Covered Entity Details

CH011190 OUTER CAPE HEALTH SERVICES, INC. (Active) - information as of 4/25/2025 12:01:50 AM

Main Details

Name

OUTER CAPE HEALTH SERVICES, INC.

Subdivision Name

PROVINCETOWN HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-000460

340B ID

CH011190

Grant Number

H80CS00468

Additional Details

Current Program Status

Active

Registration Date

4/1/2002

Participating Start Date

4/1/2002

Participating Approval Date

4/1/2002

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Outer Cape Health Services
Damian Archer, CEO
(774) 209-3281 Ext: 2234

Primary Contact

Outer Cape Health Service
Pamela DeChellis, Director of Pharmacy
(508) 905-2853

Addresses

Street Address

49 Harry Kemp Way
Provincetown, MA 02657-1618

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
MA	110027866A	1841384013

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	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/14/2023	10/01/2023	01/24/2025	04/02/2025
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/14/2023	10/01/2023	01/24/2025	04/02/2025
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/14/2023	10/01/2023	01/24/2025	04/02/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/14/2023	10/01/2023		10/01/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/14/2023	10/01/2023	01/24/2025	04/02/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/14/2023	10/01/2023	01/24/2025	04/02/2025
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA CVS PHARMACY # 1878	12 QUEEN ANNE ROAD	CHATHAM	MA	02633	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11131	132 BRADFORD ST	PROVINCETOWN	MA	02657	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01021	500 ROUTE 134 STE 2	SOUTH DENNIS	MA	02660	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01857	9 WEST RD SKAKET CORNERS	ORLEANS	MA	02653	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00719	110 ROUTE 6A	ORLEANS	MA	02653	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00860	6 POST OFFICE SQ	HARWICH PORT	MA	02646	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01859	148 ROUTE 137	HARWICH	MA	02645	07/07/2023	10/01/2023		10/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/07/2023	10/01/2023		10/01/2023
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/14/2023	10/01/2023		10/01/2023
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/14/2023	10/01/2023		10/01/2023
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/14/2023	10/01/2023		10/01/2023
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/14/2023	10/01/2023	01/24/2025	04/02/2025
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/07/2023	10/01/2023		10/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/07/2023	10/01/2023		10/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/07/2023	10/01/2023		10/01/2023
Contract Detail	THE STOP & SHOP SUPERMARKET CO	STOP & SHOP PHARMACY #2403	56 SHANK PAINTER ROAD	PROVINCETOWN	MA	02657	07/07/2023	10/01/2023		10/01/2023
Contract Detail	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #64	2110 CRANBERRY COVE PLAZA	ORLEANS	MA	02653	07/07/2023	10/01/2023		10/01/2023
Contract Detail	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #475	111 ROUTE 137	HARWICH	MA	02645	07/07/2023	10/01/2023		10/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10460	1041ROUTE 28	SOUTH YARMOUTH	MA	02664-4115	07/07/2023	10/01/2023		10/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19695	918 ROUTE 6A	YARMOUTH PORT	MA	02675	07/07/2023	10/01/2023		10/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19983	711 MAIN ST	DENNISPORT	MA	02639	07/07/2023	10/01/2023	03/31/2025	04/02/2025
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19659	130 ROUTE 6A	ORLEANS	MA	02653	07/07/2023	10/01/2023		10/01/2023
Contract Detail	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	10/16/2023	01/01/2024		01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH011190	Active	BPS-H80-000460	OUTER CAPE HEALTH SERVICES, INC.	PROVINCETOWN HEALTH CENTER	49 Harry Kemp Way	Provincetown	MA
CH01119B	Active	BPS-H80-000898	OUTER CAPE HEALTH SERVICES, INC.	WELLFLEET HEALTH CENTER	3130 State Hwy Rte 6	Wellfleet	MA
CH01119C	Active	BPS-H80-021542	OUTER CAPE HEALTH SERVICES, INC.	Outer Cape Health Services Inc., Harwich	710 Route 28	Harwich Port	MA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH011190	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2023	01/24/2025
CH011190	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2023	01/24/2025
CH011190	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2023	01/24/2025
CH011190	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2023
CH011190	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2023	01/24/2025
CH011190	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2023	01/24/2025
CH011190	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2023
CH011190	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2023
CH011190	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2023
