340B Drug Pricing Program Database


FQHCLA247L HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O) (Active) - information as of 5/13/2025 10:54:01 PM

Main Details
HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O)
Sacramento Community Clinic - Ntsa Iab
Health Center Program Look-Alike
BPS-LAL-035841
FQHCLA247L
LALCS00018


Additional Details
Active
8/12/2024
10/1/2024
8/25/2024
2/11/2025

Contacts

Health and Life Organization, Inc.
JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236

Health and Life Organization, Inc.
Melissa Yang, 340B Compliance Specialist
(916) 642-1867 Ext: 4011

Addresses

7215 55th Street
Sacramento, CA 95823-2601

Health and Life Organization, Inc. (H.A.L.O.) dba Sacramento Community Clinic
3030 Explorer Drive
Sacramento, CA 95827


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
FQHCLA247TerminatedBPS-LAL-009959HEALTH AND LIFE ORGANIZATION INC.SACRAMENTO COMMUNITY CLINIC - SOUTHGATE7275 E. SOUTHGATE DRIVESUITE 204SACRAMENTOCA
FQHCLA247AActiveBPS-LAL-009960HEALTH AND LIFE ORGANIZATION INC.SACRAMENTO COMMUNITY CLINIC - DEL PASO2200 DEL PASO BLVD SACRAMENTOCA
FQHCLA247BActiveBPS-LAL-010356HEALTH AND LIFE ORGANIZATION INC.Sacramento Community Clinic-Assembly Court5524 Assembly Ct. SacramentoCA
FQHCLA247CActiveBPS-LAL-012294HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)Sacramento Community Clinic - Del Paso Dental2138 Del Paso Blvd SacramentoCA
FQHCLA247DActiveBPS-LAL-016808HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)Sacramento Community Clinic - Explorer Drive3030 Explorer Drive SacramentoCA
FQHCLA247ETerminatedBPS-LAL-019620HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)Sacramento Community Clinics- B. Teri Burns Clinic3301 Fong Ranch Road SacramentoCA
FQHCLA247FActiveBPS-LAL-027786HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)Sacramento Community Clinic - Southgate Dental7275 E Southgate Dr Ste 106 SacramentoCA
FQHCLA247GActiveBPS-LAL-030238HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)Sacramento Community Clinic - Watt4986 Watt Ave Ste D North HighlandsCA
FQHCLA247HActiveBPS-LAL-030239HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)Sacramento Community Clinic- 55th7215 55th St Ste B SacramentoCA
FQHCLA247JActiveBPS-LAL-034274HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)Sacramento Community Clinic- El Camino965 El Camino Ave SacramentoCA
FQHCLA247KActiveBPS-LAL-035963HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O)Sacramento Community Clinics - Kajsiab7215 55th Street SacramentoCA
FQHCLA247LActiveBPS-LAL-035841HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O)Sacramento Community Clinic - Ntsa Iab7215 55th Street SacramentoCA
FQHCLA247MActiveBPS-LAL-039510HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O)Sacramento Community Clinic - Sunrise2485 Sunrise Blvd STE A Rancho CordovaCA
FQHCLA247NActiveBPS-LAL-039227HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O)Sacramento Community Clinic - Explorer Drive Admin3040 Explorer Dr SacramentoCA
FQHCLA247PActiveBPS-LAL-038647HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O)Sacramento Community Clinic - B Teri Burns3314 Fong Ranch Rd SacramentoCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
FQHCLA247ACARIAHEALTH PHARMACY #14, INC.4151 E COMMERCE WAY # 1041
SACRAMENTOCA95834-967910/01/2019 10/01/2019
FQHCLA247CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2022 10/01/2023
FQHCLA247DCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2024  
FQHCLA247ACAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2024  
FQHCLA247BCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2024  
FQHCLA247CCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2024  
FQHCLA247CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2022 10/01/2023
FQHCLA247DCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2024  
FQHCLA247ACAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2024  
FQHCLA247BCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2024  
FQHCLA247CCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2024  
FQHCLA247CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2022 10/01/2023
FQHCLA247DCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2024  
FQHCLA247ACAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2024  
FQHCLA247BCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2024  
FQHCLA247CCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2024  
FQHCLA247CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2022 10/01/2023
FQHCLA247DCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2024  
FQHCLA247ACAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2024  
FQHCLA247BCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2024  
FQHCLA247CCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2024  
FQHCLA247CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2022 10/01/2023
FQHCLA247DCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2024  
FQHCLA247ACAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2024  
FQHCLA247BCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2024  
FQHCLA247CCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2024  
FQHCLA247CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2022 10/01/2023
FQHCLA247DCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2024  
FQHCLA247ACAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2024  
FQHCLA247BCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2024  
FQHCLA247CCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2024  
FQHCLA247CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2022 10/01/2023
FQHCLA247DCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2024  
FQHCLA247ACAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2024  
FQHCLA247BCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2024  
FQHCLA247CCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2024  
FQHCLA247CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2022 10/01/2023
FQHCLA247DCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2024  
FQHCLA247ACAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2024  
FQHCLA247BCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2024  
FQHCLA247CCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2024  
FQHCLA247CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2022 10/01/2023
FQHCLA247DCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2024  
FQHCLA247ACAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2024  
FQHCLA247BCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2024  
FQHCLA247CCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2024  
FQHCLA247CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2022 10/01/2023
FQHCLA247DCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2024  
FQHCLA247ACAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2024  
FQHCLA247BCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2024  
FQHCLA247CCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2024  
FQHCLA247CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2022 10/01/2023
FQHCLA247DCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2024  
FQHCLA247ACVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2024  
FQHCLA247BCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2024  
FQHCLA247CCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2024  
FQHCLA247GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582001/01/2019 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10005 6401 MACK RD.
