Covered Entity Details

CH0921430 LOS ANGELES CHRISTIAN HEALTH CENTERS (Active) - information as of 4/29/2025 1:41:11 AM

Main Details

Name

LOS ANGELES CHRISTIAN HEALTH CENTERS

Subdivision Name

JOSHUA HOUSE CLINIC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-001980

340B ID

CH0921430

Grant Number

H80CS06674

Additional Details

Current Program Status

Active

Registration Date

11/29/2007

Participating Start Date

1/1/2005

Participating Approval Date

11/29/2007

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Los Angeles Christian Health Centers
Bettina Lewis, Chief Operations Officer
(213) 893-1960

Primary Contact

Los Angeles Christian Health Centers
Elaine Rivera, Pharmacy Director
(323) 268-8391

Addresses

Street Address

311 Winston Street
Los Angeles, CA 90013

Billing Address

Los Angeles Christian Health Centers
453 S Spring Street, Suite 1201
Los Angeles, CA 90013

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
CA	1770855132	1942398367,1770855132

Shipping Addresses

Shipping Address 1

Los Angeles Christian Health Centers
1625 E 4th Street
Los Angeles, CA 90033

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AVITA PHARMACY 1004	PHARMEDQUEST PHARMACY SERVICES DBA AVITA	325 E 7TH ST RM 101	LOS ANGELES	CA	90014-2209	04/10/2020	07/01/2020		07/01/2020
Contract Detail	AVITA PHARMACY 1025	PHARMEDQUEST PHARMACY SERVICES DBA AVITA	3020 SATURN ST STE 100	BREA	CA	92821	10/09/2020	01/01/2021		01/01/2021
Contract Detail	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	04/06/2020	07/01/2020	04/01/2021	04/01/2021
Contract Detail	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	07/06/2021	10/01/2021		10/01/2021
Contract Detail	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	10/08/2018	01/01/2019	04/01/2021	04/01/2021
Contract Detail	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	10/08/2018	01/01/2019	04/01/2021	04/01/2021
Contract Detail	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	10/15/2015	01/01/2016	08/21/2018	08/21/2018
Contract Detail	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	07/06/2021	10/01/2021		10/01/2021
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	10/10/2017	01/01/2018	10/19/2017	10/19/2017

