Covered Entity Details

CH03072K EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED (Active) - information as of 5/20/2025 12:47:55 AM

Main Details

Name

EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED

Subdivision Name

Occohannock Dental

Type

HRSA-Funded Health Center

Site ID

BPS-H80-035149

340B ID

CH03072K

Grant Number

H80CS00791

Additional Details

Current Program Status

Active

Registration Date

8/7/2023

Participating Start Date

10/1/2023

Participating Approval Date

8/21/2023

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Eastern Shore Rural Health System Inc.
Jeannette Edwards, CEO-Intrim
(757) 414-0400 Ext: 1112

Primary Contact

Eastern Shore Rural Health System, Inc.
KIMBERLY Bloxom SAVAGE, CHIEF COMPLIANCE OFFICER
(757) 414-0400 Ext: 108

Addresses

Street Address

4208 Seaside Rd
Exmore, VA 23350-2575

Billing Address

Eastern Shore Rural Health System Inc.
20280 Market St
Onancock, VA 23417

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	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
CH030720	Active	BPS-H80-013713	EASTERN SHORE RURAL HEALTH SYSTEM, INC	Eastern Shore Rural Health System, Inc.	20280 Market St	Onancock	VA
CH03072B	Active	BPS-H80-014660	EASTERN SHORE RURAL HEALTH SYSTEM, INC	ATLANTIC COMMUNITY HEALTH CENTER	5219 Lankford Highway	New Church	VA
CH03072C	Active	BPS-H80-003353	EASTERN SHORE RURAL HEALTH SYSTEM, INC	FRANKTOWN COMMUNITY HEALTH CENTER	9159 FRANKTOWN ROAD	FRANKTOWN	VA
CH03072D	Active	BPS-H80-029754	EASTERN SHORE RURAL HEALTH SYSTEM, INC	EASTVILLE COMMUNITY HEALTH CENTER	17068 LANKFORD HIGHWAY	EASTVILLE	VA
CH03072F	Active	BPS-H80-008761	EASTERN SHORE RURAL HEALTH SYSTEMS INC	Onley Community Health Center	20306 Badger Lane	Onley	VA
CH03072G	Active	BPS-H80-004326	EASTERN SHORE RURAL HEALTH SYSTEMS INC	CHINCOTEAGUE ISLAND COMM HLTH CTR	4049 Main St	Chincoteague Island	VA
CH03072H	Terminated	BPS-H80-036420	EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED	Atlantic Community Pharmacy	7001 Lankford Hwy	Oak Hall	VA
CH03072J	Active	BPS-H80-036498	EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED	Express Care	25228 Lankford Highway	Onley	VA
CH03072K	Active	BPS-H80-035149	EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED	Occohannock Dental	4208 Seaside Rd	Exmore	VA
CH03072L	Active	BPS-H80-007087	EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED	METOMPKIN SCHOOL DENTAL PROGRAM	24501 Parksley Rd	Parksley	VA
CH03072M	Active	BPS-H80-033670	EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED	Nandua Middle School	20330 Warrior Dr	Onley	VA
CH03072N	Active	BPS-H80-034774	EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED	Kiptopeke Dental	24023 Fairview Rd	Cape Charles	VA
CH03072P	Active	BPS-H80-006537	EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED	PUNGOTEAGUE DENTAL PROGRAM	28480 Bobtown Rd	Melfa	VA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH030720	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CH030720	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CH030720	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CH030720	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CH030720	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CH030720	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CH030720	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CH030720	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CH030720	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CH030720	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CH030720	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2022
CH030720	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2022
CH030720	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CH030720	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2023
CH03072C	H & H PHARMACY-OAK HALL	7001 LANKFORD HWY		OAK HALL	VA	23416-2223	03/09/2011
CH03072B	H & H PHARMACY-OAK HALL	7001 LANKFORD HWY		OAK HALL	VA	23416-2223	03/09/2011
CH030720	H & H PHARMACY-OAK HALL	7001 LANKFORD HWY		OAK HALL	VA	23416-2223	04/21/2011	06/21/2023
CH03072C	H&H PHARMACY INC	6300 MADDOX BLVD		CHINCOTEAGUE	VA	23336-2617	03/09/2011
CH03072B	H&H PHARMACY INC	6300 MADDOX BLVD		CHINCOTEAGUE	VA	23336-2617	03/09/2011
CH030720	H&H PHARMACY INC	6300 MADDOX BLVD		CHINCOTEAGUE	VA	23336-2617	04/21/2011
CH030720	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04017	28 MAGOTHY BEACH RD.	PASADENA	MD	21122	04/01/2022
CH030720	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/01/2024
CH030720	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/01/2025
CH030720	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2025
CH030720	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CH030720	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CH030720	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
CH030720	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CH03072C	RAYFIELD'S PHARMACY	2 FIG ST		CAPE CHARLES	VA	23310-3322	03/09/2011