SACRAMENTOCA9582301/01/2019 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16857 8101 COSUMNES RIVER BLVD
SACRAMENTOCA9582301/01/2019 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582104/01/2020 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567004/01/2020 10/01/2023
FQHCLA247AGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582104/01/2020  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567004/01/2020  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582104/01/2020  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567004/01/2020  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582104/01/2020  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567004/01/2020  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582104/01/2020  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567004/01/2020  
FQHCLA247GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17516 10881 OLSON DR
RANCHO CORDOVACA9567010/01/2020 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16413 7505 LAGUNA BLVD
ELK GROVECA9575810/01/2020 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 00182 8400 BRADSHAW RD.
ELK GROVECA9562410/01/2020 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17538 6507 4TH AVE
SACRAMENTOCA9581710/01/2020 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16106 1919 FULTON AVE
SACRAMENTOCA9582510/01/2020 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17200 3601 N FREEWAY BLVD
SACRAMENTOCA9583404/01/2022 10/01/2023
FQHCLA247GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #17822 1707 J STREET
SACRAMENTOCA9581107/01/2023 10/01/2023
FQHCLA247DGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #17822 1707 J STREET
SACRAMENTOCA9581104/01/2024 02/27/2024
FQHCLA247DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16857 8101 COSUMNES RIVER BLVD
SACRAMENTOCA9582304/01/2024  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17200 3601 N FREEWAY BLVD
SACRAMENTOCA9583404/01/2024  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16106 1919 FULTON AVE
SACRAMENTOCA9582504/01/2024  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17538 6507 4TH AVE
SACRAMENTOCA9581704/01/2024  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 00182 8400 BRADSHAW RD.
ELK GROVECA9562404/01/2024  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582004/01/2024  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17516 10881 OLSON DR
RANCHO CORDOVACA9567004/01/2024  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10005 6401 MACK RD.
SACRAMENTOCA9582304/01/2024  
FQHCLA247DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16413 7505 LAGUNA BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17200 3601 N FREEWAY BLVD
SACRAMENTOCA9583404/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #17822 1707 J STREET
SACRAMENTOCA9581104/01/2024 02/27/2024
FQHCLA247AGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10005 6401 MACK RD.
SACRAMENTOCA9582304/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582004/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17516 10881 OLSON DR
RANCHO CORDOVACA9567004/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16413 7505 LAGUNA BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16857 8101 COSUMNES RIVER BLVD
SACRAMENTOCA9582304/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 00182 8400 BRADSHAW RD.
ELK GROVECA9562404/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16106 1919 FULTON AVE
SACRAMENTOCA9582504/01/2024  
FQHCLA247AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17538 6507 4TH AVE
SACRAMENTOCA9581704/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16106 1919 FULTON AVE
SACRAMENTOCA9582504/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16413 7505 LAGUNA BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16857 8101 COSUMNES RIVER BLVD
SACRAMENTOCA9582304/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17200 3601 N FREEWAY BLVD
SACRAMENTOCA9583404/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17516 10881 OLSON DR
RANCHO CORDOVACA9567004/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17538 6507 4TH AVE
SACRAMENTOCA9581704/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10005 6401 MACK RD.
SACRAMENTOCA9582304/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #17822 1707 J STREET
SACRAMENTOCA9581104/01/2024 02/27/2024
FQHCLA247BGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582004/01/2024  
FQHCLA247BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 00182 8400 BRADSHAW RD.
ELK GROVECA9562404/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17200 3601 N FREEWAY BLVD
SACRAMENTOCA9583404/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16857 8101 COSUMNES RIVER BLVD
SACRAMENTOCA9582304/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16106 1919 FULTON AVE
SACRAMENTOCA9582504/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17516 10881 OLSON DR
RANCHO CORDOVACA9567004/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17538 6507 4TH AVE
SACRAMENTOCA9581704/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16413 7505 LAGUNA BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10005 6401 MACK RD.
SACRAMENTOCA9582304/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #17822 1707 J STREET
SACRAMENTOCA9581104/01/2024 02/27/2024
FQHCLA247CGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582004/01/2024  
FQHCLA247CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 00182 8400 BRADSHAW RD.
