Covered Entity Details

CH092366D EL DORADO COUNTY COMMUNITY HEALTH CENTER (Approved) - information as of 6/8/2025 11:55:18 PM

Main Details

Name

EL DORADO COUNTY COMMUNITY HEALTH CENTER

Subdivision Name

El Dorado Community Health Center Cameron Park MAT

Type

HRSA-Funded Health Center

Site ID

BPS-H80-030082

340B ID

CH092366D

Grant Number

H80CS06671

Additional Details

Current Program Status

Approved

Registration Date

4/10/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/29/2025

Last Recertification Date

Contacts

Authorizing Official

El Dorado County Community Health Center
Judy Stein, CFO
(530) 748-2327

Primary Contact

El Dorado County Community Health Center
Graham Giles, Director of Clinic Pharmacy Services
(530) 748-2533

Addresses

Street Address

3104 Ponte Morino Dr Ste 100
Cameron Park, CA 95682-8282

Billing Address
Same as Street Address

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
CH0923660	Active	BPS-H80-031575	EL DORADO COUNTY COMMUNITY HEALTH CENTER	EL DORADO COUNTY COMMUNITY HEALTH CENTER	4212 Missouri Flat Road	Placerville	CA
CH092366A	Terminated	BPS-H80-007535	EL DORADO COUNTY COMMUNITY HEALTH CENTER	El Dorado County Community Health Center	4641 Missouri Flat Rd	Placerville	CA
CH092366B	Active	BPS-H80-013097	EL DORADO COUNTY COMMUNITY HEALTH CENTER	Cameron Park Health Center	3104 Ponte Morino Dr STE 110	Cameron Park	CA
CH092366C	Active	BPS-H80-015735	EL DORADO COUNTY COMMUNITY HEALTH CENTER	El Dorado Community Health Center Cameron Park Medical and Dental	3100 Ponte Morino Dr Ste 120	Cameron Park	CA
CH092366D	Approved	BPS-H80-030082	EL DORADO COUNTY COMMUNITY HEALTH CENTER	El Dorado Community Health Center Cameron Park MAT	3104 Ponte Morino Dr Ste 100	Cameron Park	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0923660	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 04950	3301 ZINFANDEL DR.	RANCHO CORDOVA	CA	95670	01/01/2024
CH0923660	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17344	4400 TOWN CENTER BLVD	EL DORADO HILLS	CA	95762	01/01/2024
CH0923660	GARFIELD BEACH CVS, L.L.C.	CVS/PHARMACY # 17787	3968 MISSOURI FLAT RD	PLACERVILLE	CA	95667	01/01/2024	03/05/2024
CH0923660	IMGRX SALUD INC	DBA EL DORADO COMMUNITY PHARMACY	3100 PONTE MORINO DRIVE, SUITE 120	CAMERON PARK	CA	95682	10/01/2016	03/12/2021
CH092366C	IMGRX SALUD INC	DBA EL DORADO COMMUNITY PHARMACY	3100 PONTE MORINO DRIVE, SUITE 120	CAMERON PARK	CA	95682	01/13/2019
CH0923660	IMGRX SALUD, INC. DBA	EL DORADO COMMUNITY PHARMACY	3104 PONTE MORINO DRIVE, SUITE 100	CAMERON PARK	CA	95682	03/12/2021	05/31/2025
CH0923660	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03950	2790 E BIDWELL ST	FOLSOM	CA	95630	01/01/2024
CH0923660	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09184	3964 MISSOURI FLAT RD STE A	PLACERVILLE	CA	95667	01/01/2024
CH0923660	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09233	515 S STATE HIGHWAY 49	JACKSON	CA	95642	01/01/2024
CH0923660	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03009	3500 PALMER DR	CAMERON PARK	CA	95682	01/01/2024
CH0923660	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09199	5420 DEWEY DR	FAIR OAKS	CA	95628	01/01/2024
CH0923660	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09490	6450 PONY EXPRESS TRL	POLLOCK PINES	CA	95726	01/01/2024
CH0923660	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 06793	3020 GREEN VALLEY RD STE B	CAMERON PARK	CA	95682	01/01/2024
CH0923660	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03909	4330 LATROBE RD	EL DORADO HILLS	CA	95762	01/01/2024
CH0923660	ROBINSON'S PHARMACY	359 MAIN ST		PLACERVILLE	CA	95667-5605	09/04/2007
CH0923660	SAFEWAY INC	SAFEWAY PHARMACY #1825	6498 PONY EXPRESS TRAIL	POLLOCK PINES	CA	95726	10/01/2015
CH0923660	SAFEWAY INC	SAFEWAY PHARMACY #2778	12110 INDUSTRY BLVD.	JACKSON	CA	95642	10/01/2015	09/24/2020
