Covered Entity Details

CHC12872-33 WELLSPACE HEALTH (Approved) - information as of 5/16/2025 11:36:45 PM

Main Details

Name

WELLSPACE HEALTH

Subdivision Name

WellSpace Health - North Behavioral Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039811

340B ID

CHC12872-33

Grant Number

H80CS12872

Additional Details

Current Program Status

Approved

Registration Date

4/6/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/6/2025

Last Recertification Date

Contacts

Authorizing Official

WellSpace Health
Alasdair Jonathan Porteus, CEO
(916) 550-5444

Primary Contact

WellSpace Health
Reggie Singh, 340B Primary Contact
(530) 680-8068

Addresses

Street Address

4441 Auburn Blvd, #E
Sacramento, CA 95841-4139

Billing Address

Wellspace Health
1500 Expo Parkway
Sacramento, CA 95815

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
CA		1346765351

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
CHC12872-00	Active	BPS-H80-008360	WellSpace Health	J Street Community Health Center	1820 J Street	Sacramento	CA
CHC12872-01	Active	BPS-H80-008361	WellSpace Health	South Valley Community Health Center	8233 East Stockton Blvd	Sacramento	CA
CHC12872-02	Active	BPS-H80-008362	WellSpace Health	North Highlands Community Health Center	6015 Watt Avenue, Suite 2	North Highlands	CA
CHC12872-03	Terminated	BPS-H80-008363	WellSpace Health	Salvation Army - Interim Care Program	1200 North B Street	Sacramento	CA
CHC12872-04	Terminated	BPS-H80-008364	WellSpace Health	St. Johns Shelter for Women and Children	4410 Power Inn Road	Sacramento	CA
CHC12872-06	Active	BPS-H80-009163	WellSpace Health	Oak Park Community Health Center	3415 Martin Luther King Jr Blvd	Sacramento	CA
CHC12872-07	Active	BPS-H80-010964	WellSpace Health	WellSpace Health at Boulevard Court	5321 Stockton Blvd.	Sacramento	CA
CHC12872-08	Active	BPS-H80-013549	WellSpace Health	South Valley Children's Dental Clinic	8231 E Stockton Blvd., Suite C	Sacramento	CA
CHC12872-09	Active	BPS-H80-013406	WellSpace Health	Rancho Cordova Community Health Center	10423 Old Placerville Road, Suite A	Sacramento	CA
CHC12872-10	Active	BPS-H80-013405	WellSpace Health	Roseville Community Health Center	5 Medical Plaza, Suite 170	Roseville	CA
CHC12872-11	Active	BPS-H80-013934	WellSpace Health	San Juan Community Health Center	5959 Greenback Lane, Suite 500	Citrus Heights	CA
CHC12872-12	Active	BPS-H80-014454	WellSpace Health	WellSpace Health Tom Gagen Community Health Center	631 H ST	SACRAMENTO	CA
CHC12872-13	Active	BPS-H80-009338	WellSpace Health	WellSpace Health - Martin Luther King Jr. Village	3900 47th Ave	Sacramento	CA
CHC12872-14	Terminated	BPS-H80-017979	WELLSPACE HEALTH	WellSpace Health - South Area Pediatric (#16)	3811 Florin Rd, Ste 16 Sacramento, CA 95823-5408	Sacramento	CA
CHC12872-15	Terminated	BPS-H80-017819	WELLSPACE HEALTH	WellSpace Health - South Area Pediatric (#9)	3811 Florin Rd, Ste 9 Sacramento, CA 95823-5408	Sacramento	CA
CHC12872-16	Active	BPS-H80-014474	WELLSPACE HEALTH	WellSpace Health - Health Care for Women Community Health Center	7601 Hospital Drive, Suite 220	Sacramento	CA
CHC12872-17	Active	BPS-H80-018233	WELLSPACE HEALTH	WellSpace Health - Alhambra Community Health Center	2425 Alhambra Boulevard	Sacramento	CA
CHC12872-18	Active	BPS-H80-010070	WellSpace Health	WellSpace Health - North Highlands Community Health Center	6015 Watt Avenue, Suite 3	North Highlands	CA
CHC12872-19	Terminated	BPS-H80-020939	WellSpace Health	WellSpace Health - Amador Community Health Center	11333 Prospect Drive	Jackson	CA
CHC12872-20	Terminated	BPS-H80-021361	WellSpace Health	WellSpace Health	777 12th Street, Suite 250	Sacramento	CA