ELK GROVECA9562404/01/2024  
FQHCLA247DGENOA HEALTHCARE LLC6950 65TH ST RM PHARMACY
SACRAMENTOCA9582307/01/2024  
FQHCLA247CGENOA HEALTHCARE LLC6950 65TH ST RM PHARMACY
SACRAMENTOCA9582307/01/2024  
FQHCLA247BGENOA HEALTHCARE LLC6950 65TH ST RM PHARMACY
SACRAMENTOCA9582307/01/2024  
FQHCLA247AGENOA HEALTHCARE LLC6950 65TH ST RM PHARMACY
SACRAMENTOCA9582307/01/2024  
FQHCLA247INNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089610/01/2021 10/01/2023
FQHCLA247DINNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089604/01/2024  
FQHCLA247AINNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089604/01/2024  
FQHCLA247BINNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089604/01/2024  
FQHCLA247CINNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089604/01/2024  
FQHCLA247INNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554210/01/2021 10/01/2023
FQHCLA247DINNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554204/01/2024  
FQHCLA247AINNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554204/01/2024  
FQHCLA247BINNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554204/01/2024  
FQHCLA247CINNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554204/01/2024  
FQHCLA247INNOVA PHARMACY III2400 GLENDALE LN STE A
SACRAMENTOCA95825-243110/01/2021 10/01/2021
FQHCLA247INNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510810/01/2021 10/01/2023
FQHCLA247DINNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510804/01/2024  
FQHCLA247AINNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510804/01/2024  
FQHCLA247BINNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510804/01/2024  
FQHCLA247CINNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510804/01/2024  
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583301/01/2019 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09823 1350 FLORIN ROAD
SACRAMENTOCA9582201/01/2019 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09972 7465 RUSH RIVER DR STE 500
SACRAMENTOCA9583104/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01825 5040 LAGUNA BLVD
ELK GROVECA9575804/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03066 8351 ELK GROVE FLORIN RD
SACRAMENTOCA9582904/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03943 5039 FOLSOM BLVD
SACRAMENTOCA9581904/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 04151 2050 CLUB CENTER DR
SACRAMENTOCA9583504/01/2020 10/01/2023
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09972 7465 RUSH RIVER DR STE 500
SACRAMENTOCA9583104/01/2020  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01825 5040 LAGUNA BLVD
ELK GROVECA9575804/01/2020  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03066 8351 ELK GROVE FLORIN RD
SACRAMENTOCA9582904/01/2020  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03943 5039 FOLSOM BLVD
SACRAMENTOCA9581904/01/2020  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 04151 2050 CLUB CENTER DR
SACRAMENTOCA9583504/01/2020  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09972 7465 RUSH RIVER DR STE 500
SACRAMENTOCA9583104/01/2020  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01825 5040 LAGUNA BLVD
ELK GROVECA9575804/01/2020  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03066 8351 ELK GROVE FLORIN RD
SACRAMENTOCA9582904/01/2020  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03943 5039 FOLSOM BLVD
SACRAMENTOCA9581904/01/2020  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 04151 2050 CLUB CENTER DR
SACRAMENTOCA9583504/01/2020  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09972 7465 RUSH RIVER DR STE 500
SACRAMENTOCA9583104/01/2020  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01825 5040 LAGUNA BLVD
ELK GROVECA9575804/01/2020  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03066 8351 ELK GROVE FLORIN RD
SACRAMENTOCA9582904/01/2020  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03943 5039 FOLSOM BLVD
SACRAMENTOCA9581904/01/2020  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 04151 2050 CLUB CENTER DR
SACRAMENTOCA9583504/01/2020  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09972 7465 RUSH RIVER DR STE 500
SACRAMENTOCA9583104/01/2020  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01825 5040 LAGUNA BLVD
ELK GROVECA9575804/01/2020  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03066 8351 ELK GROVE FLORIN RD
SACRAMENTOCA9582904/01/2020  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03943 5039 FOLSOM BLVD
SACRAMENTOCA9581904/01/2020  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 04151 2050 CLUB CENTER DR
SACRAMENTOCA9583504/01/2020  
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09992 3338 ARDEN WAY
SACRAMENTOCA9582510/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09826 5333 ELKHORN BLVD
SACRAMENTOCA9584210/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03945 1701 K ST
SACRAMENTOCA9581110/01/2020 04/25/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09199 5420 DEWEY DR
FAIR OAKSCA9562810/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457710/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09809 4959 MARCONI AVE
CARMICHAELCA9560810/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09322 2085 FAIR OAKS BLVD
SACRAMENTOCA9582510/01/2020 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09188 869 NEWVILLE RD
ORLANDCA9596304/01/2022 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09904 3667 CASTRO VALLEY BLVD
CASTRO VALLEYCA9454604/01/2022 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09814 8101 GREENBACK LANE
FAIR OAKSCA9562804/01/2022 10/01/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03862 1030 PLEASANT GROVE BLVD
ROSEVILLECA9567804/01/2022 08/08/2023
FQHCLA247LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02124 8585 ELK GROVE BLVD
ELK GROVECA9562404/01/2022 10/01/2023
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09823 1350 FLORIN ROAD
SACRAMENTOCA9582204/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09322 2085 FAIR OAKS BLVD
SACRAMENTOCA9582504/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583304/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09809 4959 MARCONI AVE
CARMICHAELCA9560804/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09826 5333 ELKHORN BLVD
SACRAMENTOCA9584204/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09188 869 NEWVILLE RD
ORLANDCA9596304/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09814 8101 GREENBACK LANE
FAIR OAKSCA9562804/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09199 5420 DEWEY DR
FAIR OAKSCA9562804/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457704/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02124 8585 ELK GROVE BLVD
