Covered Entity Details

CH09242AF OLE HEALTH (Approved) - information as of 4/24/2025 12:02:35 AM

Main Details

Name

OLE HEALTH

Subdivision Name

CommuniCare+OLE Travis

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039647

340B ID

CH09242AF

Grant Number

H80CS04219

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/3/2025

Last Recertification Date

Contacts

Authorizing Official

OLE Health
Kevin E. Moses, Legal Officer
(707) 254-1774 Ext: 8222

Primary Contact

OLE Health
Antonio Olea, Director of Pharmacy
(619) 756-9987

Addresses

Street Address

1313 Travis Blvd, Ste A
Fairfield, CA 94533-4621

Billing Address

OLE Health
1141 Pear Tree Lane
Suite 100
Napa, CA 94558

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	Address Cont.	City	State
CH092420	Active	BPS-H80-001711	OLE HEALTH	OLE Health - North Napa Campus	1141 PEAR TREE LANE		NAPA	CA
CH09242A	Active	BPS-H80-014340	OLE HEALTH	OLE Health - St. Helena	1222 Pine Street, Suite A		Saint Helena	CA
CH09242AA	Active	BPS-H80-037771	OLE HEALTH	Family Wellness Center - Hope Building	619 Lincoln Ave		Woodland	CA
CH09242AB	Active	BPS-H80-037765	OLE HEALTH	Hansen Family Health Center	215 W Beamer St		Woodland	CA
CH09242AC	Active	BPS-H80-037766	OLE HEALTH	Vida Family Health Center	954 Sacramento Ave		West Sacramento	CA
CH09242AD	Terminated	BPS-H80-037768	OLE HEALTH	Respite Center	Domestic Violence Setting - Address Undisclosed		Undisclosed	CA
CH09242AE	Active	BPS-H80-037759	OLE HEALTH	Family Wellness Center - Courage Building	455 1st St		Woodland	CA
CH09242AF	Approved	BPS-H80-039647	OLE HEALTH	CommuniCare+OLE Travis	1313 Travis Blvd, Ste A		Fairfield	CA
CH09242B	Active	BPS-H80-006619	OLE HEALTH	OLE Health - Calistoga	911 Washington St		Calistoga	CA
CH09242D	Terminated	BPS-H80-004229	OLE HEALTH	OLE Health - Hope Center	1301 4th St		Napa	CA
CH09242E	Terminated	BPS-H80-010257	OLE Health	OLE Health - Trancas Ste 250	1100 Trancas St. STE 250		Napa	CA
CH09242G	Terminated	BPS-H80-018375	OLE HEALTH	OLE Health - County Campus	2751 Napa Valley Corporate Drive	Suite 1100	Napa	CA
CH09242H	Active	BPS-H80-007558	OLE HEALTH	South Napa Shelter	100 Hartle Ct		Napa	CA
CH09242J	Active	BPS-H80-015226	OLE HEALTH	OLE Health - Fairfield	470 CHADBOURNE RD, SUITE A		FAIRFIELD	CA
CH09242K	Active	BPS-H80-024740	OLE Health	East Fairfield	1101 B Gale Wilson Blvd		Fairfield	CA
CH09242L	Active	BPS-H80-027578	OLE Health	OLE Health - South Napa Campus	300 Hartle Court		Napa	CA
CH09242M	Active	BPS-H80-035489	OLE HEALTH	OLE Health Mobile Health Center	2650 Napa Valley Corporate Dr		Napa	CA
CH09242N	Active	BPS-H80-035917	OLE HEALTH	OLE Health American Canyon	3431 Broadway STE A8-A9		American Canyon	CA
CH09242P	Active	BPS-H80-037761	OLE HEALTH	Cache Creek High School	14320 Second Street		YOLO	CA
CH09242Q	Active	BPS-H80-037763	OLE HEALTH	Martin Luther King Jr. High School	635 B St		Davis	CA
CH09242R	Active	BPS-H80-037764	OLE HEALTH	Salud Clinic	500B Jefferson BLVD STE 180		West Sacramento	CA
CH09242S	Active	BPS-H80-037758	OLE HEALTH	Esparto Elementary School	17120 Omega St		Esparto	CA
CH09242T	Active	BPS-H80-037770	OLE HEALTH	Woodland Community College	2300 E Gibson Rd		Woodland	CA
CH09242U	Active	BPS-H80-037762	OLE HEALTH	Riverbank Elementary School	1100 Carrie St		West Sacramento	CA
CH09242V	Active	BPS-H80-037769	OLE HEALTH	Family Wellness Center - Unity Building	453 1st St		Woodland	CA
CH09242W	Active	BPS-H80-037767	OLE HEALTH	DAVIS COMMUNITY CLINIC	2051 John Jones Rd		Davis	CA
CH09242Y	Terminated	BPS-H80-037760	OLE HEALTH	Davis Mental Health Navigation Control	600 A St BLDG		Davis	CA
CH09242Z	Active	BPS-H80-037743	OLE HEALTH	Drew Avenue Administration	1590 Drew Ave STE 210		Davis	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH092420	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	01/01/2025
CH092420	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	01/01/2025
CH092420	AMAZON PHARMACY #008	408 TECHNOLOGY PARKWAY	BUILDING B, STE 101	COLLEGE STATION	TX	77845	01/01/2025