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH0921430	Active	BPS-H80-001980	LOS ANGELES CHRISTIAN HEALTH CENTERS	JOSHUA HOUSE CLINIC	311 Winston Street		Los Angeles	CA
CH092143AA	Terminated	BPS-H80-019345	Los Angeles Christian Health Centers	Los Angeles Christian Health Centers @ HHCLA Harm Reduction Center (Exam Rm 1 & 2)	512 E 4th Street		Los Angeles	CA
CH092143AB	Active	BPS-H80-029760	Los Angeles Christian Health Centers	Los Angeles Christian Health Centers at Joshua House Health Center	325 E 7th St		Los Angeles	CA
CH092143AC	Active	BPS-H80-035231	Los Angeles Christian Health Centers	LACHC Mobile Medical Van #1	325 E 7th St		Los Angeles	CA
CH092143AD	Terminated	BPS-H80-032666	Los Angeles Christian Health Centers	Los Angeles Christian Health Centers At Union Rescue Mission	545 S San Pedro St (Rms 237, 268-274, Nursing Office Suite)		Los Angeles	CA
CH092143AE	Terminated	BPS-H80-035643	Los Angeles Christian Health Centers	Los Angeles Christian Health Centers at URM Angeles House	13200 Avalon Blvd. (Rms 1013, 1014, 1016, 1018, 1019, 1027, 1028)		Los Angeles	CA
CH092143G	Terminated	BPS-H80-006753	LOS ANGELES CHRISTIAN HEALTH CENTERS	VOLUNTEERS OF AMERICA DROP-IN-CENTER	628 San Julian St		Los Angeles	CA
CH092143I	Active	BPS-H80-006239	LOS ANGELES CHRISTIAN HEALTH CENTERS	MIDNIGHT MISSION	601 S San Pedro St		Los Angeles	CA
CH092143L	Active	BPS-H80-000692	LOS ANGELES CHRISTIAN HEALTH CENTERS	Los Angeles Christian Health Centers at Pico Aliso	1625 E 4th St		Los Angeles	CA
CH092143N	Terminated	BPS-H80-009305	LOS ANGELES CHRISTIAN HEALTH CENTERS	Los Angeles Mission- Anne Douglas Center	303 E 5th St		Los Angeles	CA
CH092143P	Active	BPS-H80-009488	LOS ANGELES CHRISTIAN HEALTH CENTERS	Gateway Percy Village	3455 Percy St		Los Angeles	CA
CH092143Q	Terminated	BPS-H80-009434	LOS ANGELES CHRISTIAN HEALTH CENTERS	PowerHouse Church of World Impact	2003 E Imperial Hwy		Los Angeles	CA
CH092143R	Terminated	BPS-H80-011758	LOS ANGELES CHRISTIAN HEALTH CENTERS	TeleCare- Core LA	1005 S Central Ave		Los Angeles	CA
CH092143S	Terminated	BPS-H80-011757	LOS ANGELES CHRISTIAN HEALTH CENTERS	TeleCare- LA 4	600 St. Paul Ave., Ste. 100		Los Angeles	CA
CH092143T	Active	BPS-H80-012648	LOS ANGELES CHRISTIAN HEALTH CENTERS	Los Angeles Christian Health Centers at New Genesis	456 S. Main Street	(Exam Rm 1 & 2, vitals room, waiting room)	Los Angeles	CA
CH092143U	Terminated	BPS-H80-006688	LOS ANGELES CHRISTIAN HEALTH CENTERS	LAMP COMMUNITY VILLAGE	527 Crocker St		Los Angeles	CA
CH092143V	Active	BPS-H80-012640	LOS ANGELES CHRISTIAN HEALTH CENTERS	Los Angeles Christian Health Centers-Exodus Recovery/Marengo	1920 Marengo Street (Exam Rm 1 & 2)		Los Angeles	CA
CH092143W	Terminated	BPS-H80-018444	Los Angeles Christian Health Centers	Los Angeles Christian Health Centers at TeleCare- LA 4	600 St. Paul Ave., Suite 200 (Exam Rms 1 & 2, waiting area)		Los Angeles	CA
CH092143X	Terminated	BPS-H80-018114	Los Angeles Christian Health Centers	Los Angeles Christian Health Centers at Dolores Mission School	170 South Gless Street		Los Angeles	CA
CH092143Y	Terminated	BPS-H80-018112	Los Angeles Christian Health Centers	Los Angeles Christian Health Centers at Grape Street Elementary	1940 E. 111th Street		Los Angeles	CA
CH092143Z	Terminated	BPS-H80-013008	Los Angeles Christian Health Centers	Los Angeles Christian Health Centers-Exodus Recovery IMHT	8511 1/2 S. Vermont Ave., Rms 1 &		Los Angeles	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0921430	AVITA PHARMACY 1004	PHARMEDQUEST PHARMACY SERVICES DBA AVITA	325 E 7TH ST RM 101	LOS ANGELES	CA	90014-2209	07/01/2020
CH092143AB	AVITA PHARMACY 1004	PHARMEDQUEST PHARMACY SERVICES DBA AVITA	325 E 7TH ST RM 101	LOS ANGELES	CA	90014-2209	07/01/2021
CH0921430	AVITA PHARMACY 1025	PHARMEDQUEST PHARMACY SERVICES DBA AVITA	3020 SATURN ST STE 100	BREA	CA	92821	01/01/2021
CH092143AB	AVITA PHARMACY 1025	PHARMEDQUEST PHARMACY SERVICES DBA AVITA	3020 SATURN ST STE 100	BREA	CA	92821	07/01/2021
CH0921430	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2020	04/01/2021
CH092143L	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2020	04/01/2021
CH092143L	BOTICA DEL SOL	HYGEIA APOTHECARY, INC. DBA	2331 CESAR CHAVEZ AVENUE	LOS ANGELES	CA	90033	01/01/2014	10/15/2015
CH0921430	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021
CH092143AA	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2025
CH092143AB	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021
CH092143I	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021
CH092143L	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021
CH092143P	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021
CH092143Q	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH092143T	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021
CH092143V	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021
CH0921430	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2021
CH092143AA	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2021
CH092143I	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2021
CH092143L	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2021
CH092143P	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2021
CH092143Q	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2021
CH092143R	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2020
CH092143S	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	01/01/2019
CH092143V	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2021
CH092143W	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	01/01/2021
CH092143X	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2021
CH092143Y	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	01/01/2019	04/01/2020
CH092143T	KROGER SPECIALTY PHARMACY CA 2	6240 WILSHIRE BLVD.		LOS ANGELES	CA	90048	04/01/2020	04/01/2021
CH0921430	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2021
CH092143AA	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2021
CH092143I	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2021
CH092143L	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2021
CH092143P	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2021
CH092143Q	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2021
CH092143R	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2020
CH092143S	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	01/01/2019
CH092143V	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2021
CH092143W	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	01/01/2021
CH092143X	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2021
CH092143Y	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	01/01/2019	04/01/2020
CH092143T	KROGER SPECIALTY PHARMACY INC	KROGER SPECIALTY PHARMACY CA 3	1821 KAISER AVE	IRVINE	CA	92614-5707	04/01/2020	04/01/2021
CH092143G	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	04/01/2018
CH092143I	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	08/21/2018
CH0921430	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	08/21/2018
CH092143L	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	10/07/2020
CH092143N	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	04/01/2018
CH092143Q	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	08/21/2018
CH092143P	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	08/21/2018
CH092143R	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	08/21/2018
CH092143S	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	08/21/2018
CH092143V	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	08/21/2018
CH092143T	LOS ANGELES CHRISTIAN HEALTH CENTERS	1625 E 4TH ST		LOS ANGELES	CA	90033	01/01/2016	08/21/2018
CH092143AA	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2025
CH0921430	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021
CH092143AB	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021
CH092143I	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021
CH092143L	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021
CH092143P	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021
CH092143Q	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH092143T	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021
CH092143V	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021
CH092143L	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH0921430	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143G	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143P	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143I	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143Q	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143R	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143S	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143T	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143V	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143AA	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143W	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017
CH092143X	THRIFTY PAYLESS, INC.	RITE AID #5429	500 SOUTH BROADWAY	LOS ANGELES	CA	90013	01/01/2018	10/19/2017