ELK GROVECA9562404/01/2024  
FQHCLA247DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09904 3667 CASTRO VALLEY BLVD
CASTRO VALLEYCA9454604/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09904 3667 CASTRO VALLEY BLVD
CASTRO VALLEYCA9454604/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09823 1350 FLORIN ROAD
SACRAMENTOCA9582204/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09809 4959 MARCONI AVE
CARMICHAELCA9560804/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09188 869 NEWVILLE RD
ORLANDCA9596304/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09199 5420 DEWEY DR
FAIR OAKSCA9562804/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09814 8101 GREENBACK LANE
FAIR OAKSCA9562804/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583304/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02124 8585 ELK GROVE BLVD
ELK GROVECA9562404/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09826 5333 ELKHORN BLVD
SACRAMENTOCA9584204/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457704/01/2024  
FQHCLA247ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09322 2085 FAIR OAKS BLVD
SACRAMENTOCA9582504/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02124 8585 ELK GROVE BLVD
ELK GROVECA9562404/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583304/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09188 869 NEWVILLE RD
ORLANDCA9596304/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09199 5420 DEWEY DR
FAIR OAKSCA9562804/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09322 2085 FAIR OAKS BLVD
SACRAMENTOCA9582504/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09809 4959 MARCONI AVE
CARMICHAELCA9560804/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09814 8101 GREENBACK LANE
FAIR OAKSCA9562804/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09823 1350 FLORIN ROAD
SACRAMENTOCA9582204/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09826 5333 ELKHORN BLVD
SACRAMENTOCA9584204/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09904 3667 CASTRO VALLEY BLVD
CASTRO VALLEYCA9454604/01/2024  
FQHCLA247BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457704/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02124 8585 ELK GROVE BLVD
ELK GROVECA9562404/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583304/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09188 869 NEWVILLE RD
ORLANDCA9596304/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09199 5420 DEWEY DR
FAIR OAKSCA9562804/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09322 2085 FAIR OAKS BLVD
SACRAMENTOCA9582504/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09809 4959 MARCONI AVE
CARMICHAELCA9560804/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09814 8101 GREENBACK LANE
FAIR OAKSCA9562804/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09823 1350 FLORIN ROAD
SACRAMENTOCA9582204/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09826 5333 ELKHORN BLVD
SACRAMENTOCA9584204/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09904 3667 CASTRO VALLEY BLVD
CASTRO VALLEYCA9454604/01/2024  
FQHCLA247CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457704/01/2024  
FQHCLA247DOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850707/01/2024  
FQHCLA247DOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502907/01/2024  
FQHCLA247COPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502907/01/2024  
FQHCLA247COPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850707/01/2024  
FQHCLA247BOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502907/01/2024  
FQHCLA247BOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850707/01/2024  
FQHCLA247AOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502907/01/2024  
FQHCLA247AOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850707/01/2024  
FQHCLA247DOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2024  
FQHCLA247COPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2024  
FQHCLA247BOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2024  
FQHCLA247AOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2024  
FQHCLA247DOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/01/2024  
FQHCLA247COPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/01/2024  
FQHCLA247BOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/01/2024  
FQHCLA247AOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/01/2024  
FQHCLA247DOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/01/2024  
FQHCLA247COPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/01/2024  
FQHCLA247BOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/01/2024  
FQHCLA247AOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/01/2024  
FQHCLA247DOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/01/2024  
FQHCLA247COPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/01/2024  
FQHCLA247BOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/01/2024  
FQHCLA247AOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/01/2024  
FQHCLA247DOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/01/2024  
FQHCLA247COPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/01/2024  
FQHCLA247BOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/01/2024  
FQHCLA247AOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/01/2024  
FQHCLA247PREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170601/01/2019 10/01/2023
FQHCLA247DPREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170604/01/2024  
FQHCLA247APREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170604/01/2024  
FQHCLA247BPREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170604/01/2024  
FQHCLA247CPREMIER PHARMACY SERVICES410 CLOVERLEAF DR
BALDWIN PARKCA9170604/01/2024  
FQHCLA247PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2022 10/01/2023
FQHCLA247DPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2024  
FQHCLA247APROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2024  
FQHCLA247BPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2024  
FQHCLA247CPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2024  
FQHCLA247PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2022 10/01/2023
FQHCLA247PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2022 10/01/2023
FQHCLA247PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/01/2022 10/01/2023
FQHCLA247DPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2024  
FQHCLA247DPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2024  
FQHCLA247DPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/01/2024  
FQHCLA247APROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2024  
FQHCLA247APROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2024  
