Covered Entity Details

FQHCLA423K Bowen Health, INC. (Active) - information as of 6/24/2025 12:04:21 AM

Main Details

Name

Bowen Health, INC.

Subdivision Name

Bowen Center Angola

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-037012

340B ID

FQHCLA423K

Grant Number

LALCS40296

Additional Details

Current Program Status

Active

Registration Date

1/2/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/9/2024

Last Recertification Date

2/24/2025

Contacts

Authorizing Official

Otis R. Bowen Center for Human Services, Inc.
Melissa Knecht, Vice President of Finance
(574) 269-0532

Primary Contact

Otis R. Bowen Center for Human Services, Inc
Alisha Jackson, Director of Healthcare Quality
(765) 624-6789

Addresses

Street Address

200 Hoosier Dr
Angola, IN 46703-9345

Billing Address

Bowen Health, INC.
2621 E. Jefferson Street
Warsaw, IN 46580-4658

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
FQHCLA423	Active	BPS-LAL-036703	Bowen Health, INC.	Bowen Health Clinic	850 N Harrison St	Warsaw	IN
FQHCLA423A	Active	BPS-LAL-035331	Bowen Health, INC.	Bowen Center- Huntington	2860 Northpark Ave	Huntington	IN
FQHCLA423B	Active	BPS-LAL-035591	Bowen Health, INC.	Bowen Center- Fort Wayne	201 Rudisill Blvd	Fort Wayne	IN
FQHCLA423C	Active	BPS-LAL-036051	Bowen Health, INC.	Bowen Center- Wabash	255 N Miami St	Wabash	IN
FQHCLA423D	Active	BPS-LAL-035951	Bowen Health, INC.	Bowen Center- Goshen Road	2100 Goshen Rd	Fort Wayne	IN
FQHCLA423E	Active	BPS-LAL-037009	Bowen Health, INC.	Bowen Center Syracuse	901 S Huntington St	Syracuse	IN
FQHCLA423F	Terminated	BPS-LAL-037566	THE OTIS R BOWEN CENTER FOR HUMAN SERVICES INC	Bowen Center Marshall	990 Illinois St	Plymouth	IN
FQHCLA423G	Active	BPS-LAL-037565	Bowen Health, INC.	Bowen Center LaGrange	836 N Detroit St	Lagrange	IN
FQHCLA423H	Active	BPS-LAL-037510	Bowen Health, INC.	Bowen Center Albion	101 E Park Dr	Albion	IN
FQHCLA423J	Active	BPS-LAL-038243	Bowen Health, INC.	Bowen Center- Whitley	1259 E. State Road 205	Columbia City	IN
FQHCLA423K	Active	BPS-LAL-037012	Bowen Health, INC.	Bowen Center Angola	200 Hoosier Dr	Angola	IN
FQHCLA423L	Active	BPS-LAL-037011	Bowen Health, INC.	Bowen Center Auburn	923 Cardinal Ct	Auburn	IN
FQHCLA423M	Active	BPS-LAL-039229	Bowen Health, INC.	Bowen Health- Kokomo	2312 S Dixon Rd, Ste 250	Kokomo	IN
FQHCLA423N	Active	BPS-LAL-039507	Bowen Health, INC.	Bowen Center Marshall	2904 Miller Dr	Plymouth	IN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA423	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2024
FQHCLA423	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2024
FQHCLA423	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2024
FQHCLA423	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2024
FQHCLA423	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2024
FQHCLA423	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2024
FQHCLA423	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2024
FQHCLA423	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2024
FQHCLA423	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2024
FQHCLA423	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2024
FQHCLA423	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2024
FQHCLA423	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
FQHCLA423	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
FQHCLA423	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2024
FQHCLA423	GENOA HEALTHCARE LLC	2100 GOSHEN ROAD, STE 111		FORT WAYNE	IN	46808-1408	10/01/2021
FQHCLA423	GENOA HEALTHCARE LLC	850 HARRISON STREET, ROOM 230		WARSAW	IN	46580-3163	10/01/2021
FQHCLA423	GENOA HEALTHCARE LLC	1909 CAREW STREET		FORT WAYNE	IN	46805-4707	10/01/2021
FQHCLA423	GENOA HEALTHCARE LLC	2860 NORTHPARK AVE	ROOM 115	HUNTINGTON	IN	46750	10/01/2022
FQHCLA423	GENOA HEALTHCARE LLC	255 N MIAMI ST RM 101A		WABASH	IN	46992	07/01/2025