CHC12872-21	Terminated	BPS-H80-021229	WellSpace Health	WellSpace Health - Professional Health Center for Women	4150 Truxel Road, Suite C	Sacramento	CA
CHC12872-22	Active	BPS-H80-021710	WellSpace Health	WellSpace Health - Arden Arcade Community Health Center	2433 Marconi Ave	Sacramento	CA
CHC12872-23	Active	BPS-H80-021712	WellSpace Health	WellSpace Health - Galt Dental Health Center	216 N. Lincoln	Galt	CA
CHC12872-24	Active	BPS-H80-027660	WellSpace Health	WellSpace Health - Norwood Community Health Center	3946 Norwood Ave	Sacramento	CA
CHC12872-25	Active	BPS-H80-027659	WellSpace Health	WellSpace Health - Del Paso Heights Community Health Center	3441 Marysville Blvd	Sacramento	CA
CHC12872-26	Active	BPS-H80-027658	WellSpace Health	WellSpace Health - Florin Community Health Center	4241 Florin Road	Sacramento	CA
CHC12872-27	Active	BPS-H80-027661	WellSpace Health	WellSpace Health - Sunrise Community Health Center	7777 Sunrise Blvd	Citrus Heights	CA
CHC12872-28	Terminated	BPS-H80-027662	WellSpace Health	WellSpace Health - Folsom Community Health Center	1710 Prairie City Road # 125	Folsom	CA
CHC12872-29	Active	BPS-H80-029854	WellSpace Health	WellSpace Health - Sierra Gardens 2 Community Health Center	151 N Sunrise Ave	Roseville	CA
CHC12872-30	Active	BPS-H80-035201	WellSpace Health	WellSpace Health - Gregory Bunker Community Health Center	4990 Stockton Blvd	Sacramento	CA
CHC12872-31	Active	BPS-H80-035126	WellSpace Health	WellSpace Health - Perinatal Education Center	7501 Hospital Dr STE 204	Sacramento	CA
CHC12872-32	Approved	BPS-H80-038523	WELLSPACE HEALTH	WellSpace Health -- THRIVE Outpatient Program	2435 Marconi Ave	Sacramento	CA
CHC12872-33	Approved	BPS-H80-039811	WELLSPACE HEALTH	WellSpace Health - North Behavioral Health Center	4441 Auburn Blvd, #E	Sacramento	CA
CHC12872-34	Approved	BPS-H80-039810	WELLSPACE HEALTH	WellSpace Health - Women's Health Education Center	7601 Hospital Dr, #104B	Sacramento	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC12872-00	ACARIAHEALTH PHARMACY #11, INC	1311 W SAM HOUSTON PKWY N STE 130		HOUSTON	TX	77043-4015	07/01/2020
CHC12872-00	ACARIAHEALTH PHARMACY #14, INC.	4151 E COMMERCE WAY # 1041		SACRAMENTO	CA	95834-9679	07/01/2020
CHC12872-00	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2025
CHC12872-00	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2025
CHC12872-00	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2025
CHC12872-00	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2025
CHC12872-00	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2025
CHC12872-00	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2025
CHC12872-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2024
CHC12872-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2024
CHC12872-04	DOLPHIN HEALTH PHARMACY	7400 MACARTHUR BLVD	SUITE A	OAKLAND	CA	94605	07/15/2010	04/01/2018
CHC12872-00	DOLPHIN HEALTH PHARMACY	7400 MACARTHUR BLVD	SUITE A	OAKLAND	CA	94605	01/01/2020
CHC12872-00	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2025
CHC12872-00	EVERGREEN PHARMACEUTICAL OF CALIFORNIA,	OMNICARE OF SACRAMENTO	3630 BUSINESS DR. SUITE D	SACRAMENTO	CA	95820	04/01/2024
CHC12872-00	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2025
CHC12872-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2025
CHC12872-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2025