FQHCLA247APROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/01/2024  
FQHCLA247BPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2024  
FQHCLA247BPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/01/2024  
FQHCLA247BPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2024  
FQHCLA247CPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2024  
FQHCLA247CPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/01/2024  
FQHCLA247CPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2024  
FQHCLA247THRIFTY PAYLESS INC.RITE AID #6070 2419 DEL PASO BOULEVARD
SACRAMENTOCA9581510/01/2013 05/03/2021
FQHCLA247THRIFTY PAYLESS INC.RITE AID #6077 4020 FLORIN ROAD
SACRAMENTOCA9582310/01/2013 05/03/2021
FQHCLA247THRIFTY PAYLESS INC.RITE AID #6082 7900 FLORIN ROAD SUITE 5
SACRAMENTOCA9582810/01/2013 05/03/2021
FQHCLA247THRIFTY PAYLESS INC.RITE AID #6264 8368 ELK GROVE FLORIN ROAD
SACRAMENTOCA9582907/01/2019 12/11/2019
FQHCLA247THRIFTY PAYLESS INC.RITE AID #6494 9260 ELK GROVE BLVD
ELK GROVECA9562407/01/2019 12/11/2019
FQHCLA247ATHRIFTY PAYLESS INC.RITE AID #6264 8368 ELK GROVE FLORIN ROAD
SACRAMENTOCA9582907/01/2019 08/05/2021
FQHCLA247ATHRIFTY PAYLESS INC.RITE AID #6494 9260 ELK GROVE BLVD
ELK GROVECA9562407/01/2019 08/05/2021
FQHCLA247BTHRIFTY PAYLESS INC.RITE AID #6264 8368 ELK GROVE FLORIN ROAD
SACRAMENTOCA9582907/01/2019 08/05/2021
FQHCLA247BTHRIFTY PAYLESS INC.RITE AID #6494 9260 ELK GROVE BLVD
ELK GROVECA9562407/01/2019 08/05/2021
FQHCLA247DTHRIFTY PAYLESS INC.RITE AID #6264 8368 ELK GROVE FLORIN ROAD
SACRAMENTOCA9582907/01/2019 08/05/2021
FQHCLA247DTHRIFTY PAYLESS INC.RITE AID #6494 9260 ELK GROVE BLVD
ELK GROVECA9562407/01/2019 08/05/2021
FQHCLA247CTHRIFTY PAYLESS INC.RITE AID #6264 8368 ELK GROVE FLORIN ROAD
SACRAMENTOCA9582907/01/2019 08/05/2021
FQHCLA247CTHRIFTY PAYLESS INC.RITE AID #6494 9260 ELK GROVE BLVD
ELK GROVECA9562407/01/2019 08/05/2021
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582410/01/2013 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6083 7860 GERBER ROAD
SACRAMENTOCA9582810/01/2013 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583810/01/2013 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6076 4980 FREEPORT BOULEVARD
SACRAMENTOCA9582207/01/2019 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566007/01/2019 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6084 980 FLORIN ROAD
SACRAMENTOCA9583107/01/2019 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6432 7211 ELK GROVE BOULEVARD
ELK GROVECA9575807/01/2019 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6081 9133 KIEFER BOULEVARD
SACRAMENTOCA9582607/01/2019 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6086 4300 ELVERTA ROAD
ANTELOPECA9584307/01/2019 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6448 2751 DEL PASO ROAD
SACRAMENTOCA9583507/01/2019 10/01/2023
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6505 2211 F STREET
SACRAMENTOCA9581607/01/2019 03/04/2022
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6076 4980 FREEPORT BOULEVARD
SACRAMENTOCA9582207/01/2019  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566007/01/2019  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6084 980 FLORIN ROAD
SACRAMENTOCA9583107/01/2019  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6432 7211 ELK GROVE BOULEVARD
ELK GROVECA9575807/01/2019 04/17/2024
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6081 9133 KIEFER BOULEVARD
SACRAMENTOCA9582607/01/2019  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6086 4300 ELVERTA ROAD
ANTELOPECA9584307/01/2019  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6448 2751 DEL PASO ROAD
SACRAMENTOCA9583507/01/2019  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6505 2211 F STREET
SACRAMENTOCA9581607/01/2019 03/04/2022
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6076 4980 FREEPORT BOULEVARD
SACRAMENTOCA9582207/01/2019  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566007/01/2019  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6084 980 FLORIN ROAD
SACRAMENTOCA9583107/01/2019  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6432 7211 ELK GROVE BOULEVARD
ELK GROVECA9575807/01/2019 04/17/2024
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6081 9133 KIEFER BOULEVARD
SACRAMENTOCA9582607/01/2019  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6086 4300 ELVERTA ROAD
ANTELOPECA9584307/01/2019  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6448 2751 DEL PASO ROAD
SACRAMENTOCA9583507/01/2019  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6505 2211 F STREET
SACRAMENTOCA9581607/01/2019 03/04/2022
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6076 4980 FREEPORT BOULEVARD
SACRAMENTOCA9582207/01/2019  
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566007/01/2019  
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6084 980 FLORIN ROAD
SACRAMENTOCA9583107/01/2019  
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6432 7211 ELK GROVE BOULEVARD
ELK GROVECA9575807/01/2019 04/17/2024
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6081 9133 KIEFER BOULEVARD
SACRAMENTOCA9582607/01/2019  
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6086 4300 ELVERTA ROAD
ANTELOPECA9584307/01/2019  
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6448 2751 DEL PASO ROAD
SACRAMENTOCA9583507/01/2019  
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6505 2211 F STREET
SACRAMENTOCA9581607/01/2019 03/04/2022
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6076 4980 FREEPORT BOULEVARD
SACRAMENTOCA9582207/01/2019  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566007/01/2019  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6084 980 FLORIN ROAD
SACRAMENTOCA9583107/01/2019  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6432 7211 ELK GROVE BOULEVARD
ELK GROVECA9575807/01/2019 04/17/2024
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6081 9133 KIEFER BOULEVARD
SACRAMENTOCA9582607/01/2019  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6086 4300 ELVERTA ROAD
ANTELOPECA9584307/01/2019  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6448 2751 DEL PASO ROAD
SACRAMENTOCA9583507/01/2019  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6505 2211 F STREET
SACRAMENTOCA9581607/01/2019 03/04/2022
FQHCLA247THRIFTY PAYLESS, INC.RITE AID #6788 6420 RIO LINDA BLVD
RIO LINDACA95673-333201/01/2023 10/01/2023
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582404/01/2024 04/23/2024
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6083 7860 GERBER ROAD
SACRAMENTOCA9582804/01/2024  
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583804/01/2024  
