Covered Entity Details

CH012010 MATTAPAN COMMUNITY HEALTH CENTER, INC. (Active) - information as of 6/27/2025 12:28:44 AM

Main Details

Name

MATTAPAN COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Mattapan Community Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-009258

340B ID

CH012010

Grant Number

H80CS00395

Additional Details

Current Program Status

Active

Registration Date

7/1/2002

Participating Start Date

7/1/2002

Participating Approval Date

7/1/2002

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Mattapan CHC
GUALE VALDEZ, CEO
(617) 898-9020

Primary Contact

Mattapan Community Health Center
Regina Izmaylova, Chief Financial Officer
(617) 898-9041

Addresses

Street Address

1575 Blue Hill Ave
Mattapan, MA 02126-2122

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?
No

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	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01049	942A HYDE PARK AVENUE	HYDE PARK	MA	02136	10/15/2013	01/01/2014	02/23/2024	02/23/2024
Contract Detail	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 5464	1575 BLUE HILL AVE	MATTAPAN	MA	02126	10/15/2013	01/01/2014	02/23/2024	02/23/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS	28727 OREGON ROAD	PERRYSBURG	OH	43551	02/22/2013	04/01/2013	08/10/2015	08/10/2015
Contract Detail	WALGREEN EASTERN CO INC	WALGREENS SPECIALTY PHARMACY #15307	21 STANHOPE STREET #23	BOSTON	MA	02116	07/07/2020	10/01/2020		10/01/2020
Contract Detail	WALGREEN EASTERN CO. INC.	DBA STRAND, A WALGREENS PHARMACY #13806	533 COLUMBIA ROAD	DORCHESTER	MA	02125	01/09/2012	01/09/2012	03/09/2020	07/07/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #15001	980 AMERICAN LEGION HWY	ROSLINDALE	MA	02131-4701	01/09/2012	01/09/2012		03/28/2013
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02977	1101 MAIN STREET	BROCKTON	MA	02301	01/09/2012	01/09/2012		03/28/2013
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03135	825 MORTON STREET	BOSTON	MA	02126	01/09/2012	01/09/2012		03/28/2013
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03758	610 PLEASANT ST.	BROCKTON	MA	02301-2513	01/09/2012	01/09/2012		03/28/2013
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04072	1890 COLUMBUS AVE	ROXBURY	MA	02119	01/09/2012	01/09/2012		03/28/2013
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04535	170 N MAIN STREET	RANDOLPH	MA	02368	01/09/2012	01/09/2012		03/28/2013
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06349	585 WASHINGTON ST	DORCHESTER	MA	02124-2032	01/09/2012	01/09/2012		03/28/2013
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06805	130 BOWDOIN ST	DORCHESTER	MA	02122-1837	01/09/2012	01/09/2012	01/28/2020	01/28/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10317	1035 TRUMAN HWY	BOSTON	MA	02136	01/09/2012	01/09/2012		03/28/2013
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03016	416 WARREN ST	ROXBURY	MA	02119	01/09/2012	01/09/2012	01/15/2024	02/23/2024
Contract Detail	WALGREEN EASTERN CO., INC.		80 INTERNATIONAL DR.	WINDSOR	CT	06095-1044	02/22/2013	04/01/2013	08/10/2015	08/10/2015
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17257	90 RIVER ST STE 7	MATTAPAN	MA	02126	07/07/2020	10/01/2020	01/05/2023	01/05/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY#10996	429 BROOKLINE AVENUE	BOSTON	MA	02215	03/23/2021	03/23/2021		03/23/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01847	757 GALLIVAN BLVD STE 3	DORCHESTER	MA	02122	10/05/2021	01/01/2022		01/01/2022
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19067	1329 HYDE PARK AVE	HYDE PARK	MA	02136	10/05/2021	01/01/2022	01/05/2023	01/05/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03564	99 HARVARD ST.	BROOKLINE	MA	02446	10/05/2021	01/01/2022		01/01/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02759	550 ADAMS ST SUITE 6	QUINCY	MA	02169	10/05/2021	01/01/2022		01/01/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05755	413 WASHINGTON STREET	STOUGHTON	MA	02072-4210	10/05/2021	01/01/2022		01/01/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06470	750 WASHINGTON ST	WEYMOUTH	MA	02188	10/05/2021	01/01/2022		01/01/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19437	1100 DORCHESTER AVE	DORCHESTER	MA	02125	10/05/2021	01/01/2022		01/01/2022
Contract Detail	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	01/05/2023	04/01/2023		04/01/2023
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/11/2013	07/01/2013	08/10/2015	08/10/2015
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/11/2013	07/01/2013	08/10/2015	08/10/2015

