Covered Entity Details

CHC12848C Wesley Community Center Inc (Active) - information as of 6/22/2025 12:13:35 AM

Main Details

Name

Wesley Community Center Inc

Subdivision Name

Wesley Health Center - Recker Road

Type

HRSA-Funded Health Center

Site ID

BPS-H80-034120

340B ID

CHC12848C

Grant Number

H80CS12848

Additional Details

Current Program Status

Active

Registration Date

5/31/2023

Participating Start Date

7/1/2023

Participating Approval Date

6/1/2023

Last Recertification Date

2/25/2025

Contacts

Authorizing Official

Wesley Community & Health Center
Blaine Bandi, CEO
(602) 368-9616

Primary Contact

Wesley Community Centers Inc.
Jason Rentscheler, Chief Compliance and Information Officer
(602) 368-9603

Addresses

Street Address

5845 E Still Cir Ste 104
Mesa, AZ 85206-3635

Billing Address

Wesley Community Centers Inc.
1300 South 10th Street
Phoenix, AZ 85034

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
AZ	121190	1699431726

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	City	State
CHC12848	Active	BPS-H80-008229	WESLEY COMMUNITY CENTER INC	Wesley Health Center	1300 S. 10th St.	Phoenix	AZ
CHC12848A	Active	BPS-H80-015012	WESLEY COMMUNITY CENTER INC	Golden Gate Site	1625 N 39TH AVE	PHOENIX	AZ
CHC12848B	Active	BPS-H80-031891	Wesley Community Center Inc	Coffelt	1510 S 19th Dr Ste 100	Phoenix	AZ
CHC12848C	Active	BPS-H80-034120	Wesley Community Center Inc	Wesley Health Center - Recker Road	5845 E Still Cir Ste 104	Mesa	AZ
CHC12848D	Active	BPS-H80-033125	Wesley Community Center Inc	Wesley - Mobile Medical Unit	1300 S 10TH ST (Active)	Phoenix	AZ
CHC12848E	Active	BPS-H80-038068	WESLEY COMMUNITY CENTER INC	Mom and Baby Mobile Health Center	1625 N 39th Ave	Phoenix	AZ

