Covered Entity Details

CHC10609-07 UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC (Approved) - information as of 5/29/2025 1:55:25 AM

Main Details

Name

UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC

Subdivision Name

UMMA Health Al Shifa Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039792

340B ID

CHC10609-07

Grant Number

H80CS10609

Additional Details

Current Program Status

Approved

Registration Date

4/14/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/6/2025

Last Recertification Date

Contacts

Authorizing Official

UMMA Community Clinic
Adel Syed, CEO
(323) 217-7298

Primary Contact

University Muslim Medical Association Inc
Alfredo Reynoso, Chief Operating Officer
(323) 647-1520

Addresses

Street Address

2334 N Sierra Way
San Bernardino, CA 92405-3546

Billing Address

UMMA Community Clinic
711 W. Florence Ave.
Los Angeles, CA 90044

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

Shipping Address 1

UMMA Community Clinic
711 W. Florence Ave.
Los Angeles, CA 90044

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
CHC10609-00	Active	BPS-H80-007685	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC.	UMMA Community Clinic	711 W.Florence Ave	Los Angeles	CA
CHC10609-01	Active	BPS-H80-013332	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC.	Fremont Wellness Center	7821 S. Avalon Blvd	Los Angeles	CA
CHC10609-02	Active	BPS-H80-034824	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC	UMMA Community Clinic - Vermont (8114 Vermont Ave.)	8114 S Vermont Ave	Los Angeles	CA
CHC10609-03	Active	BPS-H80-038471	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC	Jordan Wellness Center	10110 Juniper St	Los Angeles	CA
CHC10609-04	Active	BPS-H80-039277	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC	UMMA Health Dental Mobile Unit	7821 Avalon Blvd	Los Angeles	CA
CHC10609-05	Active	BPS-H80-039032	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC	UMMA Mobile 2	7821 Avalon Blvd	Los Angeles	CA
CHC10609-06	Active	BPS-H80-039033	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC	UMMA Mobile 1	7821 Avalon Blvd	Los Angeles	CA
CHC10609-07	Approved	BPS-H80-039792	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC	UMMA Health Al Shifa Clinic	2334 N Sierra Way	San Bernardino	CA
CHC10609-08	Approved	BPS-H80-039577	UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC	Locke Wellness Center	316 E 111th St	Los Angeles	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
CHC10609-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2025
CHC10609-00	BRAVO PHARMACY		7316 S. COMPTON AVE	LOS ANGELES	CA	90001-2532	05/15/2012
CHC10609-01	BRAVO PHARMACY		7316 S. COMPTON AVE	LOS ANGELES	CA	90001-2532	04/01/2015
CHC10609-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2025
CHC10609-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2025
CHC10609-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2025
CHC10609-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2025
CHC10609-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2025
CHC10609-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2025
CHC10609-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2025
CHC10609-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2025
CHC10609-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2025
CHC10609-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2025
CHC10609-00	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	01/01/2017
CHC10609-01	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2019
CHC10609-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2025
CHC10609-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08837	222 N. MARKET ST.	INGLEWOOD	CA	90301	01/01/2025
CHC10609-00	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #4019	5837 S. CENTRAL AVE.	LOS ANGELES	CA	90001	01/01/2025
CHC10609-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08853	1645 EAST 103RD STREET	LOS ANGELES	CA	90002	01/01/2025
CHC10609-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08892	5822 SOUTH VERMONT AVENUE	LOS ANGELES	CA	90044	01/01/2025
CHC10609-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08898	7300 S ALAMEDA ST	WALNUT PARK	CA	90255	01/01/2025
CHC10609-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09578	3120 W. IMPERIAL HWY.	INGLEWOOD	CA	90303	01/01/2025
CHC10609-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2025
CHC10609-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2025
CHC10609-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2025
CHC10609-00	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	01/01/2017
CHC10609-01	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Syed, Adel CEO UMMA Community Clinic 3232177298	5/6/2025 1:51 PM
Details	340B ID	Update	New Registration		CHC10609-07	5/6/2025 1:51 PM
Dates	Participating Approval Date	Update	New Registration		5/6/2025 1:51:33 PM	5/6/2025 1:51 PM
Details	State	Update	New Registration	Pending	Approved	5/6/2025 1:51 PM
Dates	Signed By Date	Update	New Registration		4/14/2025 3:11:29 PM	5/6/2025 1:51 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/6/2025 1:51 PM
Addresses	Main Address	Insert	New Registration		2334 N Sierra Way San Bernardino, CA 92405-3546	4/14/2025 2:13 PM
Addresses	Billing Address	Insert	New Registration		UMMA Community Clinic 711 W. Florence Ave. Los Angeles, CA 90044	4/14/2025 2:13 PM
Addresses	Shipping Address	Insert	New Registration		UMMA Community Clinic 711 W. Florence Ave. Los Angeles, CA 90044	4/14/2025 2:13 PM
Contacts	Authorizing Official	Insert	New Registration		Syed, Adel CEO UMMA Community Clinic 3232177298	4/14/2025 2:13 PM
Contacts	Primary Contact	Insert	New Registration		Reynoso, Alfredo Chief Operating Officer University Muslim Medical Association Inc 3236471520	4/14/2025 2:13 PM
Details	Assistance Received From Date	Insert	New Registration			4/14/2025 2:13 PM
Details	Assistance Received To Date	Insert	New Registration			4/14/2025 2:13 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2025 2:13 PM
Details	Grant Number	Insert	New Registration		H80CS10609	4/14/2025 2:13 PM
Details	340B ID	Insert	New Registration			4/14/2025 2:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2025 2:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2025 2:13 PM
Details	Medicare Provider Number	Insert	New Registration			4/14/2025 2:13 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC	4/14/2025 2:13 PM
Details	NOFO Number	Insert	New Registration			4/14/2025 2:13 PM
Details	Program Code	Insert	New Registration		CH	4/14/2025 2:13 PM
Details	Entity Subname	Insert	New Registration		UMMA Health Al Shifa Clinic	4/14/2025 2:13 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2025 2:13 PM
Details	State	Insert	New Registration		Pending	4/14/2025 2:13 PM
Dates	Registration Date	Insert	New Registration		4/14/2025 2:13:42 PM	4/14/2025 2:13 PM
Dates	Signed By Date	Insert	New Registration			4/14/2025 2:13 PM
Dates	Start Date	Insert	New Registration			4/14/2025 2:13 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2025 2:13 PM
Terminations	Termination Date	Insert	New Registration			4/14/2025 2:13 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2025 2:13 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2025 2:13 PM

340B Drug Pricing Program Database