FQHCLA247DTHRIFTY PAYLESS, INC.RITE AID #6788 6420 RIO LINDA BLVD
RIO LINDACA95673-333204/01/2024  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6788 6420 RIO LINDA BLVD
RIO LINDACA95673-333204/01/2024  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582404/01/2024 04/23/2024
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583804/01/2024  
FQHCLA247ATHRIFTY PAYLESS, INC.RITE AID #6083 7860 GERBER ROAD
SACRAMENTOCA9582804/01/2024  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582404/01/2024 04/23/2024
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6083 7860 GERBER ROAD
SACRAMENTOCA9582804/01/2024  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583804/01/2024  
FQHCLA247BTHRIFTY PAYLESS, INC.RITE AID #6788 6420 RIO LINDA BLVD
RIO LINDACA95673-333204/01/2024  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582404/01/2024 04/23/2024
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6083 7860 GERBER ROAD
SACRAMENTOCA9582804/01/2024  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583804/01/2024  
FQHCLA247CTHRIFTY PAYLESS, INC.RITE AID #6788 6420 RIO LINDA BLVD
RIO LINDACA95673-333204/01/2024  
FQHCLA247VANGS PHARMACYDBA: VANGS PHARMACY INC. 7260 E SOUTHGATE DR STE E
SACRAMENTOCA9582310/01/2013 10/23/2019
FQHCLA247WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2017 10/01/2023
FQHCLA247DWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2024  
FQHCLA247AWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2024  
FQHCLA247BWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2024  
FQHCLA247CWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2024  
FQHCLA247WAL-MART PHARMACY 10-16978465 ELK GROVE BLVD
ELK GROVECA9575807/01/2017 10/01/2023
FQHCLA247DWAL-MART PHARMACY 10-16978465 ELK GROVE BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247AWAL-MART PHARMACY 10-16978465 ELK GROVE BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247BWAL-MART PHARMACY 10-16978465 ELK GROVE BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247CWAL-MART PHARMACY 10-16978465 ELK GROVE BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247WAL-MART PHARMACY 10-18817901 WATT AVE
ANTELOPECA9584301/01/2019 10/01/2023
FQHCLA247DWAL-MART PHARMACY 10-18817901 WATT AVE
ANTELOPECA9584304/01/2024  
FQHCLA247AWAL-MART PHARMACY 10-18817901 WATT AVE
ANTELOPECA9584304/01/2024  
FQHCLA247BWAL-MART PHARMACY 10-18817901 WATT AVE
ANTELOPECA9584304/01/2024  
FQHCLA247CWAL-MART PHARMACY 10-18817901 WATT AVE
ANTELOPECA9584304/01/2024  
FQHCLA247WAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583307/01/2017 10/01/2023
FQHCLA247DWAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583304/01/2024  
FQHCLA247AWAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583304/01/2024  
FQHCLA247BWAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583304/01/2024  
FQHCLA247CWAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583304/01/2024  
FQHCLA247WAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582307/01/2017 10/01/2023
FQHCLA247DWAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582304/01/2024  
FQHCLA247AWAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582304/01/2024  
FQHCLA247BWAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582304/01/2024  
FQHCLA247CWAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582304/01/2024  
FQHCLA247WAL-MART PHARMACY 10-584810075 BRUCEVILLE RD
ELK GROVECA9575701/01/2019 10/01/2023
FQHCLA247DWAL-MART PHARMACY 10-584810075 BRUCEVILLE RD
ELK GROVECA9575704/01/2024  
FQHCLA247AWAL-MART PHARMACY 10-584810075 BRUCEVILLE RD
ELK GROVECA9575704/01/2024  
FQHCLA247BWAL-MART PHARMACY 10-584810075 BRUCEVILLE RD
ELK GROVECA9575704/01/2024  
FQHCLA247CWAL-MART PHARMACY 10-584810075 BRUCEVILLE RD
ELK GROVECA9575704/01/2024  
FQHCLA247WAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582101/01/2019 10/01/2023
FQHCLA247DWAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582104/01/2024  
FQHCLA247AWAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582104/01/2024  
FQHCLA247BWAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582104/01/2024  
FQHCLA247CWAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582104/01/2024  
FQHCLA247WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2017 10/01/2023
FQHCLA247DWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2024  
FQHCLA247AWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2024  
FQHCLA247BWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2024  
FQHCLA247CWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2024  
FQHCLA247WALGREEN CODBA: WALGREENS #10693 6819 WATT AVE
NORTH HIGHLANDSCA95660-320304/11/2012 10/01/2023
FQHCLA247WALGREEN CODBA: WALGREENS #10114 3521 DEL PASO ROAD
SACRAMENTOCA9583504/11/2012 10/01/2023
FQHCLA247WALGREEN CODBA: WALGREENS #10716 250 FLORIN RD
SACRAMENTOCA9583104/11/2012 10/01/2023
FQHCLA247WALGREEN CODBA: WALGREENS 2370 E MAIN STREET
WOODLANDCA9577604/11/2012 08/03/2015
FQHCLA247DWALGREEN CODBA: WALGREENS #10114 3521 DEL PASO ROAD
SACRAMENTOCA9583504/01/2024  
FQHCLA247DWALGREEN CODBA: WALGREENS #10693 6819 WATT AVE
NORTH HIGHLANDSCA95660-320304/01/2024 02/22/2024
FQHCLA247DWALGREEN CODBA: WALGREENS #10716 250 FLORIN RD
SACRAMENTOCA9583104/01/2024  
FQHCLA247AWALGREEN CODBA: WALGREENS #10114 3521 DEL PASO ROAD
SACRAMENTOCA9583504/01/2024  
FQHCLA247AWALGREEN CODBA: WALGREENS #10716 250 FLORIN RD
SACRAMENTOCA9583104/01/2024  
FQHCLA247AWALGREEN CODBA: WALGREENS #10693 6819 WATT AVE
NORTH HIGHLANDSCA95660-320304/01/2024 02/22/2024
FQHCLA247BWALGREEN CODBA: WALGREENS #10114 3521 DEL PASO ROAD
SACRAMENTOCA9583504/01/2024  
FQHCLA247BWALGREEN CODBA: WALGREENS #10693 6819 WATT AVE
NORTH HIGHLANDSCA95660-320304/01/2024 02/22/2024
FQHCLA247BWALGREEN CODBA: WALGREENS #10716 250 FLORIN RD
SACRAMENTOCA9583104/01/2024  
FQHCLA247CWALGREEN CODBA: WALGREENS #10114 3521 DEL PASO ROAD
SACRAMENTOCA9583504/01/2024  
FQHCLA247CWALGREEN CODBA: WALGREENS #10693 6819 WATT AVE
NORTH HIGHLANDSCA95660-320304/01/2024 02/22/2024
FQHCLA247CWALGREEN CODBA: WALGREENS #10716 250 FLORIN RD
SACRAMENTOCA9583104/01/2024  
FQHCLA247WALGREEN CO.DBA: WALGREENS #11262 840 EL CAMINO AVE
SACRAMENTOCA95815-251304/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 05036 4495 MACK RD
SACRAMENTOCA9582304/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 06706 7155 24TH STREET
SACRAMENTOCA9582204/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 06193 2201 ARDEN WAY
SACRAMENTOCA9582504/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 05374 2900 STOCKTON BLVD
SACRAMENTOCA9581704/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 05499 7299 LAGUNA BLVD
ELK GROVECA9575804/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 04136 1919 FRUITRIDGE RD.
