Covered Entity Details

CH10103AD YAKIMA VALLEY FARM WORKERS CLINIC (Active) - information as of 5/9/2025 10:45:59 PM

Main Details

Name

YAKIMA VALLEY FARM WORKERS CLINIC

Subdivision Name

ROSEWOOD FAMILY HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-036451

340B ID

CH10103AD

Grant Number

H80CS00639

Additional Details

Current Program Status

Active

Registration Date

2/15/2007

Participating Start Date

4/1/2007

Participating Approval Date

2/16/2007

Last Recertification Date

2/21/2025

Contacts

Authorizing Official

Yakima Valley Farm Workers Clinic
Christine Sue Trotter, CEO
(509) 865-6175 Ext: 2128

Primary Contact

Yakima Valley Farm Workers Clinic
Glen Davis, COO
(509) 865-6175 Ext: 2618

Addresses

Street Address

3530 SE 88th Avenue
PORTLAND, OR 97266

Billing Address

Yakima Valley Farm Workers Clinic
PO Box 190
Toppenish, WA 98948

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?
Yes

State	Medicaid Number	NPI Number
OR	022793,500814580,500801943,500801942,500802377,090435,500802808,500802812,500802366,500813319,276202,500726175,500847726	1679526107,1083743538,1336859875,1396831624,1073604039,1508957572,1740376078,1831285162,1346583325,1194315002,1194450536,1538387824,1568908978,1275002552,1033355599
WA	2292098,1044044,10042748,1044519,1045493,1045864,2030982,2177632,2221216,2145135,2296608,1016047	1679526107,1083743538,1336859875,1396831624,1073604039,1508957572,1740376078,1831285162,1346583325,1194315002,1194450536,1538387824,1568908978,1275002552,1033355599