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17516	10881 OLSON DR	RANCHO CORDOVA	CA	95670	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10005	6401 MACK RD.	SACRAMENTO	CA	95823	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #7136	3710 FRANKLIN BLVD	SACRAMENTO	CA	95820	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16413	7505 LAGUNA BLVD	ELK GROVE	CA	95758	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16857	8101 COSUMNES RIVER BLVD	SACRAMENTO	CA	95823	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 04950	3301 ZINFANDEL DR.	RANCHO CORDOVA	CA	95670	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17538	6507 4TH AVE	SACRAMENTO	CA	95817	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16106	1919 FULTON AVE	SACRAMENTO	CA	95825	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY # 5225	2636 MARCONI AVE.	SACRAMENTO	CA	95821	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 00182	8400 BRADSHAW RD.	ELK GROVE	CA	95624	01/01/2020
CHC12872-00	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #17822	1707 J STREET	SACRAMENTO	CA	95811	04/01/2024	02/13/2024
CHC12872-01	L & S PHARMACY, INC	DBA VALLEY PHARMACY OF SACRAMENTO	7600 HOSPITAL DRIVE SUITE A	SACRAMENTO	CA	95823	04/01/2013	04/01/2018
CHC12872-02	L & S PHARMACY, INC	DBA VALLEY PHARMACY OF SACRAMENTO	7600 HOSPITAL DRIVE SUITE A	SACRAMENTO	CA	95823	04/01/2013	04/01/2018
CHC12872-06	L & S PHARMACY, INC	DBA VALLEY PHARMACY OF SACRAMENTO	7600 HOSPITAL DRIVE SUITE A	SACRAMENTO	CA	95823	04/01/2013	04/01/2018
CHC12872-00	L & S PHARMACY, INC	DBA VALLEY PHARMACY OF SACRAMENTO	7600 HOSPITAL DRIVE SUITE A	SACRAMENTO	CA	95823	10/01/2013	04/01/2018
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09814	8101 GREENBACK LANE	FAIR OAKS	CA	95628	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03945	1701 K ST	SACRAMENTO	CA	95811	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09809	4959 MARCONI AVE	CARMICHAEL	CA	95608	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03943	5039 FOLSOM BLVD	SACRAMENTO	CA	95819	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 02290	1587 W EL CAMINO AVE	SACRAMENTO	CA	95833	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09199	5420 DEWEY DR	FAIR OAKS	CA	95628	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09826	5333 ELKHORN BLVD	SACRAMENTO	CA	95842	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09992	3338 ARDEN WAY	SACRAMENTO	CA	95825	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03066	8351 ELK GROVE FLORIN RD	SACRAMENTO	CA	95829	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09233	515 S STATE HIGHWAY 49	JACKSON	CA	95642	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09823	1350 FLORIN ROAD	SACRAMENTO	CA	95822	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 01825	5040 LAGUNA BLVD	ELK GROVE	CA	95758	01/01/2020
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09546	3251 STANFORD RANCH RD	ROCKLIN	CA	95765	04/01/2023
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09322	2085 FAIR OAKS BLVD	SACRAMENTO	CA	95825	04/01/2023
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09958	5090 FOOTHILLS BLVD	ROSEVILLE	CA	95747	04/01/2023
CHC12872-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09487	8861 GREENBACK LN	ORANGEVALE	CA	95662	04/01/2023
CHC12872-01	MED-AID PHARMACY	3100 STOCKTON BLVD.		SACRAMENTO	CA	95820-1417	04/01/2013	04/01/2018
CHC12872-02	MED-AID PHARMACY	3100 STOCKTON BLVD.		SACRAMENTO	CA	95820-1417	04/01/2013	04/01/2018
CHC12872-06	MED-AID PHARMACY	3100 STOCKTON BLVD.		SACRAMENTO	CA	95820-1417	04/01/2013	04/01/2018
CHC12872-00	MED-AID PHARMACY	3100 STOCKTON BLVD.		SACRAMENTO	CA	95820-1417	10/01/2013	05/19/2016
CHC12872-00	SPECIALTY THERAPEUTIC CARE	1311 W SAM HOUSTON PKWY N STE 150		HOUSTON	TX	77043-4015	07/01/2020
CHC12872-01	TIMBERLAKE PHARMACY	TIMBERLAKE PHARMACY, INC.	8120 TIMBERLAKE WAY STE 108	SACRAMENTO	CA	95823-5413	04/01/2013	04/01/2018