CH0923660	SAFEWAY INC	SAFEWAY PHARMACY #1724	3955 MISSOURI FLAT ROAD	PLACERVILLE	CA	95667	10/01/2015	02/02/2025
CH0923660	SAFEWAY INC	SAFEWAY PHARMACY #1618	3380 COACH LANE	CAMERON PARK	CA	95682	10/01/2015
CH0923660	THRIFTY PAYLESS, INC.	RITE AID #6057	1220 BROADWAY	PLACERVILLE	CA	95667	10/01/2020
CH0923660	THRIFTY PAYLESS, INC.	RITE AID #6058	31 FAIR LANE	PLACERVILLE	CA	95667	10/01/2020	01/08/2024
CH0923660	THRIFTY PAYLESS, INC.	RITE AID #6526	3101 GREEN VALLEY ROAD	CAMERON PARK	CA	95682	10/01/2021	04/07/2022
CH0923660	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH0923660	WAL-MART PHARMACY 10-1760	1018 RILEY STREET		FOLSOM	CA	95630	04/01/2017	06/13/2023
CH0923660	WAL-MART PHARMACY 10-2418	4300 MISSOURI FLAT RD		PLACERVILLE	CA	95667	04/01/2017
CH0923660	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH0923660	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH0923660	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Stein, Judy CFO El Dorado County Community Health Center 5307482327	4/29/2025 9:42 AM
Details	340B ID	Update	New Registration		CH092366D	4/29/2025 9:42 AM
Dates	Participating Approval Date	Update	New Registration		4/29/2025 9:42:15 AM	4/29/2025 9:42 AM
Details	State	Update	New Registration	Pending	Approved	4/29/2025 9:42 AM
Dates	Signed By Date	Update	New Registration		4/28/2025 6:14:18 PM	4/29/2025 9:42 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/29/2025 9:42 AM
Contacts	Authorizing Official	Update	New Registration	Stein, Judy Chief Financial Officer El Dorado County Community Health Center 5307482327	Stein, Judy CFO El Dorado County Community Health Center 5307482327	4/13/2025 6:40 PM
Addresses	Main Address	Insert	New Registration		3104 Ponte Morino Dr Ste 100 Cameron Park, CA 95682-8282	4/10/2025 12:11 PM
Contacts	Authorizing Official	Insert	New Registration		Stein, Judy Chief Financial Officer El Dorado County Community Health Center 5307482327	4/10/2025 12:11 PM
Contacts	Primary Contact	Insert	New Registration		Giles, Graham Director of Clinic Pharmacy Services El Dorado County Community Health Center 5307482533	4/10/2025 12:11 PM
Details	Assistance Received From Date	Insert	New Registration			4/10/2025 12:11 PM
Details	Assistance Received To Date	Insert	New Registration			4/10/2025 12:11 PM
Details	Last Recertification Date	Insert	New Registration			4/10/2025 12:11 PM
Details	Grant Number	Insert	New Registration		H80CS06671	4/10/2025 12:11 PM
Details	340B ID	Insert	New Registration			4/10/2025 12:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2025 12:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2025 12:11 PM
Details	Medicare Provider Number	Insert	New Registration			4/10/2025 12:11 PM
Details	Entity Name	Insert	New Registration		EL DORADO COUNTY COMMUNITY HEALTH CENTER	4/10/2025 12:11 PM
Details	NOFO Number	Insert	New Registration			4/10/2025 12:11 PM
Details	Program Code	Insert	New Registration		CH	4/10/2025 12:11 PM
Details	Entity Subname	Insert	New Registration		El Dorado Community Health Center Cameron Park MAT	4/10/2025 12:11 PM
Dates	Participating Approval Date	Insert	New Registration			4/10/2025 12:11 PM
Details	State	Insert	New Registration		Pending	4/10/2025 12:11 PM
Dates	Registration Date	Insert	New Registration		4/10/2025 12:11:22 PM	4/10/2025 12:11 PM
Dates	Signed By Date	Insert	New Registration			4/10/2025 12:11 PM
Dates	Start Date	Insert	New Registration			4/10/2025 12:11 PM
Terminations	Termination Comments	Insert	New Registration			4/10/2025 12:11 PM
Terminations	Termination Date	Insert	New Registration			4/10/2025 12:11 PM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2025 12:11 PM
Terminations	Termination Reason	Insert	New Registration			4/10/2025 12:11 PM

340B Drug Pricing Program Database