340B Drug Pricing Program Database


CH09047A GOLDEN VALLEY HEALTH CENTER (Active) - information as of 4/29/2025 2:51:29 AM

Main Details
GOLDEN VALLEY HEALTH CENTER
GVHC - West Modesto
HRSA-Funded Health Center
BPS-H80-004226
CH09047A
H80CS00742


Additional Details
Active
7/1/1995
7/1/1995
12/14/2003
2/10/2025

Contacts

Golden Valley Health Centers
Gurjeet Sandhu, Vice President and Chief Financial Officer
(209) 384-6516

Golden Valley Health Center
Peter Nabil Tawfik, Senior Director of Pharmacy
(209) 628-7348

Addresses

1114 6th St
Modesto, CA 95354-2203

GOLDEN VALLEY HEALTH CENTER ADMIN OFFICE
737 WEST CHILDS
MERCED, CA 95341


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
Shipping Addresses

GVHC Pharmacy
1114 6th St,
Modesto, CA 95354
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailRODERICK PHARMACY GROUP INCDBA GOLDEN VALLEY PHARMACY 1114 6TH STREET
MODESTOCA9535408/01/200208/01/2002 09/10/201610/17/2016
Contract DetailWALGREEN CO.DBA: WALGREENS # 04331 401 PARADISE RD UNIT 3
MODESTOCA9535110/16/202301/01/2024  01/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH090470ActiveBPS-H80-005643GOLDEN VALLEY HEALTH CENTERSGVHC - MERCED SUITES847 W. CHILDS AVE MERCEDCA
CH09047AActiveBPS-H80-004226GOLDEN VALLEY HEALTH CENTERGVHC - West Modesto1114 6th St ModestoCA
CH09047AAActiveBPS-H80-018263GOLDEN VALLEY HEALTH CENTERSGVHC - Empire198 N. G Street EmpireCA
CH09047ABActiveBPS-H80-018262GOLDEN VALLEY HEALTH CENTERSGVHC - Hanshaw Dental1717 Las Vegas Street, Suite A ModestoCA
CH09047ACActiveBPS-H80-017811GOLDEN VALLEY HEALTH CENTERSGVHC - CERES EAST1920 MEMORIAL DR CERESCA
CH09047ADActiveBPS-H80-019526GOLDEN VALLEY HEALTH CENTERSGVHC - MANTECA250 Northgate Drive MantecaCA
CH09047AEActiveBPS-H80-021563Golden Valley Health CentersGVHC - TURLOCK MONTE VISTA2240 W Monte Vista Ave TurlockCA
CH09047AFActiveBPS-H80-021564Golden Valley Health CentersGVHC - TURLOCK PEDIATRIC HEALTH CENTER 1199 Suite 31199 Delbon Ave Ste 3 TurlockCA
CH09047AGActiveBPS-H80-021842Golden Valley Health CentersGVHC - TURLOCK PEDIATRIC HEALTH CENTER 11001100 Delbon Ave TurlockCA
CH09047AHActiveBPS-H80-021843Golden Valley Health CentersGVHC - TURLOCK PEDIATRIC HEALTH CENTER 11201120 Delbon Ave TurlockCA
CH09047AJActiveBPS-H80-021840Golden Valley Health CentersGVHC - TURLOCK PEDIATRIC HEALTH CENTER 1199 Suite 21199 Delbon Ave Ste 2 TurlockCA
CH09047AKActiveBPS-H80-021841Golden Valley Health CentersGVHC - TURLOCK PEDIATRIC HEALTH CENTER 1199 Suite 51199 Delbon Ave Ste 5 TurlockCA
CH09047ALActiveBPS-H80-027744Golden Valley Health CentersGVHC - Modesto Mission Health Center209 Kerr Ave ModestoCA
CH09047AMActiveBPS-H80-027683Golden Valley Health CentersGVHC – Manteca Northgate West302 Northgate Dr MantecaCA
CH09047ANActiveBPS-H80-028076Golden Valley Health CentersGVHC - Merced Northview3940 Sandpiper Avenue MercedCA
CH09047APActiveBPS-H80-030070Golden Valley Health CentersGVHC - Ceres Whitmore Avenue3109 East Whitmore Avenue CeresCA
CH09047AQTerminatedBPS-H80-029860Golden Valley Health CentersGVHC Mobile Unit - Hanshaw1717 LAS VEGAS ST MODESTOCA
CH09047ARActiveBPS-H80-029460Golden Valley Health CentersGVHC - Modesto Tully Road1801 Tully Rd Ste F ModestoCA
CH09047ASTerminatedBPS-H80-029859Golden Valley Health CentersGVHC Mobile Unit - Northview3940 Sandpiper Avenue MercedCA
CH09047ATActiveBPS-H80-030930Golden Valley Health CentersCentral Valley PACE2401 E Orangeburg Ave Ste 330 ModestoCA