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH012010	Active	BPS-H80-009258	MATTAPAN COMMUNITY HEALTH CENTER, INC.	Mattapan Community Health Center	1575 Blue Hill Ave		Mattapan	MA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH012010	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01049	942A HYDE PARK AVENUE	HYDE PARK	MA	02136	01/01/2014	02/23/2024
CH012010	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 5464	1575 BLUE HILL AVE	MATTAPAN	MA	02126	01/01/2014	02/23/2024
CH012010	WALGREEN CO	DBA: WALGREENS	28727 OREGON ROAD	PERRYSBURG	OH	43551	04/01/2013	08/10/2015
CH012010	WALGREEN EASTERN CO INC	WALGREENS SPECIALTY PHARMACY #15307	21 STANHOPE STREET #23	BOSTON	MA	02116	10/01/2020
CH012010	WALGREEN EASTERN CO. INC.	DBA STRAND, A WALGREENS PHARMACY #13806	533 COLUMBIA ROAD	DORCHESTER	MA	02125	01/09/2012	03/09/2020
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #15001	980 AMERICAN LEGION HWY	ROSLINDALE	MA	02131-4701	01/09/2012
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02977	1101 MAIN STREET	BROCKTON	MA	02301	01/09/2012
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03135	825 MORTON STREET	BOSTON	MA	02126	01/09/2012
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03758	610 PLEASANT ST.	BROCKTON	MA	02301-2513	01/09/2012
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04072	1890 COLUMBUS AVE	ROXBURY	MA	02119	01/09/2012
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04535	170 N MAIN STREET	RANDOLPH	MA	02368	01/09/2012
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06349	585 WASHINGTON ST	DORCHESTER	MA	02124-2032	01/09/2012
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06805	130 BOWDOIN ST	DORCHESTER	MA	02122-1837	01/09/2012	01/28/2020
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10317	1035 TRUMAN HWY	BOSTON	MA	02136	01/09/2012
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03016	416 WARREN ST	ROXBURY	MA	02119	01/09/2012	01/15/2024
CH012010	WALGREEN EASTERN CO., INC.		80 INTERNATIONAL DR.	WINDSOR	CT	06095-1044	04/01/2013	08/10/2015
CH012010	WALGREEN EASTERN CO., INC.	WALGREENS #17257	90 RIVER ST STE 7	MATTAPAN	MA	02126	10/01/2020	01/05/2023
CH012010	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY#10996	429 BROOKLINE AVENUE	BOSTON	MA	02215	03/23/2021
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01847	757 GALLIVAN BLVD STE 3	DORCHESTER	MA	02122	01/01/2022
CH012010	WALGREEN EASTERN CO., INC.	WALGREENS #19067	1329 HYDE PARK AVE	HYDE PARK	MA	02136	01/01/2022	01/05/2023
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03564	99 HARVARD ST.	BROOKLINE	MA	02446	01/01/2022
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02759	550 ADAMS ST SUITE 6	QUINCY	MA	02169	01/01/2022
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05755	413 WASHINGTON STREET	STOUGHTON	MA	02072-4210	01/01/2022
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06470	750 WASHINGTON ST	WEYMOUTH	MA	02188	01/01/2022
CH012010	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19437	1100 DORCHESTER AVE	DORCHESTER	MA	02125	01/01/2022
CH012010	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	04/01/2023
CH012010	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	08/10/2015
CH012010	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	08/10/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 2:38:28 PM	2/10/2025 10:09:46 AM	2/10/2025 10:09 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 9:03:25 AM	1/29/2024 2:38:28 PM	1/29/2024 2:38 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 1:25:39 PM	1/31/2023 9:03:25 AM	1/31/2023 9:03 AM
Details	Last Recertification Date	Update	Recertification	2/12/2021 2:59:41 PM	2/1/2022 1:25:39 PM	2/1/2022 1:25 PM
