Covered Entity Details

CH04907W Community Health Centers Of Pinellas, Inc. (Active) - information as of 4/25/2025 7:28:01 PM

Main Details

Name

Community Health Centers Of Pinellas, Inc.

Subdivision Name

Evara Health - Milton Park

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033870

340B ID

CH04907W

Grant Number

H80CS00463

Additional Details

Current Program Status

Active

Registration Date

1/2/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/10/2024

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Community Health Centers of Pinellas, Inc.
Elodie Leigh Dorso, CEO
(727) 824-8100

Primary Contact

Community Health Centers of Pinellas, Inc
Edward Kucher, CRO
(727) 824-8100

Addresses

Street Address

1260 S Martin Luther King Jr Ave
Clearwater, FL 33756-4172

Billing Address

Evara Health
14100 58th Street North
Clearwater, FL 33760

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
FL	029565539; 029565541; 122661500	1609586098,1821868803

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
CH049070	Active	BPS-H80-000433	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Johnnie Ruth Clarke	1344 22nd St S	Saint Petersburg	FL
CH04907A	Active	BPS-H80-039442	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Highpoint 2	14106 58th Street North	Clearwater	FL
CH04907B	Active	BPS-H80-011345	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Clearwater	707 Druid Rd E	Clearwater	FL
CH04907E	Active	BPS-H80-012370	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Pinellas Park	7550 - 43RD STREET NORTH	Pinellas Park	FL
CH04907H	Active	BPS-H80-002089	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Largo	12420 130th Ave N	Largo	FL
CH04907I	Active	BPS-H80-008975	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Tarpon Springs	247 S. Huey Avenue	Tarpon Springs	FL
CH04907J	Active	BPS-H80-012952	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Bayfront	701 Sixth Street South SPC 741	St Petersburg	FL
CH04907K	Active	BPS-H80-031834	Community Health Centers of Pinellas, Inc.	Evara Health - Highpoint	14100 58th Street North	Clearwater	FL
CH04907L	Active	BPS-H80-014191	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Clearwater Dental	702 Jasmine Way	Clearwater	FL
CH04907M	Active	BPS-H80-014244	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - St. Petersburg	612 Dr. Martin Luther King, Jr Street North	Saint Petersburg	FL
CH04907N	Active	BPS-H80-014929	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Dunedin	1721 MAIN ST	DUNEDIN	FL
CH04907P	Active	BPS-H80-017934	COMMUNITY HEALTH CENTERS OF PINELLAS, INC.	Evara Health - Lealman	4950 34th Street North	St Petersburg	FL
CH04907Q	Active	BPS-H80-027537	Community Health Centers Of Pinellas, Inc.	Evara Health - Oldsmar	3860 Tampa Rd STE C	Oldsmar	FL
CH04907R	Active	BPS-H80-027591	Community Health Centers Of Pinellas, Inc.	Evara Health - Mobile Health Center	1344 22nd St S	St Petersburg	FL
CH04907S	Active	BPS-H80-031739	Community Health Centers Of Pinellas, Inc.	Evara Health - Tarpon Springs Dental	721 E Lime St	Tarpon Springs	FL
CH04907T	Active	BPS-H80-035138	Community Health Centers Of Pinellas, Inc.	Evara Health - Campbell Park	701 16th St S Bldg 7	St Petersburg	FL
CH04907U	Active	BPS-H80-035318	Community Health Centers Of Pinellas, Inc.	Evara Health - Mobile Health Center 2	14100 58th Street North	Clearwater	FL
CH04907V	Active	BPS-H80-017729	Community Health Centers Of Pinellas, Inc.	Evara Gold - Suncoast	5523 Roosevelt Blvd	Clearwater	FL
CH04907W	Active	BPS-H80-033870	Community Health Centers Of Pinellas, Inc.	Evara Health - Milton Park	1260 S Martin Luther King Jr Ave	Clearwater	FL
CH04907X	Active	BPS-H80-038350	Community Health Centers Of Pinellas, Inc.	Evara Health - Mobile Health Center 3	14100 58th St N	Clearwater	FL
CH04907Y	Approved	BPS-H80-039947	Community Health Centers Of Pinellas, Inc.	Evara Health - Pinellas Heights	11411 Ulmerton Rd	Largo	FL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH049070	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/01/2025
CH049070	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2024
CH049070	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2024
CH049070	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2024
CH049070	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2024
CH049070	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2024
CH049070	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2024
CH049070	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2024
CH049070	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2024