CH011190	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2023
CH011190	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2023
CH011190	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2023
CH011190	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2023
CH011190	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2023
CH011190	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2023
CH011190	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2023
CH011190	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2023
CH011190	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2023
CH011190	CVS PHARMACY, INC.	DBA CVS PHARMACY # 1878	12 QUEEN ANNE ROAD	CHATHAM	MA	02633	10/01/2023
CH011190	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11131	132 BRADFORD ST	PROVINCETOWN	MA	02657	10/01/2023
CH011190	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01021	500 ROUTE 134 STE 2	SOUTH DENNIS	MA	02660	10/01/2023
CH011190	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01857	9 WEST RD SKAKET CORNERS	ORLEANS	MA	02653	10/01/2023
CH011190	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00719	110 ROUTE 6A	ORLEANS	MA	02653	10/01/2023
CH011190	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00860	6 POST OFFICE SQ	HARWICH PORT	MA	02646	10/01/2023
CH011190	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01859	148 ROUTE 137	HARWICH	MA	02645	10/01/2023
CH011190	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2023
CH011190	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2023
CH011190	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2023
CH011190	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2023
CH011190	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2023	01/24/2025
CH011190	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2023
CH011190	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2023
CH011190	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2023
CH011190	THE STOP & SHOP SUPERMARKET CO	STOP & SHOP PHARMACY #2403	56 SHANK PAINTER ROAD	PROVINCETOWN	MA	02657	10/01/2023
CH011190	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #64	2110 CRANBERRY COVE PLAZA	ORLEANS	MA	02653	10/01/2023
CH011190	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #475	111 ROUTE 137	HARWICH	MA	02645	10/01/2023
CH011190	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10460	1041ROUTE 28	SOUTH YARMOUTH	MA	02664-4115	10/01/2023
CH011190	WALGREEN EASTERN CO., INC.	WALGREENS #19695	918 ROUTE 6A	YARMOUTH PORT	MA	02675	10/01/2023
CH011190	WALGREEN EASTERN CO., INC.	WALGREENS #19983	711 MAIN ST	DENNISPORT	MA	02639	10/01/2023	03/31/2025
CH011190	WALGREEN EASTERN CO., INC.	WALGREENS #19659	130 ROUTE 6A	ORLEANS	MA	02653	10/01/2023
CH011190	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 11:30:36 AM	2/12/2025 5:39:26 PM	2/12/2025 5:39 PM
Contacts	Authorizing Official	Update	AO Change Request	pineiro, manny Chief Financial Officer Outer Cape Health Services 5089052800-2203	Archer, Damian CEO Outer Cape Health Services 7742093281-2234	2/4/2025 12:58 PM
Contacts	Primary Contact	Update	AO Change Request	Casale, Christopher Michael Pharmacy Director Outer Cape Health Service 5089052800-2058	DeChellis, Pamela Director of Pharmacy Outer Cape Health Service 5089052853	2/4/2025 12:58 PM
Details	Last Recertification Date	Update	Recertification	2/21/2023 10:26:08 AM	2/1/2024 11:30:36 AM	2/1/2024 11:30 AM
Contacts	Authorizing Official	Update	Group Change Request	Nadle, Patricia CEO Outer Cape Health Services 5089052800	pineiro, manny Chief Financial Officer Outer Cape Health Services 5089052800-2203	1/25/2024 10:02 AM
Addresses	Shipping Address	Delete	Recertification	OUTER CAPE HEALTH SERVICES PHARMACY 2700 STATE HWY, ROUTE 6 UNIT 3 WELLFLEET, MA 02667		2/21/2023 10:26 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1376884619 (MA)		2/21/2023 10:26 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1841384013	2/21/2023 10:26 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	2/21/2023 10:26 AM
Contacts	Primary Contact	Update	Recertification	Lowe, Andy Chief Strategy Officer Outer Cape Health Services, Inc. 5089052800-2217	Casale, Christopher Michael Pharmacy Director Outer Cape Health Service 5089052800-2058	2/21/2023 10:26 AM
Details	Last Recertification Date	Update	Recertification	2/1/2022 8:59:19 AM	2/21/2023 10:26:08 AM	2/21/2023 10:26 AM
Details	Last Recertification Date	Update	Recertification	2/18/2021 8:22:39 AM	2/1/2022 8:59:19 AM	2/1/2022 8:59 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	110027866A (MA)		2/18/2021 8:22 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/18/2021 8:22 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		110027866A	2/18/2021 8:22 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MA	2/18/2021 8:22 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376884619	2/18/2021 8:22 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	2/18/2021 8:22 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1841384013 ( )		2/18/2021 8:22 AM