CHC12872-02	TIMBERLAKE PHARMACY	TIMBERLAKE PHARMACY, INC.	8120 TIMBERLAKE WAY STE 108	SACRAMENTO	CA	95823-5413	04/01/2013	04/01/2018
CHC12872-06	TIMBERLAKE PHARMACY	TIMBERLAKE PHARMACY, INC.	8120 TIMBERLAKE WAY STE 108	SACRAMENTO	CA	95823-5413	04/01/2013	04/01/2018
CHC12872-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2025
CHC12872-00	WAL-MART PHARMACY 10-2457	10655 FOLSOM BLVD.		RANCHO CORDOVA	CA	95670	07/01/2025
CHC12872-00	WAL-MART PHARMACY 10-3712	7010 AUBURN BLVD		CITRUS HEIGHTS	CA	95621	07/01/2025
CHC12872-00	WAL-MART PHARMACY 10-5192	5821 ANTELOPE ROAD		SACRAMENTO	CA	95842	07/01/2025
CHC12872-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2025
CHC12872-00	WALGREEN CO	DBA: WALGREENS #10693	6819 WATT AVE	NORTH HIGHLANDS	CA	95660-3203	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO	DBA: WALGREENS #10693	6819 WATT AVE	NORTH HIGHLANDS	CA	95660-3203	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO	DBA: WALGREENS #10693	6819 WATT AVE	NORTH HIGHLANDS	CA	95660-3203	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #02170	12120 NEW AIRPORT RD	AUBURN	CA	95603	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 04136	1919 FRUITRIDGE RD.	SACRAMENTO	CA	95822	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 04198	1351 W CAPITOL AVE	WEST SACRAMENTO	CA	95691	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 04414	8900 GREENBACK LANE	ORANGEVALE	CA	95662	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05036	4495 MACK RD	SACRAMENTO	CA	95823	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05152	6144 DEWEY DRIVE	CITRUS HEIGHTS	CA	95621	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05374	2900 STOCKTON BLVD	SACRAMENTO	CA	95817	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05499	7299 LAGUNA BLVD	ELK GROVE	CA	95758	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05500	4331 ANTELOPE ROAD	SACRAMENTO	CA	95843	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05501	3999 FOOTHILLS BLVD	ROSEVILLE	CA	95747	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06036	4051 DOUGLAS BLVD	GRANITE BAY	CA	95746-5901	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06193	2201 ARDEN WAY	SACRAMENTO	CA	95825	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06419	9180 FRANKLIN BLVD	ELK GROVE	CA	95758	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06613	1401 BROADWAY	SACRAMENTO	CA	95818	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06706	7155 24TH STREET	SACRAMENTO	CA	95822	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06807	5020 MADISON AVE	SACRAMENTO	CA	95841-2605	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #11262	840 EL CAMINO AVE	SACRAMENTO	CA	95815-2513	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #12365	8275 BRUCEVILLE RD	SACRAMENTO	CA	95823	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #12525	700 TWELVE BRIDGES DR	LINCOLN	CA	95648	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #13597	1420 MEADOWVIEW RD	SACRAMENTO	CA	95832	04/01/2013	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 04170	4200 ARDEN WAY	SACRAMENTO	CA	95864	01/01/2014	04/01/2018
