340B Drug Pricing Program Database


CH09123I LA CLINICA DE LA RAZA, INC. (Active) - information as of 5/9/2025 10:42:48 PM

Main Details
LA CLINICA DE LA RAZA, INC.
LA CLINICA VALLEJO GREAT BEGINNINGS
HRSA-Funded Health Center
BPS-H80-001152
CH09123I
H80CS00631


Additional Details
Active
8/10/2007
10/1/2007
8/13/2007
2/11/2025

Contacts

La Clinica de La Raza
Jane Garcia, CEO
(510) 535-4000

La Clinica de La Raza
Dolly Davar, Pharmacy Director
(510) 535-3382

Addresses

210 HOSPITAL DRIVE
VALLEJO, CA 94589-2517

LA CLINICA DE LA RAZA
P.O. BOX 22210
OAKLAND, CA 94623


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
6/8/10 UPDATED BILL TO (WAS 1515 FRUITVALE AVE, 94601)06/08/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA 1992863096,1730476110,1184194482
Shipping Addresses

Same as Street Address
Contract Pharmacies
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH091230ActiveADMINLA CLINICA DE LA RAZA, INC. 1450 FRUITVALE AVE,3RD FLOOROAKLANDCA
CH09123AActiveBPS-H80-000255LA CLINICA DE LA RAZA, INC.SAN ANTONIO NEIGHBORHOOD HEALTH CENTER1030 INTERNATIONAL BLVD OAKLANDCA
CH09123AAActiveBPS-H80-001208LA CLINICA DE LA RAZA, INC.LA CLINICA VALLEJO GREAT BEGINNINGS/NORTH VALLEJO SUPPORT SERVICES190 Hospital Dr VallejoCA
CH09123ABActiveBPS-H80-009941LA CLINICA DE LA RAZA, INC.Casa del Sol III1415-1423 Fruitvale Avenue OaklandCA
CH09123ACActiveBPS-H80-006980LA CLINICA DE LA RAZA, INC.TECHNICLINIC (aka Oakland Technical School-Based Clinic)4351 BROADWAY OAKLANDCA
CH09123ADActiveBPS-H80-006252LA CLINICA DE LA RAZA, INC.TIGER HEALTH CLINIC (aka Fremont High School-Based Clinic)4610 FOOTHILL BLVD OAKLANDCA
CH09123AEActiveBPS-H80-007183LA CLINICA DE LA RAZA, INC.SAN LORENZO HIGH HEALTH CENTER (aka San Lorenzo High School-Based Clinic)50 E. LEWELLING BLVDRoom S5SAN LORENZOCA
CH09123AFTerminatedBPS-H80-017192LA CLINICA DE LA RAZA, INC.La Clinica Dental at Elsa Widenmann Health Center100 Whitney Ave VallejoCA
CH09123AGActiveBPS-H80-018924LA CLINICA DE LA RAZA, INC.La Clinica Julian R. Davis Pediatrics5461 Foothill Blvd OaklandCA
CH09123AHActiveBPS-H80-036968LA CLINICA DE LA RAZA, INC.La Clinica at 95th Avenue9475 International Blvd OaklandCA
CH09123AJActiveBPS-H80-008905LA CLINICA DE LA RAZA, INC.La Clinica TRUCHA1525 Fruitvale Ave OaklandCA
CH09123BActiveBPS-H80-000944LA CLINICA DE LA RAZA, INC.LA CLINICA PITTSBURG DENTAL 339 E. LELAND RD PITTSBURGCA
CH09123CActiveBPS-H80-003054LA CLINICA DE LA RAZA, INC.LA CLINICA PITTSBURG - MEDICAL2240 Gladstone Dr STE 4 PittsburgCA
CH09123EActiveBPS-H80-002390LA CLINICA DE LA RAZA, INC.LA CLINICA DE LA RAZA 3451 E 12th St OaklandCA
CH09123IActiveBPS-H80-001152LA CLINICA DE LA RAZA, INC.LA CLINICA VALLEJO GREAT BEGINNINGS210 HOSPITAL DRIVE VALLEJOCA
CH09123JTerminatedBPS-H80-000392LA CLINICA DE LA RAZA, INC.LA CLINICA VALLEJO DENTAL2920-A SONOMA BLVD VALLEJOCA
CH09123KActiveBPS-H80-032191LA CLINICA DE LA RAZA, INC.LA CLINICA VALLEJO415 GEORGIA STREET VALLEJOCA
CH09123LActiveBPS-H80-007592LA CLINICA DE LA RAZA, INC.LA CLINICA NORTH VALLEJO220 HOSPITAL DRIVE VALLEJOCA
CH09123MActiveBPS-H80-006808LA CLINICA DE LA RAZA, INC.Hawthorne Elementary School-Based Clinic1700 28th Avenue OaklandCA
CH09123NActiveBPS-H80-011034LA CLINICA DE LA RAZA, INC.La Clinica Oakley2021 Main Street OakleyCA
CH09123PActiveBPS-H80-010550LA CLINICA DE LA RAZA, INC.LA CLINICA MONUMENT2000 Sierra Rd ConcordCA