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
CH101030	Active	BPS-H80-001539	YAKIMA VALLEY FARM WORKERS CLINIC	YVFWC - TOPPENISH	510 W 1st Ave	Toppenish	WA
CH10103AD	Active	BPS-H80-036451	YAKIMA VALLEY FARM WORKERS CLINIC	ROSEWOOD FAMILY HEALTH CENTER	3530 SE 88th Avenue	PORTLAND	OR
CH10103AE	Active	BPS-H80-011122	YAKIMA VALLEY FARM WORKERS CLINIC	Unify Community Health, Northeast	4001 N Cook St	Spokane	WA
CH10103AF	Active	BPS-H80-013826	YAKIMA VALLEY FARM WORKERS CLINIC	Immediate Care	2680 Yakima Valley Hwy Ste B	Sunnyside	WA
CH10103AG	Active	BPS-H80-013827	YAKIMA VALLEY FARM WORKERS CLINIC	Yakima Valley Farm Workers Dental Clinic at the YV-Tech Campus	1120 South 18th Street RM 150	Yakima	WA
CH10103AH	Terminated	BPS-H80-010886	YAKIMA VALLEY FARM WORKERS CLINIC	Toppenish Medical-Dental Clinic Pharmacy	602 W 1st Ave	Toppenish	WA
CH10103AJ	Active	BPS-H80-005533	YAKIMA VALLEY FARM WORKERS CLINIC	CHILDREN'S VILLAGE-UPPER VALLEY	3801 Kern Rd	Yakima	WA
CH10103AK	Active	BPS-H80-014668	YAKIMA VALLEY FARM WORKERS CLINIC	Community Dental Care	1721 E LINCOLN AVE	SUNNYSIDE	WA
CH10103AL	Active	BPS-H80-015341	YAKIMA VALLEY FARM WORKERS CLINIC	Yakima Administration, Terrace Heights	601 N Keys Rd	Yakima	WA
CH10103AM	Terminated	BPS-H80-015135	YAKIMA VALLEY FARM WORKERS CLINIC	Unify Community Health, West Central	1603 N BELT ST	SPOKANE	WA
CH10103AN	Active	BPS-H80-014390	YAKIMA VALLEY FARM WORKERS CLINIC	YVFWC MOBILE MEDICAL-DENTAL	601 N Keys Rd	Yakima	WA
CH10103AP	Active	BPS-H80-017529	YAKIMA VALLEY FARM WORKERS CLINIC	Pacific Pedatrics	1475 Mount Hood Ave	Woodburn	OR
CH10103AQ	Active	BPS-H80-017530	YAKIMA VALLEY FARM WORKERS CLINIC	YVFWC MOBILE DENTAL UNIT #2	601 N Keys Rd	Yakima	WA
CH10103AR	Active	BPS-H80-017938	YAKIMA VALLEY FARM WORKERS CLINIC	Lancaster Family Health Center at Lancaster	255 Lancaster Dr NE	Salem	OR
CH10103AS	Active	BPS-H80-018884	YAKIMA VALLEY FARM WORKERS CLINIC	Granger Family Medicine Clinic	115 Sunnyside Ave Ste A	Granger	WA
CH10103AT	Active	BPS-H80-019307	YAKIMA VALLEY FARM WORKERS CLINIC	YVFWC MOBILE DENTAL UNIT #4	601 N Keys Rd	Yakima	WA
CH10103AU	Active	BPS-H80-019305	YAKIMA VALLEY FARM WORKERS CLINIC	YVFWC Dental Mobile Unit #3	601 N. Keys Rd	Yakima	WA
CH10103AV	Active	BPS-H80-017215	YAKIMA VALLEY FARM WORKERS CLINIC	Behavioral Health Services on 12th Avenue	307 S. 12th Avenue, Suites 4A-C	Yakima	WA
CH10103AW	Active	BPS-H80-011121	YAKIMA VALLEY FARM WORKERS CLINIC	Behavioral Health Services	918 E Mead Ave	Yakima	WA
CH10103AX	Terminated	BPS-H80-019293	YAKIMA VALLEY FARM WORKERS CLINIC	Programs Office at Fiesta Foods	1112 E. Nob Hill Blvd., Suite I	Yakima	WA
CH10103AY	Active	BPS-H80-021732	YAKIMA VALLEY FARM WORKERS CLINIC	Dentistry for Kids	2611 S Quillan Pl	Kennewick	WA
CH10103AZ	Active	BPS-H80-024387	YAKIMA VALLEY FARM WORKERS CLINIC	Rosewood Family Health Center at Lents	9047 SE Foster Rd	Portland	OR