FQHCLA423	HOMETOWN PHARMACY #49 - WARSAW	1775 E CENTER ST		WARSAW	IN	46580	10/01/2021
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02484	4630 SO. WASHINGTON ST.	MARION	IN	46953	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	CVS/PHARMACY # 5369	6279 E. STATE BLVD.	FORT WAYNE	IN	46815	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06462	100 NORTH DETROIT ST	WARSAW	IN	46580	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06468	1150 W. PLYMOUTH ST.	BREMEN	IN	46506	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06474	1900 N. MICHIGAN ST.	PLYMOUTH	IN	46563	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06496	115 STATE ROAD #930 E	NEW HAVEN	IN	46774	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06498	224 W. NORTH ST.	KENDALLVILLE	IN	46755	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06499	308 S. HUNTINGTON ST.	SYRACUSE	IN	46567	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06500	101 WEST US HWY 6	LIGONIER	IN	46767	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06501	0975 N 00EW	LA GRANGE	IN	46761	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06502	286 W. WALKER WAY	COLUMBIA CITY	IN	46725	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06503	618 S. MAIN ST. PO BOX 241	NORTH WEBSTER	IN	46555	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06504	601 S MAIN ST.	CHURUBUSCO	IN	46723	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06509	2802 EAST STATE BOULEVARD	FORT WAYNE	IN	46805	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06510	7330 LIMA ROAD	FORT WAYNE	IN	46818	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06513	486 N. CASS ST.,	WABASH	IN	46992	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06515	1203 S. MAIN ST.	BLUFFTON	IN	46714	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06517	1901 N. JEFFERSON ST.	HUNTINGTON	IN	46750	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06519	5802 SOUTH ANTHONY BLVD.	FORT WAYNE	IN	46816	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06520	3918 SOUTH CALHOUN ST.	FORT WAYNE	IN	46807	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06522	2811 GETZ ROAD	FORT WAYNE	IN	46804	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06525	302 E. MAIN ST.	NORTH MANCHESTER	IN	46962	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06527	6220 SAINT JOE CENTER RD.	FORT WAYNE	IN	46835	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06534	717 NORTH 3RD STREET	LOGANSPORT	IN	46947	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06536	2340 W SYCAMORE	KOKOMO	IN	46901	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06538	907 S. HEATON	KNOX	IN	46534	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06545	2 SOUTH BROADWAY	PERU	IN	46970	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06621	415 W. 3RD ST.	MARION	IN	46952	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 07188	102 E US HIGHWAY 20	MIDDLEBURY	IN	46540	10/01/2024
FQHCLA423	HOOK-SUPERX, L.L.C.	DBA CVS/PHARMACY #10190	770 E. DUPONT RD.	FORT WAYNE	IN	46825	10/01/2024
FQHCLA423	MARTIN'S PHARMACY #2322	SPARTANNASH	865 E JEFFERSON ST	PLYMOUTH	IN	46563	10/01/2021
FQHCLA423	MARTIN'S PHARMACY #2326	1150 HUSKY TRL		WARSAW	IN	46582-1952	10/01/2021
FQHCLA423	MEIJER DISTRIBUTION INC #90	2721 WALKER AVE NW		GRAND RAPIDS	MI	49544	10/01/2021
FQHCLA423	MEIJER PHARMACY #464	41255 COCA COLA DR.		BELLEVILLE	MI	48111-1827	10/01/2021
FQHCLA423	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #463	1515 PROFIT DR.	FORT WAYNE	IN	46808	10/01/2021
FQHCLA423	MEIJER STORES LIMITED PARTNERSHIP	D/B/A MEIJER PHARMACY #267	1200 LAKE CITY HWY	WARSAW	IN	46580	10/01/2021
FQHCLA423	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2024
FQHCLA423	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2024
FQHCLA423	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2024