CH049070	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH049070	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2024
CH049070	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CH049070	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CH049070	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2024
CH049070	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00171	7400 49TH ST N	PINELLAS PARK	FL	33781	07/01/2017
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00709	1000 EAST TARPON AVE.	TARPON SPRINGS	FL	34689	07/01/2017
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02873	2200 34TH STREET NORTH	SAINT PETERSBURG	FL	33713	07/01/2017
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05234	301 3RD ST S	SAINT PETERSBURG	FL	33701	07/01/2017
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07944	3426 CENTRAL AVE.	SAINT PETERSBURG	FL	33711	07/01/2017	10/11/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00104	1 S MISSOURI AVE	CLEARWATER	FL	33756	07/01/2018
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01328	2513 US HWY 19	HOLIDAY	FL	34691	07/01/2018
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02874	4000 EAST BAY DRIVE	CLEARWATER	FL	33764	07/01/2018
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03606	10195 66TH ST. N	PINELLAS PARK	FL	33782	07/01/2018
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03654	3501 54TH AVE S	SAINT PETERSBURG	FL	33711	07/01/2018
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04494	5345 66TH ST N	SAINT PETERSBURG	FL	33709	01/01/2019	05/25/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04083	51 MISSOURI AVE., NORTH	LARGO	FL	33770	01/01/2019
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03615	1899 N HIGHLAND AVE	CLEARWATER	FL	33755	01/01/2019	12/20/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05192	2390 BELCHER ROAD	LARGO	FL	33771	01/01/2019	04/16/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00574	8001 9TH ST N	SAINT PETERSBURG	FL	33702	01/01/2019
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00188	13998 WALSINGHAM RD	LARGO	FL	33774	01/01/2019
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05485	5801 CENTRAL AVE.	SAINT PETERSBURG	FL	33710	01/01/2019
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02759	845 4TH ST. NORTH	SAINT PETERSBURG	FL	33701	01/01/2019
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00160	4260 6TH ST S	SAINT PETERSBURG	FL	33705	01/01/2019	01/03/2022
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03547	2100 66TH ST N	SAINT PETERSBURG	FL	33710	01/01/2019
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02731	2200 GULF TO BAY BLVD.	CLEARWATER	FL	33765	01/01/2019
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03755	5405 49TH STREET N	SAINT PETERSBURG	FL	33709	01/01/2019
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02767	7101 PARK BLVD.	PINELLAS PARK	FL	33781	01/01/2019	10/29/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00613	9202 N FLORIDA AVE	TAMPA	FL	33612	10/01/2020	09/11/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05110	105 S PEBBLE BEACH BLVD	SUN CITY CENTER	FL	33573	10/01/2020
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03257	704 W MARTIN LUTHER KING JR BLVD	SEFFNER	FL	33584	10/01/2020
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03520	6202 US HWY 41 N	APOLLO BEACH	FL	33572	10/01/2020
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05783	8603 WEST HILLSBOROUGH AVE	TAMPA	FL	33615	10/01/2020
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03466	5400 4TH ST N	SAINT PETERSBURG	FL	33703	04/01/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03960	3765 ULMERTON RD	CLEARWATER	FL	33762	04/01/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03157	2390 E BAY DR	LARGO	FL	33771	04/01/2023	06/13/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05146	3511 US HWY 19	NEW PORT RICHEY	FL	34652	04/01/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04987	2175 MAIN ST.	DUNEDIN	FL	34698	04/01/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03218	10200 SEMINOLE BLVD	SEMINOLE	FL	33778	04/01/2023