CH10103B	Active	BPS-H80-004471	YAKIMA VALLEY FARM WORKERS CLINIC	YVFWC GRANDVIEW CLINIC	1000 WALLACE WAY	GRANDVIEW	WA
CH10103BA	Terminated	BPS-H80-024586	YAKIMA VALLEY FARM WORKERS CLINIC	Unify Family Dental	1095 SE Bishop Blvd	Pullman	WA
CH10103BB	Active	BPS-H80-029724	YAKIMA VALLEY FARM WORKERS CLINIC	11th Avenue Family Medicine Clinic	314 S 11th Ave STE A	Yakima	WA
CH10103BC	Active	BPS-H80-029718	YAKIMA VALLEY FARM WORKERS CLINIC	Columbia Basin Pediatric Dentistry	7501 W Deschutes Pl	Kennewick	WA
CH10103BD	Terminated	BPS-H80-031767	Yakima Valley Farm Workers Clinic	Rosewood Family Health at Gateway	135 NE 102nd Ave	Portland	OR
CH10103BE	Active	BPS-H80-031814	Yakima Valley Farm Workers Clinic	Miramar Health Center Kennewick	6351 W Rio Grande Ave	Kennewick	WA
CH10103BF	Active	BPS-H80-035732	YAKIMA VALLEY FARM WORKERS CLINIC ADMIN	West Valley Family Health & OB/GYN	5109 Summitview Ave	Yakima	WA
CH10103BG	Active	BPS-H80-027317	YAKIMA VALLEY FARM WORKERS CLINIC	YVFWC Operations Administration Building	2601 Commerce Ln	Yakima	WA
CH10103C	Active	BPS-H80-004780	YAKIMA VALLEY FARM WORKERS CLINIC	Lancaster Family Health Center at Beverly	3896 Beverly Ave NE	Salem	OR
CH10103E	Active	BPS-H80-003694	YAKIMA VALLEY FARM WORKERS CLINIC	FAMILY MEDICAL CENTER	1120 W Rose St	Walla Walla	WA
CH10103F	Active	BPS-H80-008455	YAKIMA VALLEY FARM WORKERS CLINIC	Mirasol Family Health Center	589 NW 11th St	Hermiston	OR
CH10103G	Active	BPS-H80-003683	YAKIMA VALLEY FARM WORKERS CLINIC	YVFWC YAKIMA CLINIC	602 E Nob Hill Blvd	Yakima	WA
CH10103K	Active	BPS-H80-001205	YAKIMA VALLEY FARM WORKERS CLINIC	SALUD MEDICAL CENTER	1175 Mount Hood Ave	Woodburn	OR
CH10103M	Active	BPS-H80-000804	YAKIMA VALLEY FARM WORKERS CLINIC	Valley Vista Medical Group	820 Memorial St Ste 1	Prosser	WA
CH10103O	Active	BPS-H80-001787	YAKIMA VALLEY FARM WORKERS CLINIC	Unify Community Health	120 W Mission Ave	Spokane	WA
CH10103P	Active	BPS-H80-003746	YAKIMA VALLEY FARM WORKERS CLINIC	MOUNTAINVIEW WOMEN'S HEALTH CENTER	240 Division St	Grandview	WA
CH10103Q	Active	BPS-H80-003344	YAKIMA VALLEY FARM WORKERS CLINIC	MIRAMAR HEALTH CENTER	1608 N Road 44	Pasco	WA
CH10103R	Active	BPS-H80-007894	YAKIMA VALLEY FARM WORKERS CLINIC	Wapato Mid-Valley Clinic	620 West 1st Street	Wapato	WA
CH10103S	Active	BPS-H80-002579	YAKIMA VALLEY FARM WORKERS CLINIC	LINCOLN AVE Medical-Dental Clinic	2205 W LINCOLN AVE	YAKIMA	WA
CH106280	Active	BPS-H80-019308	YAKIMA VALLEY FARM WORKERS CLINIC	COASTAL FAMILY HEALTH CENTER	2158 Exchange St STE 304	Astoria	OR
CH10628A	Active	BPS-H80-019306	YAKIMA VALLEY FARM WORKERS CLINIC	Community Health Center of Clatskanie	401 SW Belair Dr	Clatskanie	OR
CH10628B	Terminated	BPS-H80-019304	YAKIMA VALLEY FARM WORKERS CLINIC	Clatskanie School Based Health Center	Clatskanie Middle High School 471 Bel Air Dr	Clatskanie	OR

