340B Drug Pricing Program Database


CH092500 IMPERIAL BEACH COMMUNITY CLINIC (Active) - information as of 4/28/2025 12:40:34 AM

Main Details
IMPERIAL BEACH COMMUNITY CLINIC
IMPERIAL BEACH HEALTH CENTER
HRSA-Funded Health Center
BPS-H80-004611
CH092500
H80CS06648


Additional Details
Active
4/1/1996
4/1/1996
3/1/2006
2/26/2025

Contacts

Imperial Beach Community Clinic
Julie Ann Schwab, Chief Financial Officer
(530) 410-8124

Imperial Beach Community Clinic
Zach Lambert, Revenue Cycle Director
(760) 504-8397

Addresses

949 Palm Ave
Imperial Beach, CA 91932-1503

Imperial Beach Community Clinic
PO Box 459
Imperial Beach, CA 91933-0459


  • 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
StateMedicaid NumberNPI Number
CA17907183511790718351
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/15/202207/01/2022 02/01/202402/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/15/202207/01/2022 02/01/202402/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/15/202207/01/2022 02/01/202402/01/2024
Contract DetailDOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K 		GREENVILLESC29607-654004/15/202207/01/2022 02/01/202402/01/2024
Contract DetailEXACT CARE PHARMACYDDCRX, LLC 2701 HIGHPOINT OAKS DR STE 100
LEWISVILLETX75067-389604/15/202207/01/2022 02/01/202402/01/2024
Contract DetailEXACT CARE PHARMACY, LLC8333 ROCKSIDE RD
CLEVELANDOH4412504/15/202207/01/2022 02/01/202402/01/2024
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08859 16 3RD AVENUE EXT.
CHULA VISTACA9191001/03/201904/01/2019  04/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09115 645 SATURN BLVD
SAN DIEGOCA9215401/03/201904/01/2019  04/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09120 800 PALM AVE.
IMPERIAL BEACHCA9193201/03/201904/01/2019  04/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09138 1201 E. PLAZA BLVD
NATIONAL CITYCA9195001/03/201904/01/2019  04/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09140 555 BROADWAY STE 1054
CHULA VISTACA9191001/03/201904/01/2019 04/15/202404/15/2024
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09196 1376 3RD AVE
CHULA VISTACA9191101/03/201904/01/2019 04/15/202404/15/2024
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09524 3350 PALM AVE.
SAN DIEGOCA9215401/03/201904/01/2019  04/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16052 1240 BROADWAY
CHULA VISTACA9191101/03/201904/01/2019  04/01/2019
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04768 510 C STREET
SAN DIEGOCA9210110/07/201901/01/2020 04/15/202404/15/2024
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09113 645 E. PALOMAR ST.
CHULA VISTACA9191101/03/202004/01/2020  04/01/2020
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09193 1380 43RD ST.
SAN DIEGOCA9211304/15/202407/01/2024  07/01/2024
Contract DetailHABIBIS PHARMACY LLCFAMILY PHARMACY 3 340 4TH AVE STE 1
CHULA VISTACA9191001/10/202504/01/2025  04/01/2025
Contract DetailIMPERIAL PHARMACY1530 PALM AVE
SAN DIEGOCA9215401/18/202204/01/2022  04/01/2022
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09632 691 3RD AVE
CHULA VISTACA9191001/04/201904/01/2019  04/01/2019
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06332 645 MARKET ST
SAN DIEGOCA9210110/07/201901/01/2020  01/01/2020
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09162 3749 AVOCADO BLVD
LA MESACA9194110/07/201901/01/2020 04/15/202404/15/2024
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09240 380 E H ST
CHULA VISTACA9191004/15/202407/01/2024  07/01/2024
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255004/15/202207/01/2022 02/01/202402/01/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/15/202207/01/2022 02/01/202402/01/2024
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/03/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-2150710 DENNERY RD
SAN DIEGOCA9215401/09/201904/01/2019  04/01/2019
Contract DetailWAL-MART PHARMACY 10-5938575 SATURN BLVD
SAN DIEGOCA9215401/09/201904/01/2019  04/01/2019
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/03/202004/01/2020  04/01/2020
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH092500ActiveBPS-H80-004611IMPERIAL BEACH COMMUNITY CLINICIMPERIAL BEACH HEALTH CENTER949 Palm Ave Imperial BeachCA