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00306	5432 US HWY 19 N	NEW PORT RICHEY	FL	34652	01/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03686	30387 US HWY 19 N	CLEARWATER	FL	33761	01/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03746	11115 SPRING HILL DR	SPRING HILL	FL	34609	01/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03260	7325 STATE ROAD 54	NEW PORT RICHEY	FL	34653	01/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03228	1298 COUNTY RD 1	DUNEDIN	FL	34698	01/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02760	2911 E. FOWLER AVE.	TAMPA	FL	33612	01/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03579	3771 TAMPA RD	OLDSMAR	FL	34677	01/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03927	700 E LAKE RD	PALM HARBOR	FL	34685	04/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03463	8905 BRYAN DAIRY RD	LARGO	FL	33777	04/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00149	294 37TH AVE N	SAINT PETERSBURG	FL	33704	04/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02842	975 TAMPA RD.	PALM HARBOR	FL	34683	04/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00139	6820 GULFPORT BLVD S	SOUTH PASADENA	FL	33707	04/01/2024
CH049070	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16941	2747 GULF TO BAY BLVD	CLEARWATER	FL	33759	04/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02997	15129 MADEIRA WAY	MADEIRA BEACH	FL	33708	04/01/2024
CH04907J	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03654	3501 54TH AVE S	SAINT PETERSBURG	FL	33711	04/01/2024
CH04907P	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04083	51 MISSOURI AVE., NORTH	LARGO	FL	33770	04/01/2024
CH04907N	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02873	2200 34TH STREET NORTH	SAINT PETERSBURG	FL	33713	04/01/2024
CH04907B	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00574	8001 9TH ST N	SAINT PETERSBURG	FL	33702	04/01/2024
CH04907T	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03755	5405 49TH STREET N	SAINT PETERSBURG	FL	33709	04/01/2024
CH04907U	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00104	1 S MISSOURI AVE	CLEARWATER	FL	33756	04/01/2024
CH04907I	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00709	1000 EAST TARPON AVE.	TARPON SPRINGS	FL	34689	04/01/2024
CH04907R	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00171	7400 49TH ST N	PINELLAS PARK	FL	33781	04/01/2024
CH04907V	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02874	4000 EAST BAY DRIVE	CLEARWATER	FL	33764	04/01/2024
CH04907H	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05234	301 3RD ST S	SAINT PETERSBURG	FL	33701	04/01/2024
CH04907S	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00188	13998 WALSINGHAM RD	LARGO	FL	33774	04/01/2024
CH049070	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03211	7405 STARKEY RD	SEMINOLE	FL	33777	01/01/2025
CH049070	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/01/2022	10/01/2022
CH049070	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2024
CH049070	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2024
CH049070	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2024
CH049070	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2024
CH049070	SAMSON MERGER SUB, LLC	WINN DIXIE #2409	2139 34TH STREET NORTH	SAINT PETERSBURG	FL	33713	10/01/2021	12/20/2024
CH049070	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017	03/02/2018
CH049070	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2025
CH049070	WAL-MART PHARMACY #10-3013	7500 66TH ST		PINELLAS PARK	FL	33781	07/01/2017
CH049070	WAL-MART PHARMACY 10-1390	8001 US 19 NORTH		PINELLAS PARK	FL	33781	07/01/2017
CH049070	WAL-MART PHARMACY 10-1712	990 MISSOURI AVE (N)		LARGO	FL	33770	07/01/2017
CH04907M	WAL-MART PHARMACY 10-1712	990 MISSOURI AVE (N)		LARGO	FL	33770	04/01/2024
CH049070	WAL-MART PHARMACY 10-4669	6900 US 19 NORTH		PINELLAS PARK	FL	33781	07/01/2017	03/02/2018
CH049070	WAL-MART PHARMACY 10-4690	201 - 34TH STREET N		SAINT PETERSBURG	FL	33713	07/01/2017
CH049070	WAL-MART PHARMACY 10-5218	3501 34TH STREET SOUTH		ST.PETERSBURG	FL	33711	07/01/2017
CH049070	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH049070	WALGREEN CO.	DBA: WALGREENS #15192	710 150TH AVENUE	MADEIRA BEACH	FL	33708	04/01/2013	11/16/2023
CH049070	WALGREEN CO.	DBA: WALGREENS # 01339	3077 54TH AVE S	ST PETERSBURG	FL	33712-4613	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 02230	5420 DR MARTIN LUTHER KING JR ST N	ST PETERSBURG	FL	33703	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 15519	10801 ROOSEVELT BLVD NORTH	ST PETERSBURG	FL	33716-3818	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 02524	337 75TH AVENUE	ST PETE BEACH	FL	33706	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 02665	3350 CENTRAL AVE	ST PETERSBURG	FL	33712	04/01/2013	03/27/2025