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #13597	1420 MEADOWVIEW RD	SACRAMENTO	CA	95832	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05374	2900 STOCKTON BLVD	SACRAMENTO	CA	95817	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06036	4051 DOUGLAS BLVD	GRANITE BAY	CA	95746-5901	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06706	7155 24TH STREET	SACRAMENTO	CA	95822	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05152	6144 DEWEY DRIVE	CITRUS HEIGHTS	CA	95621	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 04136	1919 FRUITRIDGE RD.	SACRAMENTO	CA	95822	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06419	9180 FRANKLIN BLVD	ELK GROVE	CA	95758	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06613	1401 BROADWAY	SACRAMENTO	CA	95818	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #12365	8275 BRUCEVILLE RD	SACRAMENTO	CA	95823	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05500	4331 ANTELOPE ROAD	SACRAMENTO	CA	95843	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 04170	4200 ARDEN WAY	SACRAMENTO	CA	95864	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #02170	12120 NEW AIRPORT RD	AUBURN	CA	95603	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05501	3999 FOOTHILLS BLVD	ROSEVILLE	CA	95747	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #12525	700 TWELVE BRIDGES DR	LINCOLN	CA	95648	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06193	2201 ARDEN WAY	SACRAMENTO	CA	95825	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 04414	8900 GREENBACK LANE	ORANGEVALE	CA	95662	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 06807	5020 MADISON AVE	SACRAMENTO	CA	95841-2605	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05499	7299 LAGUNA BLVD	ELK GROVE	CA	95758	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #11262	840 EL CAMINO AVE	SACRAMENTO	CA	95815-2513	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 04198	1351 W CAPITOL AVE	WEST SACRAMENTO	CA	95691	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05036	4495 MACK RD	SACRAMENTO	CA	95823	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 06419	9180 FRANKLIN BLVD	ELK GROVE	CA	95758	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 04414	8900 GREENBACK LANE	ORANGEVALE	CA	95662	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 06613	1401 BROADWAY	SACRAMENTO	CA	95818	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 04198	1351 W CAPITOL AVE	WEST SACRAMENTO	CA	95691	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS #02170	12120 NEW AIRPORT RD	AUBURN	CA	95603	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS #13597	1420 MEADOWVIEW RD	SACRAMENTO	CA	95832	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 06193	2201 ARDEN WAY	SACRAMENTO	CA	95825	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 04136	1919 FRUITRIDGE RD.	SACRAMENTO	CA	95822	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 05500	4331 ANTELOPE ROAD	SACRAMENTO	CA	95843	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 05374	2900 STOCKTON BLVD	SACRAMENTO	CA	95817	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 05499	7299 LAGUNA BLVD	ELK GROVE	CA	95758	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS #12525	700 TWELVE BRIDGES DR	LINCOLN	CA	95648	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 05036	4495 MACK RD	SACRAMENTO	CA	95823	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 05501	3999 FOOTHILLS BLVD	ROSEVILLE	CA	95747	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 06036	4051 DOUGLAS BLVD	GRANITE BAY	CA	95746-5901	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 05152	6144 DEWEY DRIVE	CITRUS HEIGHTS	CA	95621	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 04170	4200 ARDEN WAY	SACRAMENTO	CA	95864	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 06706	7155 24TH STREET	SACRAMENTO	CA	95822	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS #12365	8275 BRUCEVILLE RD	SACRAMENTO	CA	95823	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS # 06807	5020 MADISON AVE	SACRAMENTO	CA	95841-2605	07/01/2018	02/22/2019
