| Details | Last Recertification Date | Update | Recertification | 1/31/2024 4:16:35 PM | 2/26/2025 5:44:27 PM | 2/26/2025 5:44 PM |
| Addresses | Main Address | Update | Change Request |
1999 Mowry Ave.
Fremont, CA 94538-1436 |
1999 Mowry Ave. STE A,D,F,N
Fremont, CA 94538-1436 | 3/25/2024 3:38 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2023 7:58:19 PM | 1/31/2024 4:16:35 PM | 1/31/2024 4:16 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Monterola, Trina
Director of Finance and Controller
Bay Area Community Health
5102526804 | Monterola, Trina
Director of Finance and Controller
Bay Area Community Health
5103045360 | 12/27/2023 4:12 PM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2022 1:10:46 PM | 2/9/2023 7:58:19 PM | 2/9/2023 7:58 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Page, Zettie D.
CEO
Bay Area
5102525881 | Page, Zettie D
CEO
Bay Area Community Health
7609025249 | 7/14/2022 3:41 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Page, Zettie D.
CEO
Tri-City Health Center
5102525881 | Page, Zettie D.
CEO
Bay Area
5102525881 | 7/14/2022 6:32 AM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2021 8:56:30 AM | 2/4/2022 1:10:46 PM | 2/4/2022 1:10 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Monterola, Trina
Controller
Tri-City Health Center
5102526804 | Monterola, Trina
Director of Finance and Controller
Bay Area Community Health
5102526804 | 10/13/2021 7:42 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/5/2021 8:56 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 1184791998 | 2/5/2021 8:56 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | CA | 2/5/2021 8:56 AM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | FHC7115F (CA) | | 2/5/2021 8:56 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1184791998 ( ) | | 2/5/2021 8:56 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1184791998 | 2/5/2021 8:56 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | CA | 2/5/2021 8:56 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 4:16:25 PM | 2/5/2021 8:56:30 AM | 2/5/2021 8:56 AM |
| Details | Entity Name | Update | Recertification | TRI-CITY HEALTH CENTER | BAY AREA COMMUNITY HEALTH | 2/5/2021 8:56 AM |
| Details | Entity Subname | Update | Recertification | TRI-CITY HEALTH CENTER | Mowry II Health Clinic | 2/5/2021 8:56 AM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2019 1:13:50 PM | 1/28/2020 4:16:25 PM | 1/28/2020 4:16 PM |
| Addresses | Billing Address | Update | Recertification | TRI-CITY HEALTH CENTER
39500 LIBERTY STREET
FREMONT, CA 94538 | Central Office: Irvington Dave Clinic
40910 Fremont Blvd
FREMONT, CA 94538 | 2/5/2019 1:13 PM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2018 2:51:18 PM | 2/5/2019 1:13:50 PM | 2/5/2019 1:13 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2017 12:00:00 AM | 2/7/2018 2:51:18 PM | 2/7/2018 2:51 PM |
| Contacts | Authorizing Official | Update | | Page, Zettie D.
CEO
5102525881 | Page, Zettie D.
CEO
Tri-City Health Center
5102525881 | 10/5/2017 4:59 PM |
| Contacts | Primary Contact | Update | | Monterola, Trina
Controller
5102526804 | Monterola, Trina
Controller
Tri-City Health Center
5102526804 | 9/26/2017 1:34 PM |
| Contacts | Authorizing Official | Insert | | | Page, Zettie D.
CEO
5102525881 | 7/21/2017 5:15 PM |
| Contacts | Primary Contact | Update | | Costa, Linda L.
CFO
5102526810 | Monterola, Trina
Controller
5102526804 | 5/10/2017 12:47 PM |
| Addresses | Main Address | Insert | | |
1999 Mowry Ave.
Fremont, CA 94538-1436 | 2/9/2017 5:11 PM |
| Medicaid Billing | Medicaid: Number | Update | | FHC70603F | FHC7115F | 2/9/2017 5:11 PM |
| Details | Last Recertification Date | Update | | 2/22/2016 12:00:00 AM | 2/9/2017 12:00:00 AM | 2/9/2017 5:11 PM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 2/22/2016 5:58 PM |
| Details | Last Recertification Date | Update | | 3/4/2015 12:00:00 AM | 2/22/2016 12:00:00 AM | 2/22/2016 5:58 PM |
| Addresses | Billing Address | Insert | | | TRI-CITY HEALTH CENTER
39500 LIBERTY STREET
FREMONT, CA 94538 | 3/25/2015 5:09 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1184791998 | 3/4/2015 8:46 AM |
| Details | Last Recertification Date | Update | | 3/17/2014 12:00:00 AM | 3/4/2015 12:00:00 AM | 3/4/2015 8:46 AM |
| Contacts | Primary Contact | Update | | Escudero, Janet
Special Projects Manager
5102525829 | Costa, Linda L.
CFO
5102526810 | 3/4/2015 8:03 AM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/17/2014 12:00:00 AM | 3/17/2014 11:01 PM |
| Details | Entity Subname | Update | | | TRI-CITY HEALTH CENTER | 3/17/2014 11:01 PM |
| Contacts | Primary Contact | Insert | | | Escudero, Janet
Special Projects Manager
5102525829 | 3/4/2013 8:25 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/4/2013 8:25 AM |
| Details | Last Recertification Date | Insert | | | | 12/11/2006 2:34 PM |
| Details | Grant Number | Insert | | | H80CS02326 | 12/11/2006 2:34 PM |
| Details | 340B ID | Insert | | | CH09122A | 12/11/2006 2:34 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 12/11/2006 2:34 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/11/2006 2:34 PM |
| Details | Medicare Provider Number | Insert | | | | 12/11/2006 2:34 PM |
| Details | Entity Name | Insert | | | TRI-CITY HEALTH CENTER | 12/11/2006 2:34 PM |
| Details | Program Code | Insert | | | CH | 12/11/2006 2:34 PM |
| Details | Entity Subname | Insert | | | | 12/11/2006 2:34 PM |
| Dates | Participating Approval Date | Insert | | | 12/8/2006 12:00:00 AM | 12/11/2006 2:34 PM |
| Details | State | Insert | | | Active | 12/11/2006 2:34 PM |
| Dates | Registration Date | Insert | | | 12/8/2006 12:00:00 AM | 12/11/2006 2:34 PM |
| Dates | Signed By Date | Insert | | | 6/23/2006 12:00:00 AM | 12/11/2006 2:34 PM |
| Dates | Start Date | Insert | | | 1/1/2007 12:00:00 AM | 12/11/2006 2:34 PM |
| Terminations | Termination Comments | Insert | | | | 12/11/2006 2:34 PM |
| Terminations | Termination Date | Insert | | | | 12/11/2006 2:34 PM |
| Terminations | Termination Effective Date | Insert | | | | 12/11/2006 2:34 PM |
| Terminations | Termination Reason | Insert | | | | 12/11/2006 2:34 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 12/8/2006 9:23 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | FHC70603F | 12/8/2006 9:23 AM |
| Medicaid Billing | Medicaid: State | Insert | | | CA | 12/8/2006 9:23 AM |