CH09047AUActiveBPS-H80-032188Golden Valley Health CentersGVHC - McHenry Suite 5601524 Mchenry Ave Ste 560 ModestoCA
CH09047AVActiveBPS-H80-032187Golden Valley Health CentersGVHC - McHenry Suite 5701524 Mchenry Ave Ste 570 ModestoCA
CH09047AWActiveBPS-H80-032190Golden Valley Health CentersGVHC - McHenry Suite 5651524 Mchenry Ave Ste 565 ModestoCA
CH09047AXActiveBPS-H80-032189Golden Valley Health CentersGVHC - McHenry Suite 5351524 Mchenry Ave Ste 535 ModestoCA
CH09047AYActiveBPS-H80-032192Golden Valley Health CentersGVHC - McHenry Suite 5501524 Mchenry Ave Ste 550 ModestoCA
CH09047AZActiveBPS-H80-034380GOLDEN VALLEY HEALTH CENTERS INCGVHC - Modesto Coolidge208 W Coolidge Ave ModestoCA
CH09047BActiveBPS-H80-004639GOLDEN VALLEY HEALTH CENTERGVHC - Merced Women's Clinic797 WEST CHILDS AVENUE MERCEDCA
CH09047BAActiveBPS-H80-038615GOLDEN VALLEY HEALTH CENTERSGVHC - McHenry Suite 3301524 McHenry Ave, Ste 330 ModestoCA
CH09047BBActiveBPS-H80-038687GOLDEN VALLEY HEALTH CENTERSGolden Valley Health Centers - Modesto Paradise Suite E103401 Paradise Rd. STE E103 ModestoCA
CH09047BCActiveBPS-H80-038670GOLDEN VALLEY HEALTH CENTERSGolden Valley Health Centers - Modesto Paradise Suite E102401 Paradise Rd STE E102 ModestoCA
CH09047BDActiveBPS-H80-038618GOLDEN VALLEY HEALTH CENTERSGVHC - McHenry Suite 3001524 McHenry Ave, Ste 300 ModestoCA
CH09047BEActiveBPS-H80-038872GOLDEN VALLEY HEALTH CENTERSCentral Valley PACE - Merced727 W Childs Ave MercedCA
CH09047BFActiveBPS-H80-038669GOLDEN VALLEY HEALTH CENTERSGVHC - Modesto Paradise E101401 Paradise Rd. STE E101 ModestoCA
CH09047BGActiveBPS-H80-036438GOLDEN VALLEY HEALTH CENTERSGVHC Mobile Unit - Tenaya2101 Tenaya Dr. ModestoCA
CH09047BHActiveBPS-H80-038740GOLDEN VALLEY HEALTH CENTERSGolden Valley Health Centers - Modesto Paradise Suite E104401 Paradise Rd STE E104 ModestoCA
CH09047BJActiveBPS-H80-035382GOLDEN VALLEY HEALTH CENTERSGVHC - Merced Ranchero2752 Ranchero Ln. MercedCA
CH09047CActiveBPS-H80-002002GOLDEN VALLEY HEALTH CENTERGVHC- Los Banos821 TEXAS AVE LOS BANOSCA
CH09047DActiveBPS-H80-002365GOLDEN VALLEY HEALTH CENTERGHVC - Planada9235 WEST BROADWAY PLANADACA
CH09047EActiveBPS-H80-005535GOLDEN VALLEY HEALTH CENTERGVHC - Patterson200 C STREET PATTERSONCA
CH09047FActiveBPS-H80-001671GOLDEN VALLEY HEALTH CENTERGVHC - Dos Palos1405 CALIFORNIA AVENUE DOS PALOSCA
CH09047HActiveBPS-H80-004480GOLDEN VALLEY HEALTH CENTERSGVHC-NEWMAN SITE637 Merced St NewmanCA
CH09047IActiveBPS-H80-000246GOLDEN VALLEY HEALTH CENTERGVHC - Robertson Road1121 HAMMOND ST MODESTOCA
CH09047JTerminatedBPS-H80-002672GOLDEN VALLEY HEALTH CENTERGVHC - Turlock Health Center1141 NORTH OLIVE TURLOCKCA
CH09047KActiveBPS-H80-004207GOLDEN VALLEY HEALTH CENTERGVHC - Hanshaw1717 LAS VEGAS ST MODESTOCA
CH09047LActiveBPS-H80-005428GOLDEN VALLEY HEALTH CENTERSGHVC - MODESTO FLORIDA SUITES1510 Florida Ave ModestoCA
CH09047MActiveBPS-H80-001553GOLDEN VALLEY HEALTH CENTERGVHC - WESTLEY301 HOWARD ROAD WESTLEYCA
CH09047NTerminatedBPS-H80-001538GOLDEN VALLEY HEALTH CENTERSGVHC - NORTH MERCED127 W. EL PORTAL DR. STE B MERCEDCA
CH09047OTerminatedBPS-H80-004876GOLDEN VALLEY HEALTH CENTERGVHC - O'Banion401 LESHER DR. MERCEDCA
CH09047PTerminatedBPS-H80-003455GOLDEN VALLEY HEALTH CENTERSGVHC - MODESTO CORNER OF HOPE1130 6th St ModestoCA
CH09047QTerminatedBPS-H80-005155GOLDEN VALLEY HEALTH CENTERGVHC - Ceres2760 THIRD STREET CERESCA