CH09250AActiveBPS-H80-008870IMPERIAL BEACH COMMUNITY CLINICNestor Community Heath Center1016 Outer Rd San DiegoCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH092500BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267007/01/2022 02/01/2024
CH092500BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771307/01/2022 02/01/2024
CH092500BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/01/2022 02/01/2024
CH09250ABIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/01/2022  
CH092500DOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K 		GREENVILLESC29607-654007/01/2022 02/01/2024
CH092500EXACT CARE PHARMACYDDCRX, LLC 2701 HIGHPOINT OAKS DR STE 100
LEWISVILLETX75067-389607/01/2022 02/01/2024
CH092500EXACT CARE PHARMACY, LLC8333 ROCKSIDE RD
CLEVELANDOH4412507/01/2022 02/01/2024
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08859 16 3RD AVENUE EXT.
CHULA VISTACA9191004/01/2019  
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09115 645 SATURN BLVD
SAN DIEGOCA9215404/01/2019  
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09120 800 PALM AVE.
IMPERIAL BEACHCA9193204/01/2019  
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09138 1201 E. PLAZA BLVD
NATIONAL CITYCA9195004/01/2019  
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09140 555 BROADWAY STE 1054
CHULA VISTACA9191004/01/2019 04/15/2024
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09196 1376 3RD AVE
CHULA VISTACA9191104/01/2019 04/15/2024
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09524 3350 PALM AVE.
SAN DIEGOCA9215404/01/2019  
CH092500GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16052 1240 BROADWAY
CHULA VISTACA9191104/01/2019  
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04768 510 C STREET
SAN DIEGOCA9210101/01/2020 04/15/2024
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09113 645 E. PALOMAR ST.
CHULA VISTACA9191104/01/2020  
CH092500GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09193 1380 43RD ST.
SAN DIEGOCA9211307/01/2024  
CH092500HABIBIS PHARMACY LLCFAMILY PHARMACY 3 340 4TH AVE STE 1
CHULA VISTACA9191004/01/2025  
CH092500IMPERIAL PHARMACY1530 PALM AVE
SAN DIEGOCA9215404/01/2022  
CH092500LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09632 691 3RD AVE
CHULA VISTACA9191004/01/2019  
CH092500LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06332 645 MARKET ST
SAN DIEGOCA9210101/01/2020  
CH092500LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09162 3749 AVOCADO BLVD
LA MESACA9194101/01/2020 04/15/2024
CH092500LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09240 380 E H ST
CHULA VISTACA9191007/01/2024  
CH092500RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255007/01/2022 02/01/2024
CH092500RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500207/01/2022 02/01/2024
CH092500WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2020  
CH092500WAL-MART PHARMACY 10-2150710 DENNERY RD
SAN DIEGOCA9215404/01/2019  
CH092500WAL-MART PHARMACY 10-5938575 SATURN BLVD
SAN DIEGOCA9215404/01/2019  
CH092500WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2020  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateRecertificationGutierrez, Francisco Business Intelligence Analyst Imperial Beach Community Clinic 6198748841Lambert, Zach Revenue Cycle Director Imperial Beach Community Clinic 76050483972/26/2025 7:12 AM
DetailsLast Recertification DateUpdateRecertification2/5/2024 9:37:55 PM2/26/2025 7:12:20 AM2/26/2025 7:12 AM
DetailsLast Recertification DateUpdateRecertification1/31/2023 12:43:14 PM2/5/2024 9:37:55 PM2/5/2024 9:37 PM
ContactsAuthorizing OfficialUpdateAO Change RequestWiese, Clinton Carroll CFO Imperial Beach Community Health Clinic 6194293733-403Schwab, Julie Ann Chief Financial Officer Imperial Beach Community Clinic 53041081242/1/2024 3:48 PM
ContactsPrimary ContactUpdatePC Change RequestSummers-Day, Courtney Interim CEO Imperial Beach Community Clinic 6194293733Gutierrez, Francisco Business Intelligence Analyst Imperial Beach Community Clinic 61987488411/29/2024 9:39 AM
ContactsPrimary ContactUpdateChange RequestJibril, Deanah CEO Imperial Beach Community Clinic 6194293733Summers-Day, Courtney Interim CEO Imperial Beach Community Clinic 61942937335/31/2023 9:38 AM
