Covered Entity Details

CHC28368-05 SOUTHERN CALIFORNIA MEDICAL CENTER, INC. (Active) - information as of 5/3/2025 11:33:21 PM

Main Details

Name

SOUTHERN CALIFORNIA MEDICAL CENTER, INC.

Subdivision Name

Southern California Medical Center - Woodland Hills

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038371

340B ID

CHC28368-05

Grant Number

H80CS28368

Additional Details

Current Program Status

Active

Registration Date

8/13/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/14/2024

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Southern California Medical Center
Sheila Busheri, CEO
(818) 324-3780

Primary Contact

Southern California Medical Center
Abbas Hosseini, System Manager
(818) 421-1035

Addresses

Street Address

20011 Ventura Blvd
Woodland Hills, CA 91364-2573

Billing Address

SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
14550 Haynes St
Van Nuys, CA 91411

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
CHC28368-00	Active	BPS-H80-015108	SOUTHERN CALIFORNIA MEDICAL CENTER, INC.	Southern California Medical Center (EM)	12100 VALLEY BLVD	EL MONTE	CA
CHC28368-01	Active	BPS-H80-017131	SOUTHERN CALIFORNIA MEDICAL CENTER, INC.	Southern California Medical Center (PR)	8825 Whittier Boulevard	Pico Rivera	CA
CHC28368-02	Active	BPS-H80-019224	SOUTHERN CALIFORNIA MEDICAL CENTER, INC.	SCMC Van Nuys	14550 Haynes Street	Van Nuys	CA
CHC28368-03	Active	BPS-H80-030432	Southern California Medical Center, Inc.	SCMC Pomona	502 W Holt Ave	Pomona	CA
CHC28368-04	Active	BPS-H80-031378	Southern California Medical Center, Inc.	SCMC Long Beach	1627 E Anaheim St	Long Beach	CA
CHC28368-05	Active	BPS-H80-038371	SOUTHERN CALIFORNIA MEDICAL CENTER, INC.	Southern California Medical Center - Woodland Hills	20011 Ventura Blvd	Woodland Hills	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC28368-00	986 PHARMACY #8011	GALACTIC HEALTHCARE INC	1203 N AVALON BLVD STE A	WILMINGTON	CA	90744	01/01/2024
CHC28368-00	ALBERTSONS LLC	SAV-ON PHARMACY #0561	298 E LIVE OAK AVE	ARCADIA	CA	91006	10/01/2023
CHC28368-00	ALLIED HEALTH PARTNER INC	DBA ALLIED HEALTH PHARMACY	14659 VICTORY BLVD	VAN NUYS	CA	91411	01/01/2019	10/05/2023
CHC28368-00	BETTER LIFE PHARMACY (NEW LIFE PHARMACY-	JESUS LOVES YOU PHARMACY INC	9420 SLAUSON AVE	PICO RIVERA	CA	90660	01/01/2020	10/05/2023
CHC28368-00	COSMED PHARMACY INC.	986 PHARMACY #8006	6521 VAN NUYS BLVD.	VAN NUYS	CA	91401-1425	07/01/2019
CHC28368-02	DAYLIGHT PHARMACY INC	DBA DAYLIGHT PHARMACY	14841 BURBANK BLVD	SHERMAN OAKS	CA	91411	07/01/2022
CHC28368-00	DAYLIGHT PHARMACY INC	DBA DAYLIGHT PHARMACY	14841 BURBANK BLVD	SHERMAN OAKS	CA	91411	07/01/2022	10/05/2023
CHC28368-00	EL MONTE PHARMACY	3948 N PECK RD STE A1-A2		EL MONTE	CA	91732	07/01/2017
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 04065	858 N. SUNSET AVE.	LA PUENTE	CA	91744	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 04789	10945 VICTORY BOULEVARD	NORTH. HOLLYWOOD	CA	91606	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 04792	15232 SHERMAN WAY	VAN NUYS	CA	91405	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY # 5483	5601 VAN NUYS BLVD.	SHERMAN OAKS	CA	91401	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05499	1954 DURFEE AVE.	