CH09047RActiveBPS-H80-005192GOLDEN VALLEY HEALTH CENTERGVHC - Le Grand13161 JEFFERSON STREET LEGRANDCA
CH09047SActiveBPS-H80-004387GOLDEN VALLEY HEALTH CENTERGVHC - TENAYA2101 TENAYA DRIVE MODESTOCA
CH09047TActiveBPS-H80-008705GOLDEN VALLEY HEALTH CENTERSGVHC - Riverbank4150 Patterson Road RiverbankCA
CH09047UActiveBPS-H80-007779Golden Valley Health CenterGVHC - Turlock West1200 West Main St. TurlockCA
CH09047VActiveBPS-H80-003145GOLDEN VALLEY HEALTH CENTERSGVHC - LOS BANOS DENTAL725 W I St Los BanosCA
CH09047WTerminatedBPS-H80-014047GOLDEN VALLEY HEALTH CENTERSGVHC-Florida North1540 FLORIDA AVE MODESTOCA
CH09047XActiveBPS-H80-007760GOLDEN VALLEY HEALTH CENTERSGVHC- Modesto Womens and Florida1500 Florida Avenue ModestoCA
CH09047YActiveBPS-H80-014425GOLDEN VALLEY HEALTH CENTERSGVHC - Senior Health and Wellness Center857 W Childs Ave MercedCA
CH09047ZTerminatedBPS-H80-001725GOLDEN VALLEY HEALTH CENTERSGVHC Mobile Unit - Le Grand13161 JEFFERSON ST LE GRANDCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH090470AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291101/01/2019  
CH090470AVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508507/01/2018 06/30/2022
CH090470AVELLA OF SACRAMENTO, INC.2288 AUBURN BLVD #102
SACRAMENTOCA9582107/01/2018 06/30/2022
CH090470AVITA PHARMACY 1019PHARMEDQUEST PHARMACY SERVICES DBA AVITA 857 W CHILDS AVE.
SUITE 101 		MERCEDCA95341-686209/27/2016 03/31/2023
CH090470AVITA PHARMACY 1020PHARMEDQUEST PHARMACY SERVICES DBA AVITA 1114 6TH ST STE A
MODESTOCA95354-220309/27/2016 04/30/2022
CH090470AVITA PHARMACY 1024PHARMEDQUEST PHARMACY SERVICES DBA AVITA 330 E LAMBERT RD STE 120
BREACA92821-410001/01/2022 03/31/2023
CH090470AVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282104/01/2021 03/31/2023
CH090470CAREKINESIS228 STRAWBRIDGE DR STE 200
MOORESTOWNNJ08057-460004/01/2020  
CH090470CAREKINESISSUITE 100 5303 SPINE RD
BOULDERCO80301-330004/01/2020  
CH090470CAREKINESIS401 S CANAL ST
SOUTH SAN FRANCISCOCA94080-460604/01/2020  
CH09047KCAREKINESISSUITE 100 5303 SPINE RD
BOULDERCO80301-330001/01/2024  
CH09047ATCAREKINESIS228 STRAWBRIDGE DR STE 200
MOORESTOWNNJ08057-460001/01/2024  
CH090470CARRANZA PHARMACY(MODESTO) 1739 CROWS LANDING ROAD
SUITE A 		MODESTOCA9535806/21/2012 10/12/2018
CH090470COMMUNITY MEDICAL CENTER PHARMACY610 GATEWAY CENTER WAY STE A - E
SAN DIEGOCA92102-454807/01/2017 03/29/2018
CH090470CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/01/2022  
CH090470CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/01/2022  
CH090470DELIVERCARERX PHARMACY LLCDELIVERCARERX PHARMACY LLC 1471 E BUSINESS CENTER DR
STE 200 		MT PROSPECTIL6005607/01/2017  
CH090470DIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268308/12/2020 06/30/2022
CH090470GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16357 3900 SISK RD
MODESTOCA9535610/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17449 1000 COMMERCE AVE
ATWATERCA9530110/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10360 474 WINTON PKWY
LIVINGSTONCA9533410/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16856 280 SPRECKELS AVE
MANTECACA9533610/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17423 1405 W PACHECO BLVD
LOS BANOSCA9363510/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16082 3405 MCHENRY AVE
MODESTOCA9535010/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 01467 2020 W. BRIGGSMORE AVE.