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH101030	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2021	12/31/2023
CH101030	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2021	12/31/2023
CH101030	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2021	12/31/2023
CH101030	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2021	12/31/2023
CH101030	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2021	12/31/2023
CH101030	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2021	12/31/2023
CH101030	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	10/01/2021	05/12/2023
CH101030	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	10/01/2021	05/12/2023
CH101030	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2021	04/26/2024
CH101030	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2021	04/26/2024
CH101030	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2021	04/08/2025
CH101030	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2021	04/26/2024
CH101030	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2021	04/26/2024
CH101030	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2021	04/08/2025
CH101030	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2021	04/26/2024
CH101030	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2021	04/26/2024
CH101030	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2021	04/08/2025
CH101030	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2021	04/08/2025
CH101030	COLUMBIA MEMORIAL HOSPITAL	OUTPATIENT PHARMACY	2120 EXCHANGE ST STE 101	ASTORIA	OR	97103	03/08/2017
CH106280	COLUMBIA MEMORIAL HOSPITAL	OUTPATIENT PHARMACY	2120 EXCHANGE ST STE 101	ASTORIA	OR	97103	04/26/2012	03/09/2017
CH101030	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2022	04/08/2025
CH101030	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2022
CH101030	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2021
CH101030	ELFERS-LYON PHARMACY	820 MEMORIAL ST STE 2		PROSSER	WA	99350-2504	07/01/2017
CH10103M	ELFERS-LYON PHARMACY	820 MEMORIAL ST STE 2		PROSSER	WA	99350-2504	06/29/2007	04/12/2017
CH101030	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2021	12/31/2023
CH101030	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2021	12/31/2023
CH101030	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2021	12/31/2023
CH101030	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2021	12/31/2023
CH106280	FRED MEYER INC	DBA FRED MEYER	695 HWY 101	WARRENTON	OR	97146	04/01/2016	03/09/2017
CH101030	FRED MEYER INC	8955 S.E. 82ND AVENUE		HAPPY VALLEY	OR	97086	07/01/2021	05/25/2025
CH101030	FRED MEYER INC	DBA FRED MEYER	695 HWY 101	WARRENTON	OR	97146	07/01/2021	05/25/2025
CH101030	FRED MEYER STORES	1206 NORTH 40TH AVENUE		YAKIMA	WA	98908	07/01/2021	05/25/2025
CH106280	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	04/01/2016	03/09/2017
CH101030	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	10/01/2021	05/25/2025
CH101030	LA PHARMACY LLC	1048 S GARFIELD AVE	STE 101	ALHAMBRA	CA	91801	10/01/2021	06/11/2023
CH101030	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	10/01/2021	05/12/2023
CH101030	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	07/01/2021	02/07/2024
CH101030	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2021	02/07/2024
CH101030	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/01/2021	02/07/2024
CH101030	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	07/01/2021	02/07/2024
CH101030	OPTUM PHARMACY 705, LLC	11142 RENNER BLVD		LENEXA	KS	66219	07/01/2021	02/07/2023
CH101030	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/01/2021	02/07/2024
CH101030	OREGON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17195	6450 KEIZER STATION BLVD NE	KEIZER	OR	97303	07/01/2022	04/01/2025
CH101030	OREGON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16154	3790 CENTER ST NE	SALEM	OR	97301	07/01/2022	04/01/2025
CH101030	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	10/01/2021	06/11/2023
CH101030	PHILLIPS TOTAL CARE PHARMACY	121 E STATE ST		MAUSTON	WI	53948	10/01/2021	10/01/2021
CH101030	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	10/01/2021	05/12/2023
CH101030	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2021	04/08/2025
CH101030	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2819	1309 NW 23RD AVE.	PORTLAND	OR	97210	07/01/2021
CH101030	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2021	04/26/2024
CH101030	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2021	04/26/2024
CH101030	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2021	04/26/2024
CH101030	RICK'S HI-SCHOOL PHARMACY INC	401 W COLUMBIA RIVER HWY		CLATSKANIE	OR	97016	03/08/2017
CH106280	RICK'S HI-SCHOOL PHARMACY INC	401 W COLUMBIA RIVER HWY		CLATSKANIE	OR	97016	01/01/2016	03/09/2017
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #1260	401 S ROOSEVELT DR	SEASIDE	OR	97138-6738	03/08/2017	02/05/2023
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #2627	3250 LEIF ERICKSON DRIVE	ASTORIA	OR	97103	03/08/2017
CH106280	SAFEWAY INC	SAFEWAY PHARMACY #2627	3250 LEIF ERICKSON DRIVE	ASTORIA	OR	97103	01/20/2011	03/09/2017
CH106280	SAFEWAY INC	SAFEWAY PHARMACY #1260	401 S ROOSEVELT DR	SEASIDE	OR	97138-6738	07/01/2014	03/09/2017
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #0462	205 NORTH 5TH AVENUE	YAKIMA	WA	98902	01/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #0584	711 W 1ST AVE	TOPPENISH	WA	98948	01/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #1593	610 E. WINE COUNTRY ROAD	GRANDVIEW	WA	98930	01/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #1660	905 E MEAD AVE	YAKIMA	WA	98903	01/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #0307	215 E ROSE STREET	WALLA WALLA	WA	99362	04/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #0563	613 S. 6TH ST.	SUNNYSIDE	WA	98944	04/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #0444	990 HWY 395 S	HERMISTON	OR	97838	04/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #1590	455 N COLUMBIA ST	MILTON FREEWATER	OR	97862	04/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #0502	5702 SUMMITVIEW AVENUE	YAKIMA	WA	98908	04/01/2019
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #0429	3380 LANCASTER DRIVE NE	SALEM	OR	97305-1354	07/01/2021
CH101030	SAFEWAY INC	SAFEWAY PHARMACY #1629	1265 CENTER ST NE	SALEM	OR	97301	07/01/2021	02/05/2023
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5343	145 SOUTH HIGHWAY 101	WARRENTON	OR	97146	03/08/2017	07/12/2019
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5342	313 SOUTH ROOSEVELT DRIVE	SEASIDE	OR	97138	03/08/2017	07/12/2019
CH106280	THRIFTY PAYLESS, INC.	RITE AID #5343	145 SOUTH HIGHWAY 101	WARRENTON	OR	97146	10/01/2013	03/09/2017
CH106280	THRIFTY PAYLESS, INC.	RITE AID #5342	313 SOUTH ROOSEVELT DRIVE	SEASIDE	OR	97138	10/01/2013	03/09/2017
CH101030	THRIFTY PAYLESS, INC.	RITE AID #4063	12 N 9TH AVENUE	YAKIMA	WA	98902	07/01/2021	03/27/2025
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5296	2204-B W. NOB HILL BLVD.	YAKIMA	WA	98902	07/01/2021	03/27/2025
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5297	2519 MAIN STREET	UNION GAP	WA	98903	07/01/2021	03/27/2025
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5300	2010 YAKIMA VALLEY HWY STE C1	SUNNYSIDE	WA	98944	07/01/2021	02/26/2025
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5302	112 NORTH HOWARD ST SUITE 115	SPOKANE	WA	99201	07/01/2021	12/06/2023
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5314	1308 NORTH 20TH AVENUE	PASCO	WA	99301	07/01/2021	03/27/2025
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5320	2028 EAST ISAACS AVENUE	WALLA WALLA	WA	99362	07/01/2021	01/19/2024
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5342	313 SOUTH ROOSEVELT DRIVE	SEASIDE	OR	97138	07/01/2021	03/27/2025
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5343	145 SOUTH HIGHWAY 101	WARRENTON	OR	97146	07/01/2021	11/29/2023
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5358	16401 SE DIVISION STREET	PORTLAND	OR	97236	07/01/2021	09/19/2023