CH092420	AMAZON PHARMACY #009	7469 KINGSPOINTE PKWY STE 400		ORLANDO	FL	32819	01/01/2025
CH092420	AMAZON PHARMACY #010	1331 E 6TH ST		CORONA	CA	92879	01/01/2025
CH092420	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 08826	2350 MIRACLE MILE	BULLHEAD CITY	AZ	86442	07/01/2022
CH092420	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	01/01/2025
CH092420	CAPITOL PHARMACY, INC.	CAPITOL PHARMACY	1250 HARBOR BLVD STE 600	WEST SACRAMENTO	CA	95691	10/01/2023
CH092420	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2022
CH092420	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2022
CH092420	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2022
CH092420	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2022
CH092420	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2022
CH092420	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2022
CH092420	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2022
CH092420	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2022
CH092420	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2022
CH092420	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2022
CH092420	CLINIC PHARMACIES III, INC	DBA CLINIC OLE PHARMACY	1141 PEAR TREE LN STE 250	NAPA	CA	94558-6445	10/01/2015	01/09/2019
CH09242A	CLINIC PHARMACIES III, INC	DBA CLINIC OLE PHARMACY	1141 PEAR TREE LN STE 250	NAPA	CA	94558-6445	01/01/2016	01/09/2019
CH09242B	CLINIC PHARMACIES III, INC	DBA CLINIC OLE PHARMACY	1141 PEAR TREE LN STE 250	NAPA	CA	94558-6445	01/01/2016	01/09/2019
CH09242D	CLINIC PHARMACIES III, INC	DBA CLINIC OLE PHARMACY	1141 PEAR TREE LN STE 250	NAPA	CA	94558-6445	01/01/2016	10/01/2018
CH09242E	CLINIC PHARMACIES III, INC	DBA CLINIC OLE PHARMACY	1141 PEAR TREE LN STE 250	NAPA	CA	94558-6445	01/01/2016	10/01/2019
CH09242G	CLINIC PHARMACIES III, INC	DBA CLINIC OLE PHARMACY	1141 PEAR TREE LN STE 250	NAPA	CA	94558-6445	01/01/2016	10/01/2022
CH09242H	CLINIC PHARMACIES III, INC	DBA CLINIC OLE PHARMACY	1141 PEAR TREE LN STE 250	NAPA	CA	94558-6445	01/01/2016	01/09/2019
CH092420	CLINIC PHARMACIES III, LLC DBA	CLINIC OLE PHARMACY	1141 PEAR TREE LANE, SUITE 250	NAPA	CA	94558	01/10/2019
CH092420	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2021
CH092420	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2021
CH092420	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2022
CH092420	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16274	3000 HARBISON DR	VACAVILLE	CA	95687	07/01/2022
CH092420	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17342	2005 TOWN CENTER PLZ	WEST SACRAMENTO	CA	95691	07/01/2023	01/31/2025
CH092420	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17468	2185 BRONZE STAR DR	WOODLAND	CA	95776	07/01/2023	01/31/2025
CH092420	IC PHARMACY LLC	AMAZON PHARMACY #004	34 35TH STREET STE 4BSW, UNIT 28	BROOKLYN	NY	11232	01/01/2025
CH092420	IMGRX SALUD, INC. DBA	SALUD CLINIC PHARMACY	500B JEFFERSON BOULEVARD, SUITE 181	WEST SACRAMENTO	CA	95605	07/01/2023
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 01804	675 TRANCAS ST	NAPA	CA	94558	04/01/2014
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 07141	291 S. COOMBS ST	NAPA	CA	94559	04/01/2014	04/14/2016
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09214	1558 TRANCAS ST	NAPA	CA	94558	04/01/2014
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 07141	291 S. COOMBS ST	NAPA	CA	94559	04/01/2017
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09371	300 TRAVIS BLVD	FAIRFIELD	CA	94533	04/01/2018
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03075	5059 BUSINESS CENTER DR	FAIRFIELD	CA	94534	07/01/2021
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09712	3340 N TEXAS ST	FAIRFIELD	CA	94533	07/01/2021
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09142	1550 E COVELL BLVD	DAVIS	CA	95616	07/01/2023
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09180	7 W MAIN ST	WOODLAND	CA	95695	07/01/2023
CH092420	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09282	1471 W COVELL BLVD	DAVIS	CA	95616	07/01/2023	01/31/2025