CH049070	WALGREEN CO.	DBA: WALGREENS # 02918	875 DR MARTIN LUTHER KING JR ST N	SAINT PETERSBURG	FL	33701	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03046	2295 EAST BAY DRIVE	LARGO	FL	33771	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03428	6735 CENTRAL AVE	ST PETERSBURG	FL	33710	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03429	13705 PARK BLVD	SEMINOLE	FL	33776	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03471	1604 SOUTH MISSOURI AVENUE	CLEARWATER	FL	33756	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03555	1880 N BELCHER RD	CLEARWATER	FL	33765	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03556	10121 SEMINOLE BLVD	SEMINOLE	FL	33772	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03597	3700 34TH STREET NORTH	ST PETERSBURG	FL	33713	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03778	1801 GULF TO BAY BLVD	CLEARWATER	FL	33765	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03793	4510 U.S. HIGHWAY 19	NEW PORT RICHEY	FL	34652	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03794	5701 GULFPORT BLVD S	GULFPORT	FL	33707	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03795	6996 US HWY 19 N	PINELLAS PARK	FL	33781	04/01/2013	03/19/2025
CH049070	WALGREEN CO.	DBA: WALGREENS # 03808	901 22ND AVE SOUTH	ST PETERSBURG	FL	33705	04/01/2013	10/13/2016
CH049070	WALGREEN CO.	DBA: WALGREENS # 03829	8398 SHELDON ROAD	TAMPA	FL	33615	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03951	900 49TH STREET N	SAINT PETERSBURG	FL	33710-3371	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 03988	10563 PARK BLVD	SEMINOLE	FL	33772	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 04124	33670 US 19 NORTH	PALM HARBOR	FL	34684	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 04263	2598 BAYSHORE BLVD	DUNEDIN	FL	34698	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 04398	1477 MAIN STREET	DUNEDIN	FL	34698	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 04481	3994 TYRONE BLVD N	ST PETERSBURG	FL	33709	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 04800	6560 ULMERTON RD	LARGO	FL	33771	04/01/2013	02/27/2024
CH049070	WALGREEN CO.	DBA: WALGREENS # 05326	800 W BAY DR	LARGO	FL	33770	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 05576	7925 GUNN HIGHWAY	TAMPA	FL	33626	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 15518	703 COURT ST	CLEARWATER	FL	33756	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 05870	14004 WALSINGHAM RD	LARGO	FL	33774	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 06292	5405 66TH STREET N	ST PETERSBURG	FL	33709-1510	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 06293	1505 S BELCHER ROAD	CLEARWATER	FL	33764-7603	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 06541	605 S PINELLAS AVE	TARPON SPRINGS	FL	34689	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 06608	2991 ROOSEVELT BLVD	CLEARWATER	FL	33760	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 06786	7751 49TH STREET N	PINELLAS PARK	FL	33781	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 06804	5767 38TH AVE N	ST PETERSBURG	FL	33710-1925	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 07157	7400 66TH STREET	PINELLAS PARK	FL	33781-3101	04/01/2013	12/01/2015
CH049070	WALGREEN CO.	DBA: WALGREENS # 07651	10697 ULMERTON RD	LARGO	FL	33771-3527	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 07827	7610 4TH ST N	SAINT PETERSBURG	FL	33702	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 07918	5 PATRICIA AVE	DUNEDIN	FL	34698-8102	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 09517	10196 66TH STREET NORTH	PINELLAS PARK	FL	33782	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 09688	1701 N MCMULLEN BOOTH RD	CLEARWATER	FL	33759-2115	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 12318	2480 US HIGHWAY 19	HOLIDAY	FL	34691	04/01/2013
CH049070	WALGREEN CO.	DBA: WALGREENS # 09031	3851 4TH ST NORTH	ST PETERSBURG	FL	33703	04/01/2013
CH049070	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15301	3030 1ST AVE N	ST PETERSBURG	FL	33713	04/01/2017
CH049070	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13630	1301 SECOND AVE, S.W. SUITE 200	LARGO	FL	33770	07/01/2017
CH049070	WALGREEN CO.	DBA: WALGREENS # 04282	1504 53RD AVE. E	BRADENTON	FL	34203	01/01/2024
CH04907Q	WALGREEN CO.	DBA: WALGREENS # 09517	10196 66TH STREET NORTH	PINELLAS PARK	FL	33782	04/01/2024
CH04907L	WALGREEN CO.	DBA: WALGREENS # 06541	605 S PINELLAS AVE	TARPON SPRINGS	FL	34689	04/01/2024
CH049070	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	01/01/2023
CH049070	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/01/2013	07/27/2015
CH049070	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	07/27/2015
CH049070	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2023
CH049070	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2023