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5359	11930 SE DIVISION STREET	PORTLAND	OR	97266	07/01/2021	03/27/2025
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5395	1900 SW COURT PLACE	PENDLETON	OR	97801	07/01/2021	03/27/2025
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5397	835 SOUTH HIGHWAY 395	HERMISTON	OR	97838	07/01/2021	01/19/2024
CH101030	THRIFTY PAYLESS, INC.	RITE AID #5399	105 SOUTHWEST SECOND AVENUE	MILTON-FREEWATER	OR	97862	07/01/2021	11/29/2023
CH101030	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	04/01/2022	06/11/2023
CH101030	TRUEPILL NY LLC	850 3RD AVE STE 404		BROOKLYN	NY	11232-1523	10/01/2021	06/11/2023
CH101030	WALGREEN CO	DBA: WALGREENS #13128	800 SWIFT BLVD SUITE 160	RICHLAND	WA	99352	04/01/2013	08/19/2015
CH101030	WALGREEN CO	DBA: WALGREENS	2370 E MAIN STREET	WOODLAND	CA	95776	04/01/2013	07/27/2015
CH101030	WALGREEN CO.	DBA: WALGREENS # 01078	2005 W COURT STREET	PASCO	WA	99301	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 01100	9159 SE 82ND AVE	HAPPY VALLEY	OR	97086	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 01993	12312 E SPRAGUE AVE	SPOKANE VALLEY	WA	99216-0720	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 02205	12315 N DIVISION ST	SPOKANE	WA	99218	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 03817	4285 W POWELL BLVD	GRESHAM	OR	97030	04/01/2013	10/10/2023
CH101030	WALGREEN CO.	DBA: WALGREENS # 16259	17979 NE GLISAN ST	PORTLAND	OR	97230	04/01/2013	11/09/2021
CH101030	WALGREEN CO.	DBA: WALGREENS # 03838	1950 NE BURNSIDE RD	GRESHAM	OR	97030	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 03890	940 SE CESAR E CHAVEZ BLVD	PORTLAND	OR	97214	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 03925	3 NE 82ND AVE	PORTLAND	OR	97220	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 04229	1992 LANCASTER DRIVE NE	SALEM	OR	97305	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 04230	5000 RIVER ROAD	KEIZER	OR	97303	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 04257	4380 COMMERCIAL STREET SE	SALEM	OR	97302	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 04296	3909 SE HOLGATE BLVD	PORTLAND	OR	97202	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 04353	4325 82ND SE	PORTLAND	OR	97266	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 04943	12215 SE POWELL BLVD.	PORTLAND	OR	97236	04/01/2013	07/22/2019
CH101030	WALGREEN CO.	DBA: WALGREENS # 05647	6116 NE MLK JR BLVD	PORTLAND	OR	97211	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 05817	1708 W NORTHWEST BLVD	SPOKANE	WA	99205	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 05818	2105 E WELLESLEY AVE	SPOKANE	WA	99207	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 05910	25699 SE STARK ST	TROUTDALE	OR	97060	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 05913	7905 N DIVISION ST	SPOKANE	WA	99208	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 05914	15510 E SPRAGUE	SPOKANE VALLEY	WA	99037	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 06426	12335 NE GLISAN ST	PORTLAND	OR	97230	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 07034	12 E EMPIRE AVE	SPOKANE	WA	99207-1706	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 15927	11995 SE SUNNYSIDE RD	HAPPY VALLEY	OR	97015	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS #07846	2702 N. ARGONNE RD.	MILLWOOD	WA	99212	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 09113	4000 W 27TH AVE	KENNEWICK	WA	99337-2422	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 09287	124 LANCASTER DR SE	SALEM	OR	97317-5331	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 09544	10903 SE OAK ST	MILWAUKIE	OR	97222-6641	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 09596	585 GAGE BLVD	RICHLAND	WA	99352-7761	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 09650	699 WALLACE RD NW	SALEM	OR	97304-3834	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS #09765	5506 ROAD 68	PASCO	WA	99301	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 09911	4001 SUMMITVIEW AVE STE 1	YAKIMA	WA	98908	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS # 10107	633 W TIETAN STREET	WALLA WALLA	WA	99362	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS #10137	38241 PROCTOR BLVD.	SANDY	OR	97055-8019	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS # 10195	2800 W CLEARWATER AVE	KENNEWICK	WA	99336-2945	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS #10478	1601 GEORGE WASHINGTON WAY	RICHLAND	WA	99354-2626	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS #10893	1080 SW 1ST AVE.	CANBY	OR	97013-3828	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS #10946	2830 S. GRAND BLVD.	SPOKANE	WA	99203	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS #11398	439 NE 223RD AVE.	GRESHAM	OR	97030	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS #11632	2150 FAIRGROUNDS RD. NE	SALEM	OR	97301	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS #12053	6400 WEST NOB HILL BLVD.	YAKIMA	WA	98908	04/01/2013
CH101030	WALGREEN CO.	DBA: WALGREENS #12095	1000 N. EVERGREEN RD.	WOODBURN	OR	97071	04/01/2013	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS #12275	610 W. YAKIMA AVE.	YAKIMA	WA	98902	04/01/2013
CH101030	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16403	1409 11TH AVE.	SEATTLE	WA	98122	04/01/2013	05/06/2025
CH101030	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #21243	327 W 3RD AVE STE A	SPOKANE	WA	99201	04/01/2013	05/06/2025
CH101030	WALGREEN CO.	DBA: WALGREENS #13768	1200 N 14TH AVE #100	PASCO	WA	99301	04/01/2013	08/04/2016
CH101030	WALGREEN CO.	DBA: WALGREENS # 09671	1625 E HARBOR DR	WARRENTON	OR	97146	03/08/2017
CH101030	WALGREEN CO.	DBA: WALGREENS # 09812	2939 OCEAN BEACH HWY	LONGVIEW	WA	98632-3513	10/01/2017
CH106280	WALGREEN CO.	DBA: WALGREENS # 09671	1625 E HARBOR DR	WARRENTON	OR	97146	07/01/2015	03/09/2017
CH101030	WALGREEN CO.	DBA: WALGREENS # 02679	2102 NEZ PERCE DR	LEWISTON	ID	83501	01/01/2019	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS #16025	425 BRIDGE ST	CLARKSTON	WA	99403-1930	01/01/2019	05/15/2024
CH101030	WALGREEN CO.	DBA: WALGREENS #12503	414 N MAIN ST	MOSCOW	ID	83843-2631	01/01/2019	05/15/2024
CH101030	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	07/27/2015
CH101030	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	07/27/2015
CH106280	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	12/02/2011	07/15/2015
CH101030	WESTERN PHARMACY GROUP LLC	DBA COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY SUITES A--E	SAN DIEGO	CA	92102	10/01/2021	10/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Recertification	2265502 (WA)		2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500801943	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500801942	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500802377	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		090435	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500802808	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500802812	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500802366	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500813319	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		276202	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500726175	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500847726	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1044044	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		10042748	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1044519	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1045493	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1045864	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2030982	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2177632	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2221216	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2145135	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2296608	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1780380519 (WA)		2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1780380519 (OR)		2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1396831624	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073604039	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508957572	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740376078	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831285162	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1346583325	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194315002	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194450536	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1538387824	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568908978	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275002552	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033355599	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1396831624	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073604039	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508957572	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740376078	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831285162	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1346583325	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194315002	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194450536	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1538387824	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568908978	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275002552	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033355599	2/21/2025 2:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/21/2025 2:09 PM
Details	Last Recertification Date	Update	Recertification	2/2/2024 6:17:11 PM	2/21/2025 2:09:01 PM	2/21/2025 2:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2024 3:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2265502	12/18/2024 3:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	12/18/2024 3:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/18/2024 3:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2292098	12/18/2024 3:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1740376078 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1568908978 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1538387824 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1275002552 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1285290924 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1740376078 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1568908978 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1538387824 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1275002552 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1285290924 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1336859875 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1023147220 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1033677307 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1063935823 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1073604039 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083743538 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114344611 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134255847 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144876905 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1174659890 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1184246134 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1194315002 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1194450536 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1205325727 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1235265455 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1255877858 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1295788602 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1316484165 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1346379542 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1346583325 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1386773588 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1396831624 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1396874590 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1407221880 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427001940 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1467868851 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1467995852 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1508817313 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1508957572 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1518093830 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1568591766 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1578649638 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619275682 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1689046674 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1700839727 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1710422407 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1710462304 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1720519192 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1740459833 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1780380519 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801925003 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831285162 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831794007 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1861097115 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1871629501 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1891821013 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1902532070 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1922051978 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1932238136 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1932400546 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1972556496 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1972684710 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1982046710 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1023147220 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1033677307 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1063935823 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1073604039 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1114344611 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134255847 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1144876905 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1174659890 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1184246134 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1194315002 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1194450536 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1205325727 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1235265455 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1255877858 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1295788602 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1316484165 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1346379542 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1346583325 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1386773588 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1396831624 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1396874590 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1407221880 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1427001940 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1467868851 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1467995852 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1508817313 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1508957572 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1518093830 