CH092420	LONGS DRUG STORES CALIFORNIA, LLC	D.B.A. CVS DISTRIBUTION CENTER	2400 KEYSTONE PACIFIC PKWY SUITE B	PATTERSON	CA	95363	01/01/2015	01/12/2018
CH092420	LUCKY PHARMACY #730		2355 CALIFORNIA BLVD	NAPA	CA	94559	04/01/2014	09/15/2022
CH092420	LUCKY PHARMACY #731		1312 TRANCAS STREET	NAPA	CA	94558	04/01/2014	09/15/2022
CH092420	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2025
CH092420	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	11/09/2022
CH092420	OPTUM INFUSION SERVICES 401, LLC	4610 NORTHGATE BLVD.	STE. 130	SACRAMENTO	CA	95834-1154	08/17/2022
CH092420	OPTUM INFUSION SERVICES 550, LLC	1819 ASTON AVE STE 104		CARLSBAD	CA	92008	08/17/2022
CH092420	OPTUM INFUSION SERVICES 550, LLC	9045 E PIMA CENTER PKWY STE 1		SCOTTSDALE	AZ	85258-4621	08/17/2022
CH092420	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	08/17/2022
CH092420	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	08/17/2022
CH092420	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	08/17/2022
CH092420	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	08/17/2022
CH092420	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	08/17/2022
CH092420	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	08/17/2022
CH092420	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	08/17/2022
CH092420	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	08/17/2022
CH092420	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	08/17/2022
CH092420	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	08/17/2022
CH092420	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	08/17/2022
CH092420	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	08/17/2022
CH092420	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2025
CH092420	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	01/01/2025
CH092420	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2022
CH092420	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2022
CH092420	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2022
CH092420	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2022
CH092420	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY	445 CASTRO STREET	SAN FRANCISCO	CA	94114	08/30/2022	01/31/2025
CH092420	SAFEWAY INC	SAFEWAY PHARMACY #1883	103 AMERICAN CANYON RD	AMERICAN CANYON	CA	94503	04/01/2014
CH092420	SAFEWAY INC	SAFEWAY PHARMACY #2449	3375 JEFFERSON STREET	NAPA	CA	94558	04/01/2014	04/13/2016
CH092420	SAFEWAY INC	SAFEWAY PHARMACY #2449	3375 JEFFERSON STREET	NAPA	CA	94558	04/01/2018
CH092420	SAFEWAY INC	SAFEWAY PHARMACY #0983	1071 11TH STREET	LAKEPORT	CA	95453	04/01/2023
CH092420	SAFEWAY PHARMACY #0913	1620 CLAY STREET		NAPA	CA	94558	04/01/2014	04/01/2018
CH092420	THRIFTY PAYLESS, INC.	RITE AID #5928	1203 W IMOLA AVE	NAPA	CA	94559-4725	01/01/2020
CH092420	THRIFTY PAYLESS, INC.	RITE AID #6197	2135 COWELL BOULEVARD	DAVIS	CA	95618-6388	10/01/2023	12/10/2023
CH092420	THRIFTY PAYLESS, INC.	RITE AID #6048	655 RUSSELL BOULEVARD	DAVIS	CA	95616	10/01/2023
CH092420	THRIFTY PAYLESS, INC.	RITE AID #6066	295 WEST MAIN STREET	WOODLAND	CA	95695	10/01/2023
CH092420	THRIFTY PAYLESS, INC.	RITE AID #6065	1260 WEST CAPITOL AVENUE	WEST SACRAMENTO	CA	95691	10/01/2023
CH092420	VASCONI DRUGS	1381 MAIN ST		SAINT HELENA	CA	94574	07/01/2014	06/17/2021
CH092420	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017
CH092420	WAL-MART PHARMACY #10-1651	7011 NORTH MAIN STREET		AMERICAN CANYON	CA	94503	07/01/2014
CH092420	WAL-MART PHARMACY 10-1979	15960 DAM ROAD		CLEARLAKE	CA	95422	05/17/2023
CH092420	WAL-MART PHARMACY 10-2048	2701 N TEXAS STREET		FAIRFIELD	CA	94533	10/01/2019	05/08/2021
CH092420	WAL-MART PHARMACY 10-2190	1720 EAST MAIN STREET		WOODLAND	CA	95776	10/01/2023
CH092420	WAL-MART PHARMACY 10-2925	681 LINCOLN AVENUE		NAPA	CA	94558	04/01/2014
CH092420	WAL-MART PHARMACY 10-3652	755 RIVER POINT CT		WEST SACRAMENTO	CA	95691	10/01/2023
CH092420	WAL-MART PHARMACY 10-5136	1131 N BEALE RD		MARYSVILLE	CA	95901	10/01/2023
CH092420	WAL-MART PHARMACY 10-5606	1250 E GIBSON ROAD		WOODLAND	CA	95776	10/01/2023