CH09123QActiveBPS-H80-004188LA CLINICA DE LA RAZA, INC.Family Optical I3060 East 9th StreetSTE BOaklandCA
CH09123RActiveBPS-H80-001899LA CLINICA DE LA RAZA, INC.La Clinica de La Raza-Dental3050 East 16th Street OaklandCA
CH09123SActiveBPS-H80-024681LA CLINICA DE LA RAZA, INC.La Clinica Dental at Children's Hospital Oakland4881 Telegraph Ave OaklandCA
CH09123TActiveBPS-H80-001726LA CLINICA DE LA RAZA, INC.Casa del Sol1501 Fruitvale Avenue OaklandCA
CH09123UActiveBPS-H80-000076LA CLINICA DE LA RAZA, INC.Casa del Sol II1450 Fruitvale AvenueSuite-EOaklandCA
CH09123VActiveBPS-H80-010973LA CLINICA DE LA RAZA, INC.Havenscourt Health Center1390 66th Ave OaklandCA
CH09123WActiveBPS-H80-000970LA CLINICA DE LA RAZA, INC.CLINICA ALTA VISTA1515 FRUITVALE AVE OAKLANDCA
CH09123XActiveBPS-H80-012140LA CLINICA DE LA RAZA, INC.Youth Heart Health Center286 East 10th Street OaklandCA
CH09123YActiveBPS-H80-006025LA CLINICA DE LA RAZA, INC.ROOSEVELT HEALTH CENTER (AKA ROOSEVELT MIDDLE SCHOOL-BASED CLINIC)1926 E 19th St OaklandCA
CH09123ZActiveBPS-H80-012661LA CLINICA DE LA RAZA, INC.Fuente Wellness Center16335 E 14th St San LeandroCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH091230GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 8431 7200 BANCROFT AVE.
OAKLANDCA9460501/01/2022  
CH091230GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16764 15555 E 14TH ST STE 400
SAN LEANDROCA9457801/01/2022  
CH09123AGGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 8431 7200 BANCROFT AVE.
OAKLANDCA9460501/01/2024  
CH09123UGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16764 15555 E 14TH ST STE 400
SAN LEANDROCA9457801/01/2024  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450101/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461101/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460201/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450101/01/2022 02/06/2023
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457701/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09832 3678 SONOMA BLVD
VALLEJOCA9459001/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09876 699 LEWELLING BLVD
SAN LEANDROCA9457901/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09927 1193 ADMIRAL CALLAGHAN LANE
VALLEJOCA9459101/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09957 344 THOMAS L. BERKLEY WAY
OAKLANDCA9461201/01/2022 03/04/2022
CH09123XLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450101/01/2024  
CH09123ELONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461101/01/2024  
CH09123MLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460201/01/2024  
CH09123ZLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457701/01/2024  
CH09123TLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09876 699 LEWELLING BLVD
SAN LEANDROCA9457901/01/2024  
CH09123ILONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09832 3678 SONOMA BLVD
VALLEJOCA9459001/01/2024  
CH09123KLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09927 1193 ADMIRAL CALLAGHAN LANE
VALLEJOCA9459101/01/2024  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09761 2100 COLUMBUS PKWY
BENICIACA9451007/01/2025  
CH091230WALGREEN CODBA: WALGREENS #09978 6570 LONE TREE WAY
BRENTWOODCA9451309/14/2012  
CH09123CWALGREEN CODBA: WALGREENS #09978 6570 LONE TREE WAY
BRENTWOODCA9451301/01/2024  
CH091230WALGREEN CO.DBA: WALGREENS # 01537 3232 FOOTHILL BLVD
OAKLANDCA9460111/25/2011  