ContactsPrimary ContactUpdateRecertificationVera, Santos Chief Executive Officer Imperial Beach Community Clinic 6194293733Jibril, Deanah CEO Imperial Beach Community Clinic 61942937331/31/2023 12:43 PM
DetailsLast Recertification DateUpdateRecertification1/31/2022 3:33:24 PM1/31/2023 12:43:14 PM1/31/2023 12:43 PM
DetailsLast Recertification DateUpdateRecertification2/1/2021 3:36:58 PM1/31/2022 3:33:24 PM1/31/2022 3:33 PM
ContactsPrimary ContactUpdateChange RequestMullenax, Nancy Alba Program Development Officer Imperial Beach Community Clinic 6194293733-530Vera, Santos Chief Executive Officer Imperial Beach Community Clinic 61942937331/18/2022 7:09 AM
Medicaid BillingNPI: NumberDeleteRecertification1790718351 ( ) 2/1/2021 3:36 PM
Medicaid BillingNPI: NumberInsertRecertification 17907183512/1/2021 3:36 PM
Medicaid BillingNPI: StateInsertRecertification CA2/1/2021 3:36 PM
DetailsLast Recertification DateUpdateRecertification1/27/2020 6:46:21 PM2/1/2021 3:36:58 PM2/1/2021 3:36 PM
ContactsAuthorizing OfficialUpdateAO Change RequestKIRK, CONSTANCE CEO Imperial Beach Community Clinic 6194295387Wiese, Clinton Carroll CFO Imperial Beach Community Health Clinic 6194293733-4035/1/2020 3:25 PM
DetailsLast Recertification DateUpdateRecertification1/30/2019 5:11:02 PM1/27/2020 6:46:21 PM1/27/2020 6:46 PM
DetailsLast Recertification DateUpdateRecertification2/7/2018 6:04:47 PM1/30/2019 5:11:02 PM1/30/2019 5:11 PM
DetailsLast Recertification DateUpdateRecertification1/25/2017 12:00:00 AM2/7/2018 6:04:47 PM2/7/2018 6:04 PM
ContactsPrimary ContactUpdateChange RequestCarino, Leslie Nursing Director 6194293733-410Mullenax, Nancy Alba Program Development Officer Imperial Beach Community Clinic 6194293733-5301/12/2018 12:42 PM
ContactsAuthorizing OfficialUpdate KIRK, CONSTANCE CEO 6194295387KIRK, CONSTANCE CEO Imperial Beach Community Clinic 61942953871/11/2018 2:36 PM
AddressesMain AddressInsert   949 Palm Ave Imperial Beach, CA 91932-15031/25/2017 12:53 PM
ContactsPrimary ContactInsert  Carino, Leslie Nursing Director 6194293733-4101/25/2017 12:53 PM
ContactsAuthorizing OfficialInsert  KIRK, CONSTANCE CEO 61942953871/25/2017 12:53 PM
DetailsLast Recertification DateUpdate 2/12/2016 12:00:00 AM1/25/2017 12:00:00 AM1/25/2017 12:53 PM
DetailsLast Recertification DateUpdate 3/4/2015 12:00:00 AM2/12/2016 12:00:00 AM2/12/2016 5:04 PM
DetailsLast Recertification DateUpdate 3/14/2014 12:00:00 AM3/4/2015 12:00:00 AM3/4/2015 5:10 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/14/2014 6:39 AM
Medicaid BillingMedicaid: NumberInsert  17907183513/14/2014 6:39 AM
Medicaid BillingMedicaid: StateInsert  CA3/14/2014 6:39 AM
Medicaid BillingNPI: NumberInsert  17907183513/14/2014 6:39 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/14/2014 12:00:00 AM3/14/2014 6:39 AM
DetailsEntity SubnameUpdate Imperial Beach Health CenterIMPERIAL BEACH HEALTH CENTER3/14/2014 6:39 AM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/27/2013 3:16 PM
AddressesBilling AddressInsert  Imperial Beach Community Clinic PO Box 459 Imperial Beach, CA 91933-04591/23/2013 3:00 PM
DetailsEntity SubnameUpdate  Imperial Beach Health Center1/23/2013 3:00 PM
DetailsLast Recertification DateInsert   3/22/2006 2:38 PM
DetailsGrant NumberInsert  H80CS066483/22/2006 2:38 PM
Details340B IDInsert  CH0925003/22/2006 2:38 PM
DetailsIs Authorizing Official EHB DataInsert   3/22/2006 2:38 PM
DatesLast Date That 340B Drugs PurchasedInsert   3/22/2006 2:38 PM
DetailsMedicare Provider NumberInsert   3/22/2006 2:38 PM
DetailsEntity NameInsert  IMPERIAL BEACH COMMUNITY CLINIC3/22/2006 2:38 PM
DetailsProgram CodeInsert  CH3/22/2006 2:38 PM
DetailsEntity SubnameInsert   3/22/2006 2:38 PM
DatesParticipating Approval DateInsert  3/1/2006 12:00:00 AM3/22/2006 2:38 PM
DetailsStateInsert  Active3/22/2006 2:38 PM
DatesRegistration DateInsert  4/1/1996 12:00:00 AM3/22/2006 2:38 PM
DatesSigned By DateInsert   3/22/2006 2:38 PM
DatesStart DateInsert  4/1/1996 12:00:00 AM3/22/2006 2:38 PM
TerminationsTermination CommentsInsert   3/22/2006 2:38 PM
TerminationsTermination DateInsert   3/22/2006 2:38 PM
TerminationsTermination Effective DateInsert   3/22/2006 2:38 PM
TerminationsTermination ReasonInsert   3/22/2006 2:38 PM