SOUTH EL MONTE	CA	91733	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05834	11574 LOWER AZUSA RD	EL MONTE	CA	91732	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08842	426 EAST CHASE AVENUE	EL CAJON	CA	92020	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09639	11940 GARVEY AVENUE	EL MONTE	CA	91732	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09689	950 WEST FOOTHILL BLVD	MONROVIA	CA	91016	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09852	11426 WASHINGTON BLVD.	WHITTIER	CA	90606	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09857	800 W. WHITTIER BLVD.	MONTEBELLO	CA	90640	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17385	950 E 33RD ST	SIGNAL HILL	CA	90755	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08781	1485 S. GAREY AVE.	POMONA	CA	91766	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08867	7915 FLORENCE AVENUE	DOWNEY	CA	90240	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08876	233 EAST WILLOW STREET	LONG BEACH	CA	90806	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09557	1250 E.PACIFIC COAST HIGHWAY	LONG BEACH	CA	90806	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09629	861 NORTH HACIENDA BOULEVARD	LA PUENTE	CA	91744	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09630	6201 SEPULVEDA BLVD.	VAN NUYS	CA	91411	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09645	8225 GARVEY AVENUE	ROSEMEAD	CA	91770	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09673	1550 PUENTE AVENUE	BALDWIN PARK	CA	91706	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09707	14735 VENTURA BLVD.	SHERMAN OAKS	CA	91403	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09708	150 W. WILLOW ST.	POMONA	CA	91768	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09717	13021 VICTORY BLVD.	NORTH HOLLYWOOD	CA	91606	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09730	2141 SOUTH HACIENDA BOULEVARD	HACIENDA HEIGHTS	CA	91745	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16650	5711 SEPULVEDA BLVD	VAN NUYS	CA	91411	01/01/2024
CHC28368-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16762	8800 WHITTIER BLVD	PICO RIVERA	CA	90660	01/01/2024
CHC28368-00	GLOVE WORK INC	DBA: CORBIN PHARMACY	19664 VENTURA BLVD	TARZANA	CA	91356	01/01/2021	10/05/2023
CHC28368-00	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	01/01/2016
CHC28368-00	LPS PHARMACY INC	986 SPECIALTY PHARMACY	1647 N. HACIENDA BLVD.	LA PUENTE	CA	91744	01/01/2024
CHC28368-00	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	07/01/2017	10/05/2023
CHC28368-00	MED-CARE RX PHARMACY	14550 HAYNES ST SUITE #200A		VAN NUYS	CA	91411	07/01/2017	10/05/2023
CHC28368-00	ROYALTY PHARMACY	1902 ROYALTY DR STE 110		POMONA	CA	91767-3036	01/01/2024
CHC28368-00	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	04/01/2016	10/05/2023
CHC28368-00	SANTA MARIA PHARMACY	1224 S BROOKHURST ST		ANAHEIM	CA	92804	07/01/2018
CHC28368-00	SANTA MARIA PHARMACY INC	DBA SANTA MARIA COMMUNITY PHARMACY	11004 VALLEY MALL	EL MONTE	CA	91731	01/01/2016
CHC28368-00	THE VONS COMPANIES INC	VONS PHARMACY #3208	745 WEST NAOMI AVENUE	ARCADIA	CA	91006	10/01/2023
CHC28368-00	WALGREEN CO	DBA: WALGREENS #7575	3643 PECK RD	EL MONTE	CA	91731-3530	07/01/2017
CHC28368-00	WALGREEN CO.	DBA: WALGREENS # 07598	11907 VALLEY BLVD	EL MONTE	CA	91732-3113	07/01/2017	07/01/2024
CHC28368-00	WALGREEN CO.	DBA: WALGREENS # 07263	8900 WASHINGTON BLVD	PICO RIVERA	CA	90660-3765	07/01/2017