FQHCLA423	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2022	01/13/2023
FQHCLA423	WAL-MART PHARMACY 10-1304	2501 WALTON BLVD		WARSAW	IN	46582	07/01/2022	01/13/2023
FQHCLA423	WAL-MART PHARMACY 10-1667	1601 N CASS ST		WABASH	IN	46992	07/01/2022	01/13/2023
FQHCLA423	WAL-MART PHARMACY 10-1804	1710 APPLE GLEN BLVD		FORT WAYNE	IN	46804	07/01/2022	01/13/2023
FQHCLA423	WAL-MART PHARMACY 10-1978	2505 NORTH OAK RD		PLYMOUTH	IN	46563	07/01/2022	01/13/2023
FQHCLA423	WAL-MART PHARMACY 10-2311	2800 WALMART DRIVE		HUNTINGTON	IN	46750	07/01/2022	01/13/2023
FQHCLA423	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2022	01/13/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/24/2025 11:48:57 AM	2/24/2025 11:48 AM
Addresses	Billing Address	Insert	Group Change Request		Bowen Health, INC. 2621 E. Jefferson Street Warsaw, IN 46580-4658	1/15/2025 10:10 AM
Details	Entity Name	Update	Group Change Request	THE OTIS R BOWEN CENTER FOR HUMAN SERVICES INC	Bowen Health, INC.	1/15/2025 10:10 AM
Contacts	Authorizing Official	Update	AO Change Request	Carey, Daniel Senior VP, Healthcare Quality The Otis R. Bowen Center for Human Services, Inc 5745261385	Knecht, Melissa Vice President of Finance Otis R. Bowen Center for Human Services, Inc. 5742690532	1/14/2025 1:12 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Carey, Daniel Senior VP, Healthcare Quality The Otis R. Bowen Center for Human Services, Inc 5745261385	2/9/2024 6:47 AM
Details	340B ID	Update	New Registration		FQHCLA423K	2/9/2024 6:47 AM
Dates	Participating Approval Date	Update	New Registration		2/9/2024 6:47:33 AM	2/9/2024 6:47 AM
Details	State	Update	New Registration	Pending	Approved	2/9/2024 6:47 AM
Dates	Signed By Date	Update	New Registration		1/2/2024 1:20:29 PM	2/9/2024 6:47 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/9/2024 6:47 AM
Addresses	Main Address	Insert	New Registration		200 Hoosier Dr Angola, IN 46703-9345	1/2/2024 1:20 PM
Contacts	Authorizing Official	Insert	New Registration		Carey, Daniel Senior VP, Healthcare Quality The Otis R. Bowen Center for Human Services, Inc 5745261385	1/2/2024 1:20 PM
Contacts	Primary Contact	Insert	New Registration		Jackson, Alisha Director of Healthcare Quality Otis R. Bowen Center for Human Services, Inc 7656246789	1/2/2024 1:20 PM
Details	Assistance Received From Date	Insert	New Registration			1/2/2024 1:20 PM
Details	Assistance Received To Date	Insert	New Registration			1/2/2024 1:20 PM
Details	Last Recertification Date	Insert	New Registration			1/2/2024 1:20 PM
Details	Grant Number	Insert	New Registration		LALCS40296	1/2/2024 1:20 PM
Details	340B ID	Insert	New Registration			1/2/2024 1:20 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/2/2024 1:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/2/2024 1:20 PM
Details	Medicare Provider Number	Insert	New Registration			1/2/2024 1:20 PM
Details	Entity Name	Insert	New Registration		THE OTIS R BOWEN CENTER FOR HUMAN SERVICES INC	1/2/2024 1:20 PM
Details	NOFO Number	Insert	New Registration			1/2/2024 1:20 PM
Details	Program Code	Insert	New Registration		FQHCLA	1/2/2024 1:20 PM
Details	Entity Subname	Insert	New Registration		Bowen Center Angola	1/2/2024 1:20 PM
Dates	Participating Approval Date	Insert	New Registration			1/2/2024 1:20 PM
Details	State	Insert	New Registration		Pending	1/2/2024 1:20 PM
Dates	Registration Date	Insert	New Registration		1/2/2024 1:20:24 PM	1/2/2024 1:20 PM
Dates	Signed By Date	Insert	New Registration			1/2/2024 1:20 PM
Dates	Start Date	Insert	New Registration			1/2/2024 1:20 PM
Terminations	Termination Comments	Insert	New Registration			1/2/2024 1:20 PM
Terminations	Termination Date	Insert	New Registration			1/2/2024 1:20 PM
Terminations	Termination Effective Date	Insert	New Registration			1/2/2024 1:20 PM
Terminations	Termination Reason	Insert	New Registration			1/2/2024 1:20 PM

340B Drug Pricing Program Database