MODESTOCA9535010/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 02994 3100 GEER RD.
TURLOCKCA9538210/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17412 16858 GOLDEN VALLEY PKWY
LATHROPCA9533010/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 03117 1651 BELLEVUE RD
ATWATERCA9530110/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05403 1175 W. LATHROP RD.
MANTECACA9533610/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17183 2425 CLARIBEL RD
RIVERBANKCA9536710/01/2022  
CH090470GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16647 3000 COUNTRYSIDE DR
TURLOCKCA9538010/01/2022  
CH09047AFGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 03117 1651 BELLEVUE RD
ATWATERCA9530101/01/2024  
CH09047AYGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 02994 3100 GEER RD.
TURLOCKCA9538201/01/2024  
CH09047VGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17423 1405 W PACHECO BLVD
LOS BANOSCA9363501/01/2024  
CH09047AMGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16357 3900 SISK RD
MODESTOCA9535601/01/2024  
CH090470GV PMQ NORTHVIEW PHARMACYPHARMEDQUEST PHARMACY SERVICES 3940 SANDPIPER AVENUE, PHARMACY 181
MERCEDCA9534003/26/2020 03/31/2021
CH090470GVHC PMQ FS PHARMACY1510 FLORIDA AVE STE E
MODESTOCA95350-443707/01/2019 03/31/2021
CH090470LA PHARMACY LLC1048 S GARFIELD AVE STE 101
ALHAMBRACA9180110/23/2020  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07206 1970 YOSEMITE PARKWAY
MERCEDCA9534101/01/2015 10/12/2018
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09623 649 W. OLIVE AVENUE
MERCEDCA9534801/01/2015 10/12/2018
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03944 1520 E F ST
OAKDALECA9536110/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09248 1700 MCHENRY AVE.
MODESTOCA9535010/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03077 801 OAKDALE RD STE F
MODESTOCA9535510/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09171 2900 STANDIFORD AVE
MODESTOCA9535010/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09919 1621 LANDER AVE
TURLOCKCA9538010/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09874 2075 E HATCH ROAD
MODESTOCA9535110/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09233 515 S STATE HIGHWAY 49
JACKSONCA9564210/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09308 901 N CARPENTER RD STE 30
MODESTOCA9535110/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09884 2601 OAKDALE RD STE E
MODESTOCA9535510/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09763 1080 SPERRY AVE
PATTERSONCA9536310/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09866 1190 N MAIN ST
MANTECACA9533610/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03079 2224 PATTERSON RD
RIVERBANKCA9536710/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09623 649 W. OLIVE AVENUE
MERCEDCA9534810/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09949 1201 W MAIN ST STE 14
RIPONCA9536610/01/2022  
CH090470LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07206 1970 YOSEMITE PARKWAY
MERCEDCA9534110/01/2022  
CH09047FLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07206 1970 YOSEMITE PARKWAY
MERCEDCA9534101/01/2024  
CH09047AHLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03077 801 OAKDALE RD STE F
MODESTOCA9535501/01/2024  
CH09047ALLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09763 1080 SPERRY AVE
PATTERSONCA9536301/01/2024  
CH09047ABLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09248 1700 MCHENRY AVE.