CH091230WALGREEN CO.DBA: WALGREENS # 03295 8102 INTERNATIONAL BLVD
OAKLANDCA9462111/25/2011 07/30/2021
CH091230WALGREEN CO.DBA: WALGREENS # 09248 2300 OTIS DRIVE
ALAMEDACA9450111/25/2011  
CH091230WALGREEN CO.DBA: WALGREENS #11706 301 E. 18TH STREET
OAKLANDCA94606-181311/25/2011 02/24/2025
CH091230WALGREEN CO.DBA: WALGREENS # 02426 15500 WASHINGTON AVE
SAN LEANDROCA9457911/25/2011  
CH091230WALGREEN CO.DBA: WALGREENS # 01536 3434 HIGH STREET
OAKLANDCA9461911/25/2011 01/22/2025
CH091230WALGREEN CO.DBA: WALGREENS # 03171 1050 REDWOOD STREET
VALLEJOCA9459009/14/2012 02/25/2025
CH091230WALGREEN CO.DBA: WALGREENS # 04724 3416 DEER VALLEY RD.
ANTIOCHCA94531-665009/14/2012 11/07/2024
CH091230WALGREEN CO.DBA: WALGREENS # 07376 2901 RAILROAD AVE
PITTSBURGCA94565-522409/14/2012  
CH091230WALGREEN CO.DBA: WALGREENS #15003 1990 MONUMENT BLVD.
CONCORDCA94520-380009/14/2012  
CH091230WALGREEN CO.DBA: WALGREENS # 02575 2647 SPRINGS ROAD
VALLEJOCA9459107/01/2013 02/27/2025
CH091230WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16477 3009 BROADWAY
OAKLANDCA9461107/01/2018  
CH091230WALGREEN CO.DBA: WALGREENS # 07274 1456 136TH AVE
SAN LEANDROCA94578-255207/01/2022 03/27/2025
CH091230WALGREEN CO.DBA: WALGREENS #11365 210 AMERICAN CANYON RD.
AMERICAN CANYONCA9450307/01/2022  
CH091230WALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460507/01/2022 01/30/2025
CH09123WWALGREEN CO.DBA: WALGREENS # 09248 2300 OTIS DRIVE
ALAMEDACA9450101/01/2024  
CH09123BWALGREEN CO.DBA: WALGREENS #11365 210 AMERICAN CANYON RD.
AMERICAN CANYONCA9450301/01/2024  
CH09123PWALGREEN CO.DBA: WALGREENS #15003 1990 MONUMENT BLVD.
CONCORDCA94520-380001/01/2024  
CH09123AWALGREEN CO.DBA: WALGREENS # 01537 3232 FOOTHILL BLVD
OAKLANDCA9460101/01/2024  
CH09123ABWALGREEN CO.DBA: WALGREENS #11706 301 E. 18TH STREET
OAKLANDCA94606-181301/01/2024  
CH09123ACWALGREEN CO.DBA: WALGREENS # 01536 3434 HIGH STREET
OAKLANDCA9461901/01/2024  
CH09123ADWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16477 3009 BROADWAY
OAKLANDCA9461101/01/2024  
CH09123QWALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460501/01/2024  
CH09123RWALGREEN CO.DBA: WALGREENS # 07376 2901 RAILROAD AVE
PITTSBURGCA94565-522401/01/2024  
CH09123SWALGREEN CO.DBA: WALGREENS # 02426 15500 WASHINGTON AVE
SAN LEANDROCA9457901/01/2024  
CH09123VWALGREEN CO.DBA: WALGREENS # 07274 1456 136TH AVE
SAN LEANDROCA94578-255201/01/2024  
CH09123LWALGREEN CO.DBA: WALGREENS # 02575 2647 SPRINGS ROAD
VALLEJOCA9459101/01/2024  
CH091230WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904907/01/2013 07/22/2015
CH091230WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528407/01/2013 07/22/2015
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/30/2024 2:04:38 PM2/11/2025 5:41:56 PM2/11/2025 5:41 PM
Medicaid BillingNPI: NumberInsertChange Request 17304761103/25/2024 5:54 PM
Medicaid BillingNPI: StateInsertChange Request CA3/25/2024 5:54 PM
Medicaid BillingNPI: NumberInsertChange Request 11841944823/25/2024 5:54 PM
Medicaid BillingNPI: StateInsertChange Request CA3/25/2024 5:54 PM
DetailsLast Recertification DateUpdateRecertification2/7/2023 4:59:28 PM1/30/2024 2:04:38 PM1/30/2024 2:04 PM
DetailsLast Recertification DateUpdateRecertification2/1/2022 6:09:43 PM2/7/2023 4:59:28 PM2/7/2023 4:59 PM
DetailsLast Recertification DateUpdateRecertification2/3/2021 1:58:59 PM2/1/2022 6:09:43 PM2/1/2022 6:09 PM