SACRAMENTOCA9582204/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS #12365 8275 BRUCEVILLE RD
SACRAMENTOCA9582304/11/2012 08/21/2019
FQHCLA247WALGREEN CO.DBA: WALGREENS # 06612 8400 ELK GROVE FLORIN ROAD
ELK GROVECA95624-945004/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 06419 9180 FRANKLIN BLVD
ELK GROVECA9575804/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 06142 9200 ELK GROVE FLORIN RD
ELK GROVECA9562404/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 06807 5020 MADISON AVE
SACRAMENTOCA95841-260504/11/2012 11/01/2019
FQHCLA247WALGREEN CO.DBA: WALGREENS # 06613 1401 BROADWAY
SACRAMENTOCA9581804/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 04198 1351 W CAPITOL AVE
WEST SACRAMENTOCA9569104/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS # 05500 4331 ANTELOPE ROAD
SACRAMENTOCA9584304/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS #09532 4050 SUNRISE BLVD
RANCHO CORDOVACA9574204/11/2012 10/01/2023
FQHCLA247WALGREEN CO.DBA: WALGREENS #13597 1420 MEADOWVIEW RD
SACRAMENTOCA9583207/01/2013 11/01/2019
FQHCLA247WALGREEN CO.DBA: WALGREENS #15602 4195 NORWOOD AVE
SACRAMENTOCA9583804/01/2015 11/01/2019
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 05500 4331 ANTELOPE ROAD
SACRAMENTOCA9584304/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 04136 1919 FRUITRIDGE RD.
SACRAMENTOCA9582204/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 06613 1401 BROADWAY
SACRAMENTOCA9581804/01/2024 01/23/2025
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 05036 4495 MACK RD
SACRAMENTOCA9582304/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 06142 9200 ELK GROVE FLORIN RD
ELK GROVECA9562404/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS #09532 4050 SUNRISE BLVD
RANCHO CORDOVACA9574204/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS #11262 840 EL CAMINO AVE
SACRAMENTOCA95815-251304/01/2024 11/08/2023
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 04198 1351 W CAPITOL AVE
WEST SACRAMENTOCA9569104/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 06612 8400 ELK GROVE FLORIN ROAD
ELK GROVECA95624-945004/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 06193 2201 ARDEN WAY
SACRAMENTOCA9582504/01/2024 04/09/2024
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 06706 7155 24TH STREET
SACRAMENTOCA9582204/01/2024 01/29/2025
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 05374 2900 STOCKTON BLVD
SACRAMENTOCA9581704/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 05499 7299 LAGUNA BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247DWALGREEN CO.DBA: WALGREENS # 06419 9180 FRANKLIN BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 06419 9180 FRANKLIN BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 06612 8400 ELK GROVE FLORIN ROAD
ELK GROVECA95624-945004/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 04136 1919 FRUITRIDGE RD.
SACRAMENTOCA9582204/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 05036 4495 MACK RD
SACRAMENTOCA9582304/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 06706 7155 24TH STREET
SACRAMENTOCA9582204/01/2024 01/29/2025
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 05374 2900 STOCKTON BLVD
SACRAMENTOCA9581704/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 06613 1401 BROADWAY
SACRAMENTOCA9581804/01/2024 01/23/2025
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 06193 2201 ARDEN WAY
SACRAMENTOCA9582504/01/2024 04/09/2024
FQHCLA247AWALGREEN CO.DBA: WALGREENS #09532 4050 SUNRISE BLVD
RANCHO CORDOVACA9574204/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 06142 9200 ELK GROVE FLORIN RD
ELK GROVECA9562404/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 05500 4331 ANTELOPE ROAD
SACRAMENTOCA9584304/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 04198 1351 W CAPITOL AVE
WEST SACRAMENTOCA9569104/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS # 05499 7299 LAGUNA BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247AWALGREEN CO.DBA: WALGREENS #11262 840 EL CAMINO AVE
SACRAMENTOCA95815-251304/01/2024 11/08/2023
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 04136 1919 FRUITRIDGE RD.
SACRAMENTOCA9582204/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 04198 1351 W CAPITOL AVE
WEST SACRAMENTOCA9569104/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 05036 4495 MACK RD
SACRAMENTOCA9582304/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 05374 2900 STOCKTON BLVD
SACRAMENTOCA9581704/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 05499 7299 LAGUNA BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 05500 4331 ANTELOPE ROAD
SACRAMENTOCA9584304/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 06142 9200 ELK GROVE FLORIN RD
ELK GROVECA9562404/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 06193 2201 ARDEN WAY
SACRAMENTOCA9582504/01/2024 04/09/2024
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 06419 9180 FRANKLIN BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 06612 8400 ELK GROVE FLORIN ROAD
ELK GROVECA95624-945004/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 06613 1401 BROADWAY
SACRAMENTOCA9581804/01/2024 01/23/2025
FQHCLA247BWALGREEN CO.DBA: WALGREENS # 06706 7155 24TH STREET
SACRAMENTOCA9582204/01/2024 01/29/2025
FQHCLA247BWALGREEN CO.DBA: WALGREENS #09532 4050 SUNRISE BLVD
RANCHO CORDOVACA9574204/01/2024  
FQHCLA247BWALGREEN CO.DBA: WALGREENS #11262 840 EL CAMINO AVE
SACRAMENTOCA95815-251304/01/2024 11/08/2023
FQHCLA247AWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15987 1020 29TH ST STE 140
SACRAMENTOCA9581604/01/2024  
FQHCLA247BWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15987 1020 29TH ST STE 140
SACRAMENTOCA9581604/01/2024  
FQHCLA247DWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15987 1020 29TH ST STE 140
SACRAMENTOCA9581604/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 04136 1919 FRUITRIDGE RD.