MODESTOCA9535001/01/2024  
CH09047AALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09308 901 N CARPENTER RD STE 30
MODESTOCA9535101/01/2024  
CH09047TLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03079 2224 PATTERSON RD
RIVERBANKCA9536701/01/2024  
CH09047RLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09623 649 W. OLIVE AVENUE
MERCEDCA9534801/01/2024  
CH09047QLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09884 2601 OAKDALE RD STE E
MODESTOCA9535501/01/2024 04/01/2025
CH09047AJLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09171 2900 STANDIFORD AVE
MODESTOCA9535001/01/2024  
CH09047ILONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09874 2075 E HATCH ROAD
MODESTOCA9535101/01/2024  
CH090470LONGS DRUG STORES CALIFORNIA, LLCD.B.A. CVS DISTRIBUTION CENTER 2400 KEYSTONE PACIFIC PKWY
SUITE B 		PATTERSONCA9536301/01/2015 10/12/2018
CH090470M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312601/01/2019  
CH090470NEWMAN PIONEER DRUG INC1261 MAIN ST
NEWMANCA9536004/01/2017  
CH09047HNEWMAN PIONEER DRUG INC1261 MAIN ST
NEWMANCA9536009/10/2009  
CH090470OPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191308/12/2020  
CH090470OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850711/07/2022  
CH090470OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713008/12/2020  
CH090470OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140101/01/2023  
CH090470OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/15/2020  
CH090470OPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161807/15/2020 06/30/2022
CH090470OPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660810/23/2020 06/30/2022
CH090470OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983812/29/2020 10/01/2022
CH090470OVERLAKE PHARMACY, LLC4124 148TH AVE NE STE JA
REDMONDWA9805210/23/2020  
CH090470PATTERSON FAMILY PHARMACYPATTERSON FAMILY PHARMACY INC 101 S DEL PUERTO AVE
PATTERSONCA9536304/01/2017 06/30/2024
CH09047EPATTERSON FAMILY PHARMACY  47 SOUTH DEL PUERTO AVENUE
PATTERSONCA9536305/29/2009  
CH09047MPATTERSON FAMILY PHARMACY  47 SOUTH DEL PUERTO AVENUE
PATTERSONCA9536306/03/2009  
CH090470PHARMEDQUEST PHARMACYPHARMEDQUEST PHARMACY SERVICES 451 W. LAMBERT RD STE 209
BREACA92821-928204/01/2021 09/01/2021
CH090470PHARMEDQUEST PHARMACY SERVICES451 W LAMBERT RD STE 208
BREACA92821-392004/01/2021 09/01/2021
CH090470PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310107/01/2018  
CH09047AKPILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310101/01/2024  
CH090470PIONEER DRUGDOS PALOS DRUG INC 1428 CENTER AVE
DOS PALOSCA93620-232007/01/2017 01/31/2022
CH090470PIONEER DRUG #2397 5TH ST
GUSTINECA95322-123604/01/2017 07/06/2017
CH09047ARODERICK PHARMACY GROUP INCDBA GOLDEN VALLEY PHARMACY 1114 6TH STREET
MODESTOCA9535408/01/2002 09/10/2016
CH09047PRODERICK PHARMACY GROUP INCDBA GOLDEN VALLEY PHARMACY 1114 6TH STREET
MODESTOCA9535408/27/2008 10/12/2018
CH090470RODERICK PHARMACY GROUP INC DBADBA:GOLDEN VALLEY PHARMACY 857 W. CHILDS AVE
SUITE 101 		MERCEDCA95341-680508/01/2002 09/10/2016
CH090470ROGERS DRUG STORE402 H ST
MODESTOCA9535107/01/2015 10/31/2016
CH090470SAFEWAY INCSAFEWAY PHARMACY #1661 2001 MCHENRY AVENUE
MODESTOCA9535007/01/2014  
CH09047LSAFEWAY INCSAFEWAY PHARMACY #1661 2001 MCHENRY AVENUE
MODESTOCA9535012/31/2009  
CH09047APSAFEWAY INCSAFEWAY PHARMACY #1661 2001 MCHENRY AVENUE
MODESTOCA9535001/01/2024  
CH090470SAN JOAQUIN DRUG9215 EAST HIGHWAY 140 P.O. BOX 1636
PLANADACA9536501/01/2015 11/30/2024