Medicaid BillingNPI: StateUpdateRecertification CA2/3/2021 1:58 PM
DetailsLast Recertification DateUpdateRecertification1/28/2020 3:13:56 PM2/3/2021 1:58:59 PM2/3/2021 1:58 PM
ContactsPrimary ContactUpdateProfile Change RequestDavar, Dolly Pharmacy Manager La Clinica de La Raza 5105353382Davar, Dolly Pharmacy Director La Clinica de La Raza 51053533827/17/2020 2:54 PM
DetailsLast Recertification DateUpdateRecertification2/6/2019 5:13:48 PM1/28/2020 3:13:56 PM1/28/2020 3:13 PM
AddressesMain AddressUpdateChange Request 210 HOSPITAL DRIVE VALLEJO, CA 94589 210 HOSPITAL DRIVE VALLEJO, CA 94589-25178/2/2019 7:21 AM
DetailsLast Recertification DateUpdateRecertification2/15/2018 2:53:50 PM2/6/2019 5:13:48 PM2/6/2019 5:13 PM
DetailsLast Recertification DateUpdateRecertification1/31/2017 12:00:00 AM2/15/2018 2:53:50 PM2/15/2018 2:53 PM
ContactsAuthorizing OfficialUpdate Garcia, Jane CEO 5105354000Garcia, Jane CEO La Clinica de La Raza 51053540002/15/2018 2:32 PM
ContactsPrimary ContactUpdate Davar, Dolly Pharmacy Manager 5105353382Davar, Dolly Pharmacy Manager La Clinica de La Raza 51053533829/29/2017 1:28 PM
ContactsAuthorizing OfficialUpdate CARP, BRUCE CHIEF FINANCIAL OFFICER 5105352915Garcia, Jane CEO 51053540005/16/2017 2:52 PM
ContactsPrimary ContactInsert  Davar, Dolly Pharmacy Manager 51053533825/16/2017 2:52 PM
AddressesMain AddressInsert   210 HOSPITAL DRIVE VALLEJO, CA 945891/31/2017 4:29 PM
DetailsLast Recertification DateUpdate 2/23/2016 12:00:00 AM1/31/2017 12:00:00 AM1/31/2017 4:29 PM
DetailsLast Recertification DateUpdate 2/12/2015 12:00:00 AM2/23/2016 12:00:00 AM2/23/2016 5:18 PM
DetailsLast Recertification DateUpdate 3/17/2014 12:00:00 AM2/12/2015 12:00:00 AM2/12/2015 10:59 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/17/2014 12:00:00 AM3/17/2014 11:07 PM
AddressesBilling AddressInsert  LA CLINICA DE LA RAZA P.O. BOX 22210 OAKLAND, CA 946234/12/2013 10:43 AM
DetailsEntity NameUpdate LA CLINICA DE LA RAZALA CLINICA DE LA RAZA, INC.4/12/2013 10:43 AM
Medicaid BillingNPI: NumberInsert  19928630962/27/2013 7:49 AM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/27/2013 7:49 AM
ContactsAuthorizing OfficialInsert  CARP, BRUCE CHIEF FINANCIAL OFFICER 51053529156/8/2010 3:17 PM
DetailsLast Recertification DateInsert   6/8/2010 3:00 PM
DetailsGrant NumberInsert  H80CS006316/8/2010 3:00 PM
Details340B IDInsert  CH09123I6/8/2010 3:00 PM
DetailsIs Authorizing Official EHB DataInsert   6/8/2010 3:00 PM
DatesLast Date That 340B Drugs PurchasedInsert   6/8/2010 3:00 PM
DetailsMedicare Provider NumberInsert   6/8/2010 3:00 PM
DetailsEntity NameInsert  LA CLINICA DE LA RAZA6/8/2010 3:00 PM
DetailsProgram CodeInsert  CH6/8/2010 3:00 PM
DetailsEntity SubnameInsert  LA CLINICA VALLEJO GREAT BEGINNINGS6/8/2010 3:00 PM
DatesParticipating Approval DateInsert  8/13/2007 12:00:00 AM6/8/2010 3:00 PM
DetailsStateInsert  Active6/8/2010 3:00 PM
DatesRegistration DateInsert  8/10/2007 12:00:00 AM6/8/2010 3:00 PM
DatesSigned By DateInsert  8/8/2007 12:00:00 AM6/8/2010 3:00 PM
DatesStart DateInsert  10/1/2007 12:00:00 AM6/8/2010 3:00 PM
TerminationsTermination CommentsInsert   6/8/2010 3:00 PM
TerminationsTermination DateInsert   6/8/2010 3:00 PM
TerminationsTermination Effective DateInsert   6/8/2010 3:00 PM
TerminationsTermination ReasonInsert   6/8/2010 3:00 PM
DetailsComments PublicInsert  6/8/10 UPDATED BILL TO (WAS 1515 FRUITVALE AVE, 94601)6/8/2010 3:00 PM