CH049070	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2023
CH049070	WALMART PHARMACY #10-6400		1794 22ND ST. SOUTH	SAINT PETERSBURG	FL	33712	07/01/2017	03/02/2018
CH049070	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2024
CH049070	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024
CH049070	WINN-DIXIE STORES	WINN-DIXIE PHARMACY #698	1049-62ND AVE NORTH	ST PETERSBURG	FL	33702	10/01/2021	12/20/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/10/2025 3:25:47 PM	2/10/2025 3:25 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	29565539; 29565541; 122661500 (FL)		1/10/2025 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/10/2025 12:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		029565539; 029565541; 122661500	1/10/2025 12:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	1/10/2025 12:39 PM
Contacts	Primary Contact	Update	Profile Change Request	Kucher, Edward VP Community Health Centers of Pinellas, Inc 7278248100	Kucher, Edward CRO Community Health Centers of Pinellas, Inc 7278248100	1/9/2025 5:27 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	29565539; 29565541 (FL)		1/6/2025 9:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/6/2025 9:27 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		29565539; 29565541; 122661500	1/6/2025 9:27 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	1/6/2025 9:27 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Dorso, Elodie Leigh CEO Community Health Centers of Pinellas, Inc. 7278248100	1/10/2024 8:16 AM
Details	340B ID	Update	New Registration		CH04907W	1/10/2024 8:16 AM
Dates	Participating Approval Date	Update	New Registration		1/10/2024 8:16:49 AM	1/10/2024 8:16 AM
Details	State	Update	New Registration	Pending	Approved	1/10/2024 8:16 AM
Dates	Signed By Date	Update	New Registration		1/8/2024 11:24:04 AM	1/10/2024 8:16 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/10/2024 8:16 AM
Addresses	Main Address	Insert	New Registration		1260 S Martin Luther King Jr Ave Clearwater, FL 33756-4172	1/2/2024 5:05 PM
Addresses	Billing Address	Insert	New Registration		Evara Health 14100 58th Street North Clearwater, FL 33760	1/2/2024 5:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/2/2024 5:05 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		29565539; 29565541	1/2/2024 5:05 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	1/2/2024 5:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1609586098	1/2/2024 5:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	1/2/2024 5:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821868803	1/2/2024 5:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	1/2/2024 5:05 PM
Contacts	Primary Contact	Insert	New Registration		Kucher, Edward VP Community Health Centers of Pinellas, Inc 7278248100	1/2/2024 5:05 PM
Contacts	Authorizing Official	Insert	New Registration		Dorso, Elodie Leigh CEO Community Health Centers of Pinellas, Inc. 7278248100	1/2/2024 5:05 PM
Details	Assistance Received From Date	Insert	New Registration			1/2/2024 5:05 PM
Details	Assistance Received To Date	Insert	New Registration			1/2/2024 5:05 PM
Details	Last Recertification Date	Insert	New Registration			1/2/2024 5:05 PM
Details	Grant Number	Insert	New Registration		H80CS00463	1/2/2024 5:05 PM
Details	340B ID	Insert	New Registration			1/2/2024 5:05 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/2/2024 5:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/2/2024 5:05 PM
Details	Medicare Provider Number	Insert	New Registration			1/2/2024 5:05 PM
Details	Entity Name	Insert	New Registration		Community Health Centers Of Pinellas, Inc.	1/2/2024 5:05 PM
Details	NOFO Number	Insert	New Registration			1/2/2024 5:05 PM
Details	Program Code	Insert	New Registration		CH	1/2/2024 5:05 PM
Details	Entity Subname	Insert	New Registration		Evara Health - Milton Park	1/2/2024 5:05 PM
Dates	Participating Approval Date	Insert	New Registration			1/2/2024 5:05 PM
Details	State	Insert	New Registration		Pending	1/2/2024 5:05 PM
Dates	Registration Date	Insert	New Registration		1/2/2024 5:05:38 PM	1/2/2024 5:05 PM
Dates	Signed By Date	Insert	New Registration			1/2/2024 5:05 PM
Dates	Start Date	Insert	New Registration			1/2/2024 5:05 PM
Terminations	Termination Comments	Insert	New Registration			1/2/2024 5:05 PM
Terminations	Termination Date	Insert	New Registration			1/2/2024 5:05 PM
Terminations	Termination Effective Date	Insert	New Registration			1/2/2024 5:05 PM
Terminations	Termination Reason	Insert	New Registration			1/2/2024 5:05 PM

340B Drug Pricing Program Database