CH09047DSAN JOAQUIN DRUG9215 EAST HIGHWAY 140 P.O. BOX 1636
PLANADACA9536503/24/2009  
CH09047RSAN JOAQUIN DRUG9215 EAST HIGHWAY 140 P.O. BOX 1636
PLANADACA9536504/17/2009  
CH090470THRIFTY PAYLESS, INC.RITE AID #6003 1830 MITCHELL ROAD
CERESCA9530701/01/2014 01/01/2017
CH090470THRIFTY PAYLESS, INC.RITE AID #6006 1158 WEST MAIN STREET
MERCEDCA9534001/01/2014 01/01/2017
CH090470THRIFTY PAYLESS, INC.RITE AID #6007 3142 G STREET
MERCEDCA9534001/01/2014 01/01/2017
CH090470THRIFTY PAYLESS, INC.RITE AID #6008 1707 MCHENRY AVENUE
MODESTOCA9535001/01/2014 01/01/2017
CH090470THRIFTY PAYLESS, INC.RITE AID #6010 1032 OAKDALE ROAD
MODESTOCA9535501/01/2014 01/01/2017
CH090470THRIFTY PAYLESS, INC.RITE AID #6013 1935 N STREET
NEWMAMCA9536001/01/2014 01/01/2017
CH090470THRIFTY PAYLESS, INC.RITE AID #6019 653 N GOLDEN STATE BLVD
TURLOCKCA95380-395201/01/2014 01/01/2017
CH090470THRIFTY PAYLESS, INC.RITE AID #5855 1317 EAST PACHECO BOULEVARD
LOS BANOSCA9363501/01/2014 01/01/2017
CH090470TRUEPILL3121 DIABLO AVE
HAYWARDCA9454510/23/2020  
CH090470TRUEPILL NY LLC850 3RD AVE STE 404
BROOKLYNNY11232-152310/23/2020  
CH090470WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2017  
CH090470WAL-MART PHARMACY 10-15872225 PLAZA PARKWAY
MODESTOCA9535007/01/2014  
CH09047ARWAL-MART PHARMACY 10-15872225 PLAZA PARKWAY
MODESTOCA9535001/01/2024  
CH090470WAL-MART PHARMACY 10-19632111 FULKERTH RD
TURLOCKCA9538007/01/2015  
CH09047AEWAL-MART PHARMACY 10-19632111 FULKERTH RD
TURLOCKCA9538001/01/2024  
CH090470WAL-MART PHARMACY 10-19833960 MITCHELL RD
CERESCA9530707/01/2014  
CH09047ACWAL-MART PHARMACY 10-19833960 MITCHELL RD
CERESCA9530701/01/2024  
CH090470WAL-MART PHARMACY 10-20393055 LOUGHBOROUGH DRIVE
MERCEDCA9534807/01/2014  
CH09047YWAL-MART PHARMACY 10-20393055 LOUGHBOROUGH DRIVE
MERCEDCA9534801/01/2024  
CH090470WAL-MART PHARMACY 10-58431030 SPERRY AVE
PATTERSONCA9536304/01/2018  
CH09047AGWAL-MART PHARMACY 10-58431030 SPERRY AVE
PATTERSONCA9536301/01/2024  
CH090470WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2017  
CH090470WALGREEN CO.DBA: WALGREENS # 02865 1101 MCHENRY AVE
MODESTOCA9535001/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 04331 401 PARADISE RD UNIT 3
MODESTOCA9535101/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 02902 2101 E HATCH RD
MODESTOCA9535101/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 03330 1640 R STREET
MERCEDCA9534001/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 02842 840 OAKDALE ROAD
MODESTOCA9535501/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 03030 1591 GEER ROAD
TURLOCKCA9538001/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 05498 3500 COFFEE ROAD
MODESTOCA9535501/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 07313 1700 STANDIFORD AVE STE #4
MODESTOCA9535001/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 04415 3098 G STREET
MERCEDCA9534001/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 06355 4201 DALE ROAD
MODESTOCA9535601/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 06418 1360 E PACHECO BLVD
LOS BANOSCA9363501/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS #09955 995 SPERRY AVE
PATTERSONCA9536301/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS #11705 3019 FLOYD AVE
MODESTOCA9535501/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 06718 2730 SHAFFER ROAD
ATWATERCA9530101/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS #11934 444 W. F ST
OAKDALECA9536101/01/2015  
CH090470WALGREEN CO.DBA: WALGREENS # 10454 1071 N MAIN ST
MANTECACA9533601/01/2020  