SACRAMENTOCA9582204/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 04198 1351 W CAPITOL AVE
WEST SACRAMENTOCA9569104/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 05036 4495 MACK RD
SACRAMENTOCA9582304/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 05374 2900 STOCKTON BLVD
SACRAMENTOCA9581704/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 05499 7299 LAGUNA BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 05500 4331 ANTELOPE ROAD
SACRAMENTOCA9584304/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 06142 9200 ELK GROVE FLORIN RD
ELK GROVECA9562404/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 06193 2201 ARDEN WAY
SACRAMENTOCA9582504/01/2024 04/09/2024
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 06419 9180 FRANKLIN BLVD
ELK GROVECA9575804/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 06612 8400 ELK GROVE FLORIN ROAD
ELK GROVECA95624-945004/01/2024  
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 06613 1401 BROADWAY
SACRAMENTOCA9581804/01/2024 01/23/2025
FQHCLA247CWALGREEN CO.DBA: WALGREENS # 06706 7155 24TH STREET
SACRAMENTOCA9582204/01/2024 01/29/2025
FQHCLA247CWALGREEN CO.DBA: WALGREENS #09532 4050 SUNRISE BLVD
RANCHO CORDOVACA9574204/01/2024  
FQHCLA247CWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15987 1020 29TH ST STE 140
SACRAMENTOCA9581604/01/2024  
FQHCLA247WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528407/01/2013 07/09/2015
FQHCLA247WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904907/01/2013 07/09/2015
FQHCLA247WALMART PHARMACY 10-30818915 GERBER ROAD
SACRAMENTOCA9582901/01/2019 10/01/2023
FQHCLA247DWALMART PHARMACY 10-30818915 GERBER ROAD
SACRAMENTOCA9582904/01/2024  
FQHCLA247AWALMART PHARMACY 10-30818915 GERBER ROAD
SACRAMENTOCA9582904/01/2024  
FQHCLA247BWALMART PHARMACY 10-30818915 GERBER ROAD
SACRAMENTOCA9582904/01/2024  
FQHCLA247CWALMART PHARMACY 10-30818915 GERBER ROAD
SACRAMENTOCA9582904/01/2024  
FQHCLA247WALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566001/01/2019 10/01/2023
FQHCLA247DWALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566004/01/2024  
FQHCLA247AWALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566004/01/2024  
FQHCLA247BWALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566004/01/2024  
FQHCLA247CWALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566004/01/2024  
FQHCLA247WALMART PHARMACY 10-65304420 FLORIN RD
SACRAMENTOCA9582307/01/2017 10/23/2019
FQHCLA247AWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
FQHCLA247BWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
FQHCLA247DWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
FQHCLA247CWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification 2/11/2025 3:20:32 PM2/11/2025 3:20 PM
DetailsStateUpdate ApprovedActive10/1/2024 12:01 AM
ContactsSigned ByInsertNew Registration BLIATOUT, JERRY T. CEO Health and Life Organization, Inc. 9164283788-42368/25/2024 11:36 AM
Details340B IDUpdateNew Registration FQHCLA247L8/25/2024 11:36 AM
DatesParticipating Approval DateUpdateNew Registration 8/25/2024 11:36:27 AM8/25/2024 11:36 AM
DetailsStateUpdateNew RegistrationPendingApproved8/25/2024 11:36 AM
DatesSigned By DateUpdateNew Registration 8/12/2024 2:11:46 PM8/25/2024 11:36 AM
DatesStart DateUpdateNew Registration 10/1/2024 12:00:00 AM8/25/2024 11:36 AM
AddressesMain AddressInsertNew Registration  7215 55th Street Sacramento, CA 95823-26018/12/2024 2:11 PM
AddressesBilling AddressInsertNew Registration Health and Life Organization, Inc. (H.A.L.O.) dba Sacramento Community Clinic 3030 Explorer Drive Sacramento, CA 958278/12/2024 2:11 PM
ContactsAuthorizing OfficialInsertNew Registration BLIATOUT, JERRY T. CEO Health and Life Organization, Inc. 9164283788-42368/12/2024 2:11 PM
ContactsPrimary ContactInsertNew Registration Yang, Melissa 340B Compliance Specialist Health and Life Organization, Inc. 9166421867-40118/12/2024 2:11 PM
DetailsAssistance Received From DateInsertNew Registration  8/12/2024 2:11 PM
DetailsAssistance Received To DateInsertNew Registration  8/12/2024 2:11 PM
DetailsLast Recertification DateInsertNew Registration  8/12/2024 2:11 PM
DetailsGrant NumberInsertNew Registration LALCS000188/12/2024 2:11 PM
Details340B IDInsertNew Registration  8/12/2024 2:11 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  8/12/2024 2:11 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  8/12/2024 2:11 PM
DetailsMedicare Provider NumberInsertNew Registration  8/12/2024 2:11 PM
DetailsEntity NameInsertNew Registration HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O)8/12/2024 2:11 PM
DetailsNOFO NumberInsertNew Registration  8/12/2024 2:11 PM
DetailsProgram CodeInsertNew Registration FQHCLA8/12/2024 2:11 PM
DetailsEntity SubnameInsertNew Registration Sacramento Community Clinic - Ntsa Iab8/12/2024 2:11 PM
DatesParticipating Approval DateInsertNew Registration  8/12/2024 2:11 PM
DetailsStateInsertNew Registration Pending8/12/2024 2:11 PM
DatesRegistration DateInsertNew Registration 8/12/2024 2:11:43 PM8/12/2024 2:11 PM
DatesSigned By DateInsertNew Registration  8/12/2024 2:11 PM
DatesStart DateInsertNew Registration  8/12/2024 2:11 PM
TerminationsTermination CommentsInsertNew Registration  8/12/2024 2:11 PM
TerminationsTermination DateInsertNew Registration  8/12/2024 2:11 PM
TerminationsTermination Effective DateInsertNew Registration  8/12/2024 2:11 PM
TerminationsTermination ReasonInsertNew Registration  8/12/2024 2:11 PM