CH03072C	RAYFIELD'S PHARMACY	P.O. BOX 213	9502 HOSPITAL AVENUE	NASSAWADOX	VA	23413	03/09/2011
CH030720	RAYFIELD'S PHARMACY	2 FIG ST		CAPE CHARLES	VA	23310-3322	06/01/2011
CH030720	RAYFIELD'S PHARMACY	P.O. BOX 213	9502 HOSPITAL AVENUE	NASSAWADOX	VA	23413	06/01/2011
CH03072D	RAYFIELD'S PHARMACY	2 FIG ST		CAPE CHARLES	VA	23310-3322	03/09/2011
CH03072D	RAYFIELD'S PHARMACY	P.O. BOX 213	9502 HOSPITAL AVENUE	NASSAWADOX	VA	23413	03/09/2011
CH03072F	RAYFIELD'S PHARMACY	P.O. BOX 213	9502 HOSPITAL AVENUE	NASSAWADOX	VA	23413	03/09/2011
CH03072F	RAYFIELD'S PHARMACY	2 FIG ST		CAPE CHARLES	VA	23310-3322	03/09/2011
CH030720	RAYFIELD'S PHARMACY	17068 LANKFORD HWY	SUITE 203	EASTVILLE	VA	23347	07/22/2020
CH030720	RITE AID OF MARYLAND, INC.	RITE AID #3837	505 LINDEN AVENUE	POCOMOKE CITY	MD	21851	10/01/2017
CH030720	RITE AID OF VIRGINIA, INC.	RITE AID #3866	25096 LANKFORD HWY	ONLEY	VA	23418	10/01/2017	01/03/2018
CH030720	RITE AID OF VIRGINIA, INC.	RITE AID #1900	4053 LANKFORD HIGHWAY P.O. BOX 850	EXMORE	VA	23350	10/01/2017	01/03/2018
CH030720	RUNNINGER'S PHARMACY INC	PO BOX 25	18465 DUNNE AVENUE	PARKSLEY	VA	23421	04/12/2011	04/07/2017
CH030720	Runningers Pharmacy	44 MARKET STREET		ONANCOCK	VA	23417	04/12/2011	04/07/2017
CH030720	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01570	25201 LANKFORD HWY.	ONLEY	VA	23418	04/01/2020
CH030720	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH030720	WAL-MART PHARMACY 10-2514	2132 OLD SNOW HILL ROAD		POCOMOKE CITY	MD	21851	04/01/2013
CH030720	WAL-MART PHARMACY 10-4378	26036 LANKFORD HWY		ONLEY	VA	23418	04/01/2013
CH030720	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH030720	WALGREEN CO.	WALGREENS #17128	25096 LANKFORD HIGHWAY	ONLEY	VA	23418	02/21/2018	06/01/2023
CH030720	WALGREEN CO.	WALGREENS #18229	4053 LANKFORD HWY P.O. BOX 850	EXMORE	VA	23350-2643	02/21/2018
CH030720	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	10/01/2023
CH030720	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2023
CH030720	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2023
CH030720	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2023
CH030720	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 10:40:17 AM	2/11/2025 3:11:56 PM	2/11/2025 3:11 PM
Details	Last Recertification Date	Update	Recertification		1/30/2024 10:40:17 AM	1/30/2024 10:40 AM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Edwards, Jeannette CEO-Intrim Eastern Shore Rural Health System Inc. 7574140400-1112	8/21/2023 1:46 PM
Details	340B ID	Update	New Registration		CH03072K	8/21/2023 1:46 PM
Dates	Participating Approval Date	Update	New Registration		8/21/2023 1:46:54 PM	8/21/2023 1:46 PM
Details	State	Update	New Registration	Pending	Approved	8/21/2023 1:46 PM
Dates	Signed By Date	Update	New Registration		8/9/2023 10:22:46 AM	8/21/2023 1:46 PM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	8/21/2023 1:46 PM
Addresses	Main Address	Insert	New Registration		4208 Seaside Rd Exmore, VA 23350-2575	8/7/2023 9:58 AM
Addresses	Billing Address	Insert	New Registration		Eastern Shore Rural Health System Inc. 20280 Market St Onancock, VA 23417	8/7/2023 9:58 AM
Contacts	Primary Contact	Insert	New Registration		SAVAGE, KIMBERLY Bloxom CHIEF COMPLIANCE OFFICER Eastern Shore Rural Health System, Inc. 7574140400-108	8/7/2023 9:58 AM
Contacts	Authorizing Official	Insert	New Registration		Edwards, Jeannette CEO-Intrim Eastern Shore Rural Health System Inc. 7574140400-1112	8/7/2023 9:58 AM
Details	Assistance Received From Date	Insert	New Registration			8/7/2023 9:58 AM
Details	Assistance Received To Date	Insert	New Registration			8/7/2023 9:58 AM
Details	Last Recertification Date	Insert	New Registration			8/7/2023 9:58 AM
Details	Grant Number	Insert	New Registration		H80CS00791	8/7/2023 9:58 AM
Details	340B ID	Insert	New Registration			8/7/2023 9:58 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			8/7/2023 9:58 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			8/7/2023 9:58 AM
Details	Medicare Provider Number	Insert	New Registration			8/7/2023 9:58 AM
Details	Entity Name	Insert	New Registration		EASTERN SHORE RURAL HEALTH SYSTEM, INCORPORATED	8/7/2023 9:58 AM
Details	NOFO Number	Insert	New Registration			8/7/2023 9:58 AM
Details	Program Code	Insert	New Registration		CH	8/7/2023 9:58 AM
Details	Entity Subname	Insert	New Registration		Occohannock Dental	8/7/2023 9:58 AM
Dates	Participating Approval Date	Insert	New Registration			8/7/2023 9:58 AM
Details	State	Insert	New Registration		Pending	8/7/2023 9:58 AM
Dates	Registration Date	Insert	New Registration		8/7/2023 9:58:00 AM	8/7/2023 9:58 AM
Dates	Signed By Date	Insert	New Registration			8/7/2023 9:58 AM
Dates	Start Date	Insert	New Registration			8/7/2023 9:58 AM
Terminations	Termination Comments	Insert	New Registration			8/7/2023 9:58 AM
Terminations	Termination Date	Insert	New Registration			8/7/2023 9:58 AM
Terminations	Termination Effective Date	Insert	New Registration			8/7/2023 9:58 AM
Terminations	Termination Reason	Insert	New Registration			8/7/2023 9:58 AM

340B Drug Pricing Program Database