CH090470WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16527 1801 N MAIN ST
JACKSONVILLEFL3220610/01/2023  
CH090470WALGREEN CO.DBA: WALGREENS #15986 8298 LANDER AVE
HILMARCA9532410/01/2023  
CH090470WALGREEN CO.DBA: WALGREENS # 09716 102 N JACK TONE RD
RIPONCA95366-951410/01/2023  
CH09047BWALGREEN CO.DBA: WALGREENS # 04415 3098 G STREET
MERCEDCA9534001/01/2024  
CH09047AUWALGREEN CO.DBA: WALGREENS # 02842 840 OAKDALE ROAD
MODESTOCA9535501/01/2024  
CH09047AVWALGREEN CO.DBA: WALGREENS # 06355 4201 DALE ROAD
MODESTOCA9535601/01/2024  
CH09047CWALGREEN CO.DBA: WALGREENS # 06418 1360 E PACHECO BLVD
LOS BANOSCA9363501/01/2024  
CH09047LWALGREEN CO.DBA: WALGREENS # 05498 3500 COFFEE ROAD
MODESTOCA9535501/01/2024  
CH09047ANWALGREEN CO.DBA: WALGREENS # 06718 2730 SHAFFER ROAD
ATWATERCA9530101/01/2024  
CH09047MWALGREEN CO.DBA: WALGREENS #09955 995 SPERRY AVE
PATTERSONCA9536301/01/2024  
CH09047UWALGREEN CO.DBA: WALGREENS # 03030 1591 GEER ROAD
TURLOCKCA9538001/01/2024  
CH09047ADWALGREEN CO.DBA: WALGREENS # 10454 1071 N MAIN ST
MANTECACA9533601/01/2024  
CH09047AZWALGREEN CO.DBA: WALGREENS # 02865 1101 MCHENRY AVE
MODESTOCA9535001/01/2024  
CH09047AWALGREEN CO.DBA: WALGREENS # 04331 401 PARADISE RD UNIT 3
MODESTOCA9535101/01/2024  
CH09047SWALGREEN CO.DBA: WALGREENS # 02902 2101 E HATCH RD
MODESTOCA9535101/01/2024  
CH09047XWALGREEN CO.DBA: WALGREENS # 07313 1700 STANDIFORD AVE STE #4
MODESTOCA9535001/01/2024  
CH09047AXWALGREEN CO.DBA: WALGREENS #11705 3019 FLOYD AVE
MODESTOCA9535501/01/2024  
CH090470WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904901/01/2015 07/12/2016
CH090470WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528401/01/2015 07/12/2016
CH090470WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/01/2020 12/08/2021
CH090470WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/01/2020  
CH090470WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/01/2020  
CH090470WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/01/2020  
CH090470WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E 		SAN DIEGOCA9210203/30/2018  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressUpdateChange RequestGolden Valley Health Center 1114 6th St, Modesto, CA 95354GVHC Pharmacy 1114 6th St, Modesto, CA 953544/24/2025 12:44 PM
AddressesShipping AddressInsertChange Request Golden Valley Health Center 1114 6th St, Modesto, CA 953544/21/2025 11:16 AM
AddressesMain AddressUpdateChange Request 1114 SIXTH STREET MODESTO, CA 95354 1114 6th St Modesto, CA 95354-22034/21/2025 11:16 AM
DetailsLast Recertification DateUpdateRecertification2/9/2024 6:29:52 PM2/10/2025 7:16:37 PM2/10/2025 7:16 PM
ContactsPrimary ContactUpdatePC Change RequestRamirez, Trisha Director of Finance Golden Valley Health Centers 2093846524Tawfik, Peter Nabil Senior Director of Pharmacy Golden Valley Health Center 20962873489/10/2024 9:38 AM
DetailsLast Recertification DateUpdateRecertification2/7/2023 7:04:12 PM2/9/2024 6:29:52 PM2/9/2024 6:29 PM
DetailsLast Recertification DateUpdateRecertification2/9/2022 5:53:15 PM2/7/2023 7:04:12 PM2/7/2023 7:04 PM
ContactsPrimary ContactUpdateProfile Change RequestRamirez, Trisha Accounting Manager Golden Valley Health Centers 2093846524Ramirez, Trisha Director of Finance Golden Valley Health Centers 20938465241/31/2023 1:37 PM
DetailsLast Recertification DateUpdateRecertification2/16/2021 11:48:58 AM2/9/2022 5:53:15 PM2/9/2022 5:53 PM
Medicaid BillingNPI: StateUpdateRecertification CA2/16/2021 11:48 AM