Details	Last Recertification Date	Update	Recertification	2/3/2020 10:45:42 AM	2/12/2021 2:59:41 PM	2/12/2021 2:59 PM
Contacts	Primary Contact	Update	Change Request	Leconte, Manouka Accounting Manager Mattapan Community Health Center 6178989008	Izmaylova, Regina Chief Financial Officer Mattapan Community Health Center 6178989041	7/2/2020 12:52 PM
Contacts	Primary Contact	Update	Recertification	Schultz, Dan CFO Mattapan Community Health Center 6178989041	Leconte, Manouka Accounting Manager Mattapan Community Health Center 6178989008	2/3/2020 10:45 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 3:40:32 PM	2/3/2020 10:45:42 AM	2/3/2020 10:45 AM
Details	Last Recertification Date	Update	Recertification	2/14/2018 2:26:05 PM	1/29/2019 3:40:32 PM	1/29/2019 3:40 PM
Contacts	Authorizing Official	Update	Profile Change Request	VALDEZ, GUALE CFO Mattapan CHC 6178989015	VALDEZ, GUALE CEO Mattapan CHC 6178989020	2/14/2018 2:27 PM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/14/2018 2:26:05 PM	2/14/2018 2:26 PM
Contacts	Authorizing Official	Update	AO Change Request	YOUNG, AZZIE CEO Mattapan 6178989020	VALDEZ, GUALE CFO Mattapan CHC 6178989015	2/14/2018 1:33 PM
Contacts	Authorizing Official	Update	OPA Edit	YOUNG, AZZIE CEO 6178989020	YOUNG, AZZIE CEO Mattapan 6178989020	2/14/2018 12:22 PM
Contacts	Primary Contact	Update	OPA Edit	VALDEZ, GUALE CFO Mattapan CHC 6178989015	Schultz, Dan CFO Mattapan Community Health Center 6178989041	2/14/2018 12:22 PM
Contacts	Primary Contact	Update		VALDEZ, GUALE CFO 6178989015	VALDEZ, GUALE CFO Mattapan CHC 6178989015	2/9/2018 3:31 PM
Addresses	Main Address	Insert			1575 Blue Hill Ave Mattapan, MA 02126-2122	1/25/2017 9:55 AM
Contacts	Primary Contact	Insert			VALDEZ, GUALE CFO 6178989015	1/25/2017 9:55 AM
Contacts	Authorizing Official	Insert			YOUNG, AZZIE CEO 6178989020	1/25/2017 9:55 AM
Details	Last Recertification Date	Update		3/3/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 9:55 AM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	3/3/2016 12:00:00 AM	3/3/2016 9:04 AM
Details	Last Recertification Date	Update		2/14/2014 12:00:00 AM	2/3/2015 12:00:00 AM	2/3/2015 10:50 AM
Details	Entity Name	Update		MATTAPAN COMMUNITY HEALTH CENTER	MATTAPAN COMMUNITY HEALTH CENTER, INC.	3/31/2014 4:25 PM
Details	Entity Subname	Update			Mattapan Community Health Center	3/31/2014 4:25 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/14/2014 12:00:00 AM	2/14/2014 4:45 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/26/2013 9:39 AM
Details	Last Recertification Date	Insert				4/1/2002 12:00 AM
Details	Grant Number	Insert			H80CS00395	4/1/2002 12:00 AM
Details	340B ID	Insert			CH012010	4/1/2002 12:00 AM
Details	Is Authorizing Official EHB Data	Insert				4/1/2002 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/1/2002 12:00 AM
Details	Medicare Provider Number	Insert				4/1/2002 12:00 AM
Details	Entity Name	Insert			MATTAPAN COMMUNITY HEALTH CENTER	4/1/2002 12:00 AM
Details	Program Code	Insert			CH	4/1/2002 12:00 AM
Details	Entity Subname	Insert				4/1/2002 12:00 AM
Dates	Participating Approval Date	Insert			7/1/2002 12:00:00 AM	4/1/2002 12:00 AM
Details	State	Insert			Active	4/1/2002 12:00 AM
Dates	Registration Date	Insert			7/1/2002 12:00:00 AM	4/1/2002 12:00 AM
Dates	Signed By Date	Insert				4/1/2002 12:00 AM
Dates	Start Date	Insert			7/1/2002 12:00:00 AM	4/1/2002 12:00 AM
Terminations	Termination Comments	Insert				4/1/2002 12:00 AM
Terminations	Termination Date	Insert				4/1/2002 12:00 AM
Terminations	Termination Effective Date	Insert				4/1/2002 12:00 AM
Terminations	Termination Reason	Insert				4/1/2002 12:00 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Grantee Sites

Grantee Sites Contract Pharmacies

History