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC12848	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09225	2406 EAST THOMAS RD.	PHOENIX	AZ	85016	10/01/2023	03/10/2025
CHC12848	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 03383	7550 SOUTH 19TH AVE.	PHOENIX	AZ	85041	10/01/2023	03/10/2025
CHC12848	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09327	6021 S CENTRAL AVE	PHOENIX	AZ	85042	10/01/2023	03/10/2025
CHC12848	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09314	3440 WEST GLENDALE AVE	PHOENIX	AZ	85051	10/01/2023	03/10/2025
CHC12848	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2023	03/10/2025
CHC12848	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2023	03/10/2025
CHC12848	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2023	03/10/2025
CHC12848	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2023	03/10/2025
CHC12848	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2023	03/10/2025
CHC12848	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2023	03/10/2025
CHC12848	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2023	03/10/2025
CHC12848	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2023	03/10/2025
CHC12848	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2023	03/10/2025
CHC12848	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2023	03/10/2025
CHC12848	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 01744	6650 W. LOWER BUCKEYE RD.	PHOENIX	AZ	85043	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 05778	4040 N. 19TH AVE.	PHOENIX	AZ	85015	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 17231	9830 W LOWER BUCKEYE RD	TOLLESON	AZ	85353	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 17024	2140 E BASELINE RD	PHOENIX	AZ	85042	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 07872	7499 W. BETHANY HOME RD.	GLENDALE	AZ	85303	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16174	1525 S POWER RD	MESA	AZ	85206	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 17418	5715 N 19TH AVE	PHOENIX	AZ	85015	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 09222	4275 W. THOMAS RD.	PHOENIX	AZ	85019	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 05026	1212 S. GREENFIELD RD.	MESA	AZ	85206	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 06718	5835 W. INDIAN SCHOOL RD.	PHOENIX	AZ	85031	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 05892	5050 W. BASELINE RD.	LAVEEN	AZ	85339	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 07263	10707 W. CAMELBACK RD.	PHOENIX	AZ	85037	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 03500	1625 N. 44TH ST.	PHOENIX	AZ	85008	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	CVS PHARMACY # 16292	7409 W VIRGINIA AVE	PHOENIX	AZ	85035	10/01/2023	03/10/2025
CHC12848	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 07860	1615 E. BASELINE RD.	PHOENIX	AZ	85042	10/01/2023	03/10/2025
CHC12848	GOODYEAR CVS, L.L.C.	DBA: CVS/PHARMACY # 03749	2840 N. DYSART RD.	GOODYEAR	AZ	85395	10/01/2023	03/10/2025
CHC12848	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2023	03/10/2025
CHC12848	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2023	03/10/2025
CHC12848	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #3129	1002 EAST MCDOWELL ROAD	PHOENIX	AZ	85006	10/01/2023	03/10/2025
CHC12848	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2023	03/10/2025
CHC12848	THOMAS PHOENIX CVS, L.L.C.	DBA: CVS/PHARMACY # 03625	8245 W. THOMAS RD.	PHOENIX	AZ	85033	10/01/2023	03/10/2025
CHC12848	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2023	03/10/2025
CHC12848	WAL-MART PHARMACY 10-2515	3721 EAST THOMAS ROAD		PHOENIX (EAST)	AZ	85018	10/01/2023	03/10/2025
CHC12848	WAL-MART PHARMACY 10-3771	6150 SOUTH 35TH AVE		PHOENIX	AZ	85041	10/01/2023	03/10/2025
CHC12848	WAL-MART PHARMACY 10-4293	2435 EAST BASELINE ROAD		PHOENIX	AZ	85042	10/01/2023	03/10/2025
CHC12848	WAL-MART PHARMACY 10-5189	5250 WEST INDIAN SCHOOL RD		PHOENIX (MARYVALE)	AZ	85031	10/01/2023	03/10/2025
CHC12848	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2023	03/10/2025
CHC12848	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2023	03/10/2025
CHC12848	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024	03/10/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 5:29:00 PM	2/25/2025 3:18:54 PM	2/25/2025 3:18 PM
Contacts	Primary Contact	Update	PC Change Request	Rentscheler, Jason Forrest Chief Compliance and Information Officer Wesley Community & Health Centers Inc. 6023689603	Rentscheler, Jason Chief Compliance and Information Officer Wesley Community Centers Inc. 6023689603	6/17/2024 3:46 PM
Contacts	Authorizing Official	Update	AO Change Request	Bandi, Blaine Chief Executive Officer Wesley Community Center, Inc 6023689616	Bandi, Blaine CEO Wesley Community & Health Center 6023689616	5/20/2024 8:40 AM
Details	Last Recertification Date	Update	Recertification		1/30/2024 5:29:00 PM	1/30/2024 5:29 PM
Contacts	Primary Contact	Update	Profile Change Request	Rentscheler, Jason Forrest Chief Operations Officer Wesley Community & Health Centers Inc. 6023689603	Rentscheler, Jason Forrest Chief Compliance and Information Officer Wesley Community & Health Centers Inc. 6023689603	1/29/2024 3:35 PM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Bandi, Blaine Chief Executive Officer Wesley Community Center, Inc 6023689616	6/1/2023 1:54 PM
Details	340B ID	Update	New Registration		CHC12848C	6/1/2023 1:54 PM
Dates	Participating Approval Date	Update	New Registration		6/1/2023 1:54:18 PM	6/1/2023 1:54 PM
Details	State	Update	New Registration	Pending	Approved	6/1/2023 1:54 PM
Dates	Signed By Date	Update	New Registration		6/1/2023 1:11:08 AM	6/1/2023 1:54 PM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	6/1/2023 1:54 PM
Addresses	Main Address	Insert	New Registration		5845 E Still Cir Ste 104 Mesa, AZ 85206-3635	5/31/2023 1:08 PM
Addresses	Billing Address	Insert	New Registration		Wesley Community Centers Inc. 1300 South 10th Street Phoenix, AZ 85034	5/31/2023 1:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/31/2023 1:08 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		121190	5/31/2023 1:08 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	5/31/2023 1:08 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1699431726	5/31/2023 1:08 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	5/31/2023 1:08 PM
Contacts	Authorizing Official	Insert	New Registration		Bandi, Blaine Chief Executive Officer Wesley Community Center, Inc 6023689616	5/31/2023 1:08 PM
Contacts	Primary Contact	Insert	New Registration		Rentscheler, Jason Forrest Chief Operations Officer Wesley Community & Health Centers Inc. 6023689603	5/31/2023 1:08 PM
Details	Assistance Received From Date	Insert	New Registration			5/31/2023 1:08 PM
Details	Assistance Received To Date	Insert	New Registration			5/31/2023 1:08 PM
Details	Last Recertification Date	Insert	New Registration			5/31/2023 1:08 PM
Details	Grant Number	Insert	New Registration		H80CS12848	5/31/2023 1:08 PM
Details	340B ID	Insert	New Registration			5/31/2023 1:08 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			5/31/2023 1:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			5/31/2023 1:08 PM
Details	Medicare Provider Number	Insert	New Registration			5/31/2023 1:08 PM
Details	Entity Name	Insert	New Registration		Wesley Community Center Inc	5/31/2023 1:08 PM
Details	NOFO Number	Insert	New Registration			5/31/2023 1:08 PM
Details	Program Code	Insert	New Registration		CH	5/31/2023 1:08 PM
Details	Entity Subname	Insert	New Registration		Wesley Health Center - Recker Road	5/31/2023 1:08 PM
Dates	Participating Approval Date	Insert	New Registration			5/31/2023 1:08 PM
Details	State	Insert	New Registration		Pending	5/31/2023 1:08 PM
Dates	Registration Date	Insert	New Registration		5/31/2023 1:08:59 PM	5/31/2023 1:08 PM
Dates	Signed By Date	Insert	New Registration			5/31/2023 1:08 PM
Dates	Start Date	Insert	New Registration			5/31/2023 1:08 PM
Terminations	Termination Comments	Insert	New Registration			5/31/2023 1:08 PM
Terminations	Termination Date	Insert	New Registration			5/31/2023 1:08 PM
Terminations	Termination Effective Date	Insert	New Registration			5/31/2023 1:08 PM
Terminations	Termination Reason	Insert	New Registration			5/31/2023 1:08 PM

340B Drug Pricing Program Database