022 3:46 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/25/2022 3:46 PM
Details	Medicare Provider Number	Insert	New Registration			7/25/2022 3:46 PM
Details	Entity Name	Insert	New Registration		APICHA COMMUNITY HEALTH CENTER	7/25/2022 3:46 PM
Details	NOFO Number	Insert	New Registration			7/25/2022 3:46 PM
Details	Program Code	Insert	New Registration		CH	7/25/2022 3:46 PM
Details	Entity Subname	Insert	New Registration		Apicha Community Health Center	7/25/2022 3:46 PM
Dates	Participating Approval Date	Insert	New Registration			7/25/2022 3:46 PM
Details	State	Insert	New Registration		Pending	7/25/2022 3:46 PM
Dates	Registration Date	Insert	New Registration		7/25/2022 3:46:26 PM	7/25/2022 3:46 PM
Dates	Signed By Date	Insert	New Registration			7/25/2022 3:46 PM
Dates	Start Date	Insert	New Registration			7/25/2022 3:46 PM
Terminations	Termination Comments	Insert	New Registration			7/25/2022 3:46 PM
Terminations	Termination Date	Insert	New Registration			7/25/2022 3:46 PM
Terminations	Termination Effective Date	Insert	New Registration			7/25/2022 3:46 PM
Terminations	Termination Reason	Insert	New Registration			7/25/2022 3:46 PM

340B Drug Pricing Program Database