CHC28368-00	WALGREEN CO.	DBA: WALGREENS # 05525	7155 VAN NUYS BLVD	VAN NUYS	CA	91405	07/01/2017
CHC28368-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15293	4940 VAN NUYS BLVD STE 104	SHERMAN OAKS	CA	91403	07/01/2017
CHC28368-00	WELLNESS SPECIALTY PHARMACY INC	19944 VENTURA BLVD		WOODLAND HILLS	CA	91364	10/01/2024
CHC28368-00	ZAND PHARMA LLC	DBA GAREY PHARMACY	350 VINTON AVE STE 102	POMONA	CA	91767	07/01/2020	10/05/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/12/2025 1:04:25 PM	2/12/2025 1:04 PM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Busheri, Sheila CEO Southern California Medical Center 8183243780	8/14/2024 8:25 AM
Details	340B ID	Update	New Registration		CHC28368-05	8/14/2024 8:25 AM
Dates	Participating Approval Date	Update	New Registration		8/14/2024 8:25:40 AM	8/14/2024 8:25 AM
Details	State	Update	New Registration	Pending	Approved	8/14/2024 8:25 AM
Dates	Signed By Date	Update	New Registration		8/13/2024 2:46:23 PM	8/14/2024 8:25 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/14/2024 8:25 AM
Addresses	Main Address	Insert	New Registration		20011 Ventura Blvd Woodland Hills, CA 91364-2573	8/13/2024 1:49 PM
Addresses	Billing Address	Insert	New Registration		SOUTHERN CALIFORNIA MEDICAL CENTER, INC. 14550 Haynes St Van Nuys, CA 91411	8/13/2024 1:49 PM
Contacts	Authorizing Official	Insert	New Registration		Busheri, Sheila CEO Southern California Medical Center 8183243780	8/13/2024 1:49 PM
Contacts	Primary Contact	Insert	New Registration		Hosseini, Abbas System Manager Southern California Medical Center 8184211035	8/13/2024 1:49 PM
Details	Assistance Received From Date	Insert	New Registration			8/13/2024 1:49 PM
Details	Assistance Received To Date	Insert	New Registration			8/13/2024 1:49 PM
Details	Last Recertification Date	Insert	New Registration			8/13/2024 1:49 PM
Details	Grant Number	Insert	New Registration		H80CS28368	8/13/2024 1:49 PM
Details	340B ID	Insert	New Registration			8/13/2024 1:49 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			8/13/2024 1:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			8/13/2024 1:49 PM
Details	Medicare Provider Number	Insert	New Registration			8/13/2024 1:49 PM
Details	Entity Name	Insert	New Registration		SOUTHERN CALIFORNIA MEDICAL CENTER, INC.	8/13/2024 1:49 PM
Details	NOFO Number	Insert	New Registration			8/13/2024 1:49 PM
Details	Program Code	Insert	New Registration		CH	8/13/2024 1:49 PM
Details	Entity Subname	Insert	New Registration		Southern California Medical Center - Woodland Hills	8/13/2024 1:49 PM
Dates	Participating Approval Date	Insert	New Registration			8/13/2024 1:49 PM
Details	State	Insert	New Registration		Pending	8/13/2024 1:49 PM
Dates	Registration Date	Insert	New Registration		8/13/2024 1:49:26 PM	8/13/2024 1:49 PM
Dates	Signed By Date	Insert	New Registration			8/13/2024 1:49 PM
Dates	Start Date	Insert	New Registration			8/13/2024 1:49 PM
Terminations	Termination Comments	Insert	New Registration			8/13/2024 1:49 PM
Terminations	Termination Date	Insert	New Registration			8/13/2024 1:49 PM
Terminations	Termination Effective Date	Insert	New Registration			8/13/2024 1:49 PM
Terminations	Termination Reason	Insert	New Registration			8/13/2024 1:49 PM

340B Drug Pricing Program Database