Details	Last Recertification Date	Update	Recertification	1/29/2020 10:31:39 AM	2/18/2021 8:22:39 AM	2/18/2021 8:22 AM
Contacts	Primary Contact	Update	Change Request	Ebersole, Robert CFO Outer Cape Health Services 5089052800	Lowe, Andy Chief Strategy Officer Outer Cape Health Services, Inc. 5089052800-2217	2/24/2020 10:58 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 10:22:47 AM	1/29/2020 10:31:39 AM	1/29/2020 10:31 AM
Contacts	Primary Contact	Update	Change Request	Callum, Jean Chief Operating Officer Outer Cape Health Services 5089052800	Ebersole, Robert CFO Outer Cape Health Services 5089052800	6/27/2019 9:35 AM
Details	Last Recertification Date	Update	Recertification	2/12/2018 12:01:30 PM	1/29/2019 10:22:47 AM	1/29/2019 10:22 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1376884619 ( )		1/2/2019 9:20 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1841384013	1/2/2019 9:20 AM
Details	Last Recertification Date	Update	Recertification	1/27/2017 12:00:00 AM	2/12/2018 12:01:30 PM	2/12/2018 12:01 PM
Contacts	Primary Contact	Update	Change Request	Lowe, Andy Chief Strategy Officer Outer Cape Health Services, Inc. 5089052800-2217	Callum, Jean Chief Operating Officer Outer Cape Health Services 5089052800	12/13/2017 12:55 PM
Contacts	Primary Contact	Update	Profile Change Request	Lowe, Andy Director of Program Management Resources Outer Cape Health Services, Inc. 5089052800-2217	Lowe, Andy Chief Strategy Officer Outer Cape Health Services, Inc. 5089052800-2217	12/13/2017 12:30 PM
Contacts	Authorizing Official	Update	Change Request	Nadle, Patricia CEO 5089052800-2229	Nadle, Patricia CEO Outer Cape Health Services 5089052800	12/13/2017 12:22 PM
Contacts	Primary Contact	Update		Lowe, Andy Director of Program Management Resources 5089052800-2217	Lowe, Andy Director of Program Management Resources Outer Cape Health Services, Inc. 5089052800-2217	12/13/2017 12:17 PM
Contacts	Authorizing Official	Update		Deane, Sally CEO 5089052800-2214	Nadle, Patricia CEO 5089052800-2229	2/2/2017 9:09 AM
Contacts	Primary Contact	Update		Johnson-Moore, Cheryl Director of Pharmacy 5082140187	Lowe, Andy Director of Program Management Resources 5089052800-2217	2/2/2017 9:09 AM
Addresses	Main Address	Insert			49 Harry Kemp Way Provincetown, MA 02657-1618	1/27/2017 11:33 AM
Details	Last Recertification Date	Update		2/22/2016 12:00:00 AM	1/27/2017 12:00:00 AM	1/27/2017 11:33 AM
Addresses	Shipping Address	Insert			OUTER CAPE HEALTH SERVICES PHARMACY 2700 STATE HWY, ROUTE 6 UNIT 3 WELLFLEET, MA 02667	1/27/2017 7:35 AM
Contacts	Authorizing Official	Insert			Deane, Sally CEO 5089052800-2214	3/1/2016 12:18 PM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	2/22/2016 12:00:00 AM	2/22/2016 4:41 PM
Medicaid Billing	NPI: Number	Insert			1376884619	2/3/2015 10:22 AM
Details	Last Recertification Date	Update		3/13/2014 12:00:00 AM	2/3/2015 12:00:00 AM	2/3/2015 10:22 AM
Contacts	Primary Contact	Insert			Johnson-Moore, Cheryl Director of Pharmacy 5082140187	7/7/2014 7:16 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/13/2014 12:00:00 AM	3/13/2014 6:34 AM
Details	Entity Subname	Update			PROVINCETOWN HEALTH CENTER	3/13/2014 6:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/13/2013 1:47 PM
Medicaid Billing	Medicaid: Number	Insert			110027866A	8/13/2013 1:47 PM
Medicaid Billing	Medicaid: State	Insert			MA	8/13/2013 1:47 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/4/2013 8:00 AM
Details	Entity Subname	Update		OUTER CAPE HEALTH SERVICES PHARMACY		2/7/2012 9:40 AM
Details	Entity Subname	Update			OUTER CAPE HEALTH SERVICES PHARMACY	12/22/2011 9:10 AM
Details	Last Recertification Date	Insert				3/15/2002 12:00 AM
Details	Grant Number	Insert			H80CS00468	3/15/2002 12:00 AM
Details	340B ID	Insert			CH011190	3/15/2002 12:00 AM
Details	Is Authorizing Official EHB Data	Insert				3/15/2002 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Insert				3/15/2002 12:00 AM
Details	Medicare Provider Number	Insert				3/15/2002 12:00 AM
Details	Entity Name	Insert			OUTER CAPE HEALTH SERVICES, INC.	3/15/2002 12:00 AM
Details	Program Code	Insert			CH	3/15/2002 12:00 AM
Details	Entity Subname	Insert				3/15/2002 12:00 AM
Dates	Participating Approval Date	Insert			4/1/2002 12:00:00 AM	3/15/2002 12:00 AM
Details	State	Insert			Active	3/15/2002 12:00 AM
Dates	Registration Date	Insert			4/1/2002 12:00:00 AM	3/15/2002 12:00 AM
Dates	Signed By Date	Insert				3/15/2002 12:00 AM
Dates	Start Date	Insert			4/1/2002 12:00:00 AM	3/15/2002 12:00 AM
Terminations	Termination Comments	Insert				3/15/2002 12:00 AM
Terminations	Termination Date	Insert				3/15/2002 12:00 AM
Terminations	Termination Effective Date	Insert				3/15/2002 12:00 AM
Terminations	Termination Reason	Insert				3/15/2002 12:00 AM

340B Drug Pricing Program Database

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Medicaid Billing

Shipping Addresses

Contract Pharmacies

Grantee Sites

Grantee Sites Contract Pharmacies

History