CH092420	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017
CH092420	WALGREEN CO.	DBA: WALGREENS # 03171	1050 REDWOOD STREET	VALLEJO	CA	94590	01/01/2014	02/25/2025
CH092420	WALGREEN CO.	DBA: WALGREENS #11365	210 AMERICAN CANYON RD.	AMERICAN CANYON	CA	94503	01/01/2014
CH092420	WALGREEN CO.	DBA: WALGREENS #11822	1685 TRANCAS ST.	NAPA	CA	94558	01/01/2014
CH092420	WALGREEN CO.	DBA: WALGREENS #15432	2590 N TEXAS ST	FAIRFIELD	CA	94533	01/01/2017
CH092420	WALGREEN CO.	DBA: WALGREENS # 03297	3093 MARLOW ROAD	SANTA ROSA	CA	95403	04/01/2017
CH092420	WALGREEN CO.	DBA: WALGREENS # 06722	4610 SONOMA HWY	SANTA ROSA	CA	95409-4137	04/01/2017
CH092420	WALGREEN CO.	DBA: WALGREENS # 01940	1955 W TEXAS STREET	FAIRFIELD	CA	94533	10/01/2019	02/28/2022
CH092420	WALGREEN CO.	DBA: WALGREENS # 04107	10 WEST MAIN ST.	WOODLAND	CA	95695	07/01/2023
CH092420	WALGREEN CO.	DBA: WALGREENS # 04198	1351 W CAPITOL AVE	WEST SACRAMENTO	CA	95691	07/01/2023
CH092420	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2014	08/17/2015
CH092420	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	11/09/2022
CH092420	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	11/09/2022
CH092420	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	11/09/2022
CH092420	WALMART PHARMACY 10-2468	901 GOLF COURSE DRIVE		ROHNERT PARK	CA	94928	10/01/2023
CH092420	WALMART PHARMACY 10-3708	350 WALTERS ROAD		SUISUN CITY	CA	94585	10/01/2019
CH092420	WALMART PHARMACY 10-4127	215 CALIFORNIA ST.		WOODLAND	CA	95695	10/01/2023
CH092420	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	05/17/2023
CH092420	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Moses, Kevin E. Legal Officer OLE Health 7072541774-8222	4/3/2025 10:12 AM
Details	340B ID	Update	New Registration		CH09242AF	4/3/2025 10:12 AM
Dates	Participating Approval Date	Update	New Registration		4/3/2025 10:12:46 AM	4/3/2025 10:12 AM
Details	State	Update	New Registration	Pending	Approved	4/3/2025 10:12 AM
Dates	Signed By Date	Update	New Registration		4/2/2025 12:08:13 PM	4/3/2025 10:12 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/3/2025 10:12 AM
Addresses	Main Address	Insert	New Registration		1313 Travis Blvd, Ste A Fairfield, CA 94533-4621	4/2/2025 12:08 PM
Addresses	Billing Address	Insert	New Registration		OLE Health 1141 Pear Tree Lane Suite 100 Napa, CA 94558	4/2/2025 12:08 PM
Contacts	Authorizing Official	Insert	New Registration		Moses, Kevin E. Legal Officer OLE Health 7072541774-8222	4/2/2025 12:08 PM
Contacts	Primary Contact	Insert	New Registration		Olea, Antonio Director of Pharmacy OLE Health 6197569987	4/2/2025 12:08 PM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 12:08 PM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 12:08 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 12:08 PM
Details	Grant Number	Insert	New Registration		H80CS04219	4/2/2025 12:08 PM
Details	340B ID	Insert	New Registration			4/2/2025 12:08 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 12:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 12:08 PM
Details	Medicare Provider Number	Insert	New Registration			4/2/2025 12:08 PM
Details	Entity Name	Insert	New Registration		OLE HEALTH	4/2/2025 12:08 PM
Details	NOFO Number	Insert	New Registration			4/2/2025 12:08 PM
Details	Program Code	Insert	New Registration		CH	4/2/2025 12:08 PM
Details	Entity Subname	Insert	New Registration		CommuniCare+OLE Travis	4/2/2025 12:08 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 12:08 PM
Details	State	Insert	New Registration		Pending	4/2/2025 12:08 PM
Dates	Registration Date	Insert	New Registration		4/2/2025 12:08:13 PM	4/2/2025 12:08 PM
Dates	Signed By Date	Insert	New Registration			4/2/2025 12:08 PM
Dates	Start Date	Insert	New Registration			4/2/2025 12:08 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 12:08 PM
Terminations	Termination Date	Insert	New Registration			4/2/2025 12:08 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 12:08 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 12:08 PM

340B Drug Pricing Program Database