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1568591766 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1578649638 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1619275682 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1689046674 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1700839727 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1710422407 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1710462304 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1720519192 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1740459833 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801925003 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831285162 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831794007 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1861097115 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1871629501 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1891821013 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1902532070 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1922051978 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1932238136 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1932400546 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1972556496 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1972684710 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1982046710 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1578000345 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1194854398 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659407872 (OR)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1578000345 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1194854398 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659407872 (WA)		12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1679526107	12/18/2024 3:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1083743538	12/18/2024 3:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1780380519	12/18/2024 3:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336859875	12/18/2024 3:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	12/18/2024 3:48 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1679526107 (OR)		12/18/2024 3:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/2/2024 6:17 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500814580	2/2/2024 6:17 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/2/2024 6:17 PM
Details	Last Recertification Date	Update	Recertification	2/23/2023 7:34:12 PM	2/2/2024 6:17:11 PM	2/2/2024 6:17 PM
Addresses	Main Address	Update	Change Request	8935 SE POWELL BLVD PORTLAND, OR 97266-1938	3530 SE 88th Avenue PORTLAND, OR 97266	4/3/2023 10:23 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1578000345	4/3/2023 10:23 AM
Medicaid Billing	NPI: State	Insert	Change Request		OR	4/3/2023 10:23 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1194854398	4/3/2023 10:23 AM
Medicaid Billing	NPI: State	Insert	Change Request		OR	4/3/2023 10:23 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1659407872	4/3/2023 10:23 AM
Medicaid Billing	NPI: State	Insert	Change Request		OR	4/3/2023 10:23 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1578000345	4/3/2023 10:23 AM
Medicaid Billing	NPI: State	Insert	Change Request		WA	4/3/2023 10:23 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1194854398	4/3/2023 10:23 AM
Medicaid Billing	NPI: State	Insert	Change Request		WA	4/3/2023 10:23 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1659407872	4/3/2023 10:23 AM
Medicaid Billing	NPI: State	Insert	Change Request		WA	4/3/2023 10:23 AM
Contacts	Authorizing Official	Update	Profile Change Request	Trotter, Christine Sue Interim CEO Yakima Valley Farm Workers Clinic 5098656175-2128	Trotter, Christine Sue CEO Yakima Valley Farm Workers Clinic 5098656175-2128	2/24/2023 6:27 AM
Addresses	Billing Address	Insert	Recertification		Yakima Valley Farm Workers Clinic PO Box 190 Toppenish, WA 98948	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1023147220	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033677307	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1063935823	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073604039	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083743538	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114344611	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134255847	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144876905	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174659890	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1184246134	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194315002	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194450536	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1205325727	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1235265455	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1255877858	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295788602	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1316484165	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1346379542	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1346583325	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386773588	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1396831624	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1396874590	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1407221880	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427001940	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1467868851	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1467995852	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508817313	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508957572	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518093830	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568591766	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578649638	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619275682	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1689046674	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1700839727	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1710422407	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1710462304	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1720519192	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740459833	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780380519	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801925003	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831285162	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831794007	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1861097115	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1871629501	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1891821013	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1902532070	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1922051978	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932238136	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932400546	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972556496	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972684710	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1982046710	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1023147220	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033677307	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1063935823	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073604039	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083743538	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114344611	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1134255847	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1144876905	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174659890	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1184246134	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194315002	