CHC12872-20	WALGREEN CO.	DBA: WALGREENS #11262	840 EL CAMINO AVE	SACRAMENTO	CA	95815-2513	07/01/2018	02/22/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS #12528	475 HIGHWAY 49	SUTTER CREEK	CA	95685	07/01/2019
CHC12872-00	WALGREEN CO.	DBA: WALGREENS # 05774	7787 SUNRISE BLVD	CITRUS HEIGHTS	CA	95610	07/01/2019
CHC12872-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2025
CHC12872-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2025
CHC12872-01	WEST COAST PHARMACY	DBA: WEST COAST PHARMACY, INC.	5731 WATT AVENUE	NORTH HIGHLANDS	CA	95660	04/01/2013	04/01/2018
CHC12872-02	WEST COAST PHARMACY	DBA: WEST COAST PHARMACY, INC.	5731 WATT AVENUE	NORTH HIGHLANDS	CA	95660	04/01/2013	04/01/2018
CHC12872-06	WEST COAST PHARMACY	DBA: WEST COAST PHARMACY, INC.	5731 WATT AVENUE	NORTH HIGHLANDS	CA	95660	04/01/2013	04/01/2018
CHC12872-00	WEST COAST PHARMACY	DBA: WEST COAST PHARMACY, INC.	5731 WATT AVENUE	NORTH HIGHLANDS	CA	95660	10/01/2013	11/06/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Porteus, Alasdair Jonathan CEO WellSpace Health 9165505444	5/6/2025 1:42 PM
Details	340B ID	Update	New Registration		CHC12872-33	5/6/2025 1:42 PM
Dates	Participating Approval Date	Update	New Registration		5/6/2025 1:42:06 PM	5/6/2025 1:42 PM
Details	State	Update	New Registration	Pending	Approved	5/6/2025 1:42 PM
Dates	Signed By Date	Update	New Registration		4/13/2025 11:25:49 AM	5/6/2025 1:42 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/6/2025 1:42 PM
Addresses	Main Address	Insert	New Registration		4441 Auburn Blvd, #E Sacramento, CA 95841-4139	4/6/2025 9:21 PM
Addresses	Billing Address	Insert	New Registration		Wellspace Health 1500 Expo Parkway Sacramento, CA 95815	4/6/2025 9:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346765351	4/6/2025 9:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/6/2025 9:21 PM
Contacts	Authorizing Official	Insert	New Registration		Porteus, Alasdair Jonathan CEO WellSpace Health 9165505444	4/6/2025 9:21 PM
Contacts	Primary Contact	Insert	New Registration		Singh, Reggie 340B Primary Contact WellSpace Health 5306808068	4/6/2025 9:21 PM
Details	Assistance Received From Date	Insert	New Registration			4/6/2025 9:21 PM
Details	Assistance Received To Date	Insert	New Registration			4/6/2025 9:21 PM
Details	Last Recertification Date	Insert	New Registration			4/6/2025 9:21 PM
Details	Grant Number	Insert	New Registration		H80CS12872	4/6/2025 9:21 PM
Details	340B ID	Insert	New Registration			4/6/2025 9:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/6/2025 9:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/6/2025 9:21 PM
Details	Medicare Provider Number	Insert	New Registration			4/6/2025 9:21 PM
Details	Entity Name	Insert	New Registration		WELLSPACE HEALTH	4/6/2025 9:21 PM
Details	NOFO Number	Insert	New Registration			4/6/2025 9:21 PM
Details	Program Code	Insert	New Registration		CH	4/6/2025 9:21 PM
Details	Entity Subname	Insert	New Registration		WellSpace Health - North Behavioral Health Center	4/6/2025 9:21 PM
Dates	Participating Approval Date	Insert	New Registration			4/6/2025 9:21 PM
Details	State	Insert	New Registration		Pending	4/6/2025 9:21 PM
Dates	Registration Date	Insert	New Registration		4/6/2025 9:21:24 PM	4/6/2025 9:21 PM
Dates	Signed By Date	Insert	New Registration			4/6/2025 9:21 PM
Dates	Start Date	Insert	New Registration			4/6/2025 9:21 PM
Terminations	Termination Comments	Insert	New Registration			4/6/2025 9:21 PM
Terminations	Termination Date	Insert	New Registration			4/6/2025 9:21 PM
Terminations	Termination Effective Date	Insert	New Registration			4/6/2025 9:21 PM
Terminations	Termination Reason	Insert	New Registration			4/6/2025 9:21 PM

340B Drug Pricing Program Database