DetailsLast Recertification DateUpdateRecertification2/7/2020 6:38:22 PM2/16/2021 11:48:58 AM2/16/2021 11:48 AM
DetailsEntity SubnameUpdateRecertificationWest ModestoGVHC - West Modesto2/16/2021 11:48 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestSandhu, Gurjeet Director of Finance Golden Valley Health Centers 2093846516Sandhu, Gurjeet Vice President and Chief Financial Officer Golden Valley Health Centers 20938465162/11/2021 6:51 AM
DetailsLast Recertification DateUpdateRecertification2/19/2019 7:37:46 AM2/7/2020 6:38:22 PM2/7/2020 6:38 PM
DetailsLast Recertification DateUpdateRecertification3/5/2018 5:21:30 PM2/19/2019 7:37:46 AM2/19/2019 7:37 AM
DetailsEntity SubnameUpdateRecertificationMODESTO SITEWest Modesto2/19/2019 7:37 AM
ContactsAuthorizing OfficialUpdateChange RequestWeber, Tony CEO Golden Valley Health Centers 2093855551Sandhu, Gurjeet Director of Finance Golden Valley Health Centers 20938465167/11/2018 11:27 AM
ContactsPrimary ContactUpdateChange RequestSandhu, Gurjeet Director of Finance Golden Valley Health Centers 2093846516Ramirez, Trisha Accounting Manager Golden Valley Health Centers 20938465247/11/2018 11:27 AM
DetailsLast Recertification DateUpdateRecertification1/25/2017 12:00:00 AM3/5/2018 5:21:30 PM3/5/2018 5:21 PM
ContactsAuthorizing OfficialUpdate Weber, Tony CEO 2093855551Weber, Tony CEO Golden Valley Health Centers 209385555111/2/2017 1:57 PM
ContactsPrimary ContactUpdate Sandhu, Gurjeet Director of Finance 2093846516Sandhu, Gurjeet Director of Finance Golden Valley Health Centers 209384651610/5/2017 3:39 PM
ContactsPrimary ContactInsert  Sandhu, Gurjeet Director of Finance 20938465167/17/2017 11:08 AM
ContactsAuthorizing OfficialInsert  Weber, Tony CEO 20938555517/17/2017 11:08 AM
AddressesMain AddressInsert   1114 SIXTH STREET MODESTO, CA 953542/1/2017 1:44 PM
DetailsLast Recertification DateUpdate 3/7/2016 12:00:00 AM1/25/2017 12:00:00 AM2/1/2017 1:44 PM
DetailsLast Recertification DateUpdate 3/4/2015 12:00:00 AM3/7/2016 12:00:00 AM3/8/2016 5:32 PM
AddressesBilling AddressInsert  GOLDEN VALLEY HEALTH CENTER ADMIN OFFICE 737 WEST CHILDS MERCED, CA 953413/4/2015 1:59 PM
DetailsLast Recertification DateUpdate 2/10/2014 12:00:00 AM3/4/2015 12:00:00 AM3/4/2015 1:58 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM2/10/2014 12:00:00 AM2/10/2014 12:37 PM
Medicaid BillingNPI: NumberInsert  14878675033/15/2013 12:04 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/15/2013 12:04 PM
DetailsLast Recertification DateInsert   8/12/2005 11:46 AM
DetailsGrant NumberInsert  H80CS007428/12/2005 11:46 AM
Details340B IDInsert  CH09047A8/12/2005 11:46 AM
DetailsIs Authorizing Official EHB DataInsert   8/12/2005 11:46 AM
DatesLast Date That 340B Drugs PurchasedInsert   8/12/2005 11:46 AM
DetailsMedicare Provider NumberInsert   8/12/2005 11:46 AM
DetailsEntity NameInsert  GOLDEN VALLEY HEALTH CENTER8/12/2005 11:46 AM
DetailsProgram CodeInsert  CH8/12/2005 11:46 AM
DetailsEntity SubnameInsert  MODESTO SITE8/12/2005 11:46 AM
DatesParticipating Approval DateInsert  12/14/2003 12:00:00 AM8/12/2005 11:46 AM
DetailsStateInsert  Active8/12/2005 11:46 AM
DatesRegistration DateInsert  7/1/1995 12:00:00 AM8/12/2005 11:46 AM
DatesSigned By DateInsert   8/12/2005 11:46 AM
DatesStart DateInsert  7/1/1995 12:00:00 AM8/12/2005 11:46 AM
TerminationsTermination CommentsInsert   8/12/2005 11:46 AM
TerminationsTermination DateInsert   8/12/2005 11:46 AM
TerminationsTermination Effective DateInsert   8/12/2005 11:46 AM
TerminationsTermination ReasonInsert   8/12/2005 11:46 AM