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194450536	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1205325727	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1235265455	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1255877858	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295788602	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1316484165	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336859875	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1346379542	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1346583325	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386773588	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1396831624	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1396874590	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1407221880	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427001940	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1467868851	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1467995852	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508817313	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508957572	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518093830	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568591766	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578649638	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1619275682	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1689046674	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1700839727	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1710422407	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1710462304	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1720519192	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740459833	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780380519	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801925003	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831285162	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831794007	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1861097115	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1871629501	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1891821013	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1902532070	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1922051978	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932238136	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932400546	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972556496	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972684710	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1982046710	2/23/2023 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/23/2023 7:34 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 10:28:57 AM	2/23/2023 7:34:12 PM	2/23/2023 7:34 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336859875	1/20/2023 5:01 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	1/20/2023 5:01 PM
Details	Last Recertification Date	Update	Recertification	2/17/2021 6:59:31 PM	2/1/2022 10:28:57 AM	2/1/2022 10:28 AM
Contacts	Authorizing Official	Update	Group Change Request	OLIVARES, JUAN CARLOS CEO Yakima Valley Farm Workers Clinic 5098655898-2101	Trotter, Christine Sue Interim CEO Yakima Valley Farm Workers Clinic 5098656175-2128	12/21/2021 2:56 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740376078	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568908978	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1538387824	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275002552	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285290924	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1679526107	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740376078	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568908978	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1538387824	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275002552	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/17/2021 6:59 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285290924	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/17/2021 6:59 PM
Medicaid Billing	NPI: State	Update	Recertification		OR	2/17/2021 6:59 PM
Details	Last Recertification Date	Update	Recertification	1/31/2020 3:46:31 PM	2/17/2021 6:59:31 PM	2/17/2021 6:59 PM
Details	Last Recertification Date	Update	Recertification	2/6/2019 8:01:00 PM	1/31/2020 3:46:31 PM	1/31/2020 3:46 PM
Details	Last Recertification Date	Update	Recertification	2/7/2018 7:23:08 PM	2/6/2019 8:01:00 PM	2/6/2019 8:01 PM
Contacts	Authorizing Official	Update	New Registration	OLIVARES, JUAN CARLOS CEO Yakima Valley Farm Workers Clinic 5098655898	OLIVARES, JUAN CARLOS CEO Yakima Valley Farm Workers Clinic 5098655898-2101	3/7/2018 11:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2018 7:23 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1016047	2/7/2018 7:23 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/7/2018 7:23 PM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/7/2018 7:23:08 PM	2/7/2018 7:23 PM
Contacts	Primary Contact	Update	Recertification	Davis, Glen COO 5098656175-2618	Davis, Glen COO Yakima Valley Farm Workers Clinic 5098656175-2618	2/7/2018 6:57 PM
Contacts	Authorizing Official	Update		OLIVARES, JUAN CARLOS CEO 5098655898	OLIVARES, JUAN CARLOS CEO Yakima Valley Farm Workers Clinic 5098655898	1/9/2018 4:20 PM
Contacts	Authorizing Official	Insert			OLIVARES, JUAN CARLOS CEO 5098655898	7/13/2017 2:14 PM
Contacts	Primary Contact	Update		Potter, Benjamin SENIOR DIRECTOR, PHARMACY OPERATIONS 5098656175-4178	Davis, Glen COO 5098656175-2618	5/22/2017 12:46 PM
Addresses	Main Address	Insert			8935 SE POWELL BLVD PORTLAND, OR 97266-1938	2/14/2017 11:24 AM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	2/13/2017 12:00:00 AM	2/14/2017 11:24 AM
Details	Last Recertification Date	Update		2/12/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 11:10 AM
Details	Last Recertification Date	Update		3/15/2014 12:00:00 AM	2/12/2015 12:00:00 AM	2/12/2015 1:55 PM
Contacts	Primary Contact	Insert			Potter, Benjamin SENIOR DIRECTOR, PHARMACY OPERATIONS 5098656175-4178	4/30/2014 10:39 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/15/2014 12:00:00 AM	3/15/2014 7:46 AM
Details	Entity Subname	Update		ROSEWOOD FAMILY HEALTH	ROSEWOOD FAMILY HEALTH CENTER	3/15/2014 7:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	3/1/2013 11:21 AM
Medicaid Billing	Medicaid: Number	Insert			022793	3/1/2013 11:21 AM
Medicaid Billing	Medicaid: State	Insert			OR	3/1/2013 11:21 AM
Medicaid Billing	NPI: Number	Insert			1679526107	3/1/2013 11:21 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/1/2013 11:21 AM
Details	Last Recertification Date	Insert				2/16/2007 10:04 AM
Details	Grant Number	Insert			H80CS00639	2/16/2007 10:04 AM
Details	340B ID	Insert			CH10103AD	2/16/2007 10:04 AM
Details	Is Authorizing Official EHB Data	Insert				2/16/2007 10:04 AM
Dates	Last Date That 340B Drugs Purchased	Insert				2/16/2007 10:04 AM
Details	Medicare Provider Number	Insert				2/16/2007 10:04 AM
Details	Entity Name	Insert			YAKIMA VALLEY FARM WORKERS CLINIC	2/16/2007 10:04 AM
Details	Program Code	Insert			CH	2/16/2007 10:04 AM
Details	Entity Subname	Insert			ROSEWOOD FAMILY HEALTH	2/16/2007 10:04 AM
Dates	Participating Approval Date	Insert			2/16/2007 12:00:00 AM	2/16/2007 10:04 AM
Details	State	Insert			Active	2/16/2007 10:04 AM
Dates	Registration Date	Insert			2/15/2007 12:00:00 AM	2/16/2007 10:04 AM
Dates	Signed By Date	Insert			1/14/2007 12:00:00 AM	2/16/2007 10:04 AM
Dates	Start Date	Insert			4/1/2007 12:00:00 AM	2/16/2007 10:04 AM
Terminations	Termination Comments	Insert				2/16/2007 10:04 AM
Terminations	Termination Date	Insert				2/16/2007 10:04 AM
Terminations	Termination Effective Date	Insert				2/16/2007 10:04 AM
Terminations	Termination Reason	Insert				2/16/2007 10:04 AM

340B Drug Pricing Program Database