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/19/2024 1:51:24 PM	2/10/2025 8:09:51 PM	2/10/2025 8:09 PM
Details	Last Recertification Date	Update	Recertification	2/9/2023 10:58:12 PM	2/19/2024 1:51:24 PM	2/19/2024 1:51 PM
Details	Last Recertification Date	Update	Recertification	2/16/2022 12:16:41 PM	2/9/2023 10:58:12 PM	2/9/2023 10:58 PM
Details	Last Recertification Date	Update	Recertification	2/10/2021 3:09:52 PM	2/16/2022 12:16:41 PM	2/16/2022 12:16 PM
Details	Last Recertification Date	Update	Recertification	2/12/2020 4:09:26 PM	2/10/2021 3:09:52 PM	2/10/2021 3:09 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1942398367 (CA)		10/9/2020 6:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/9/2020 6:23 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1770855132	10/9/2020 6:23 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	10/9/2020 6:23 PM
Addresses	Billing Address	Update	Change Request	Los Angeles Christian Health Centers 202 W 1st Street 4-0435 Los Angeles, CA 90012	Los Angeles Christian Health Centers 453 S Spring Street, Suite 1201 Los Angeles, CA 90013	10/9/2020 4:03 PM
Medicaid Billing	NPI: State	Update	Change Request		CA	10/9/2020 4:03 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1770855132	10/9/2020 4:03 PM
Medicaid Billing	NPI: State	Insert	Change Request		CA	10/9/2020 4:03 PM
Details	Last Recertification Date	Update	Recertification	2/15/2019 11:57:27 AM	2/12/2020 4:09:26 PM	2/12/2020 4:09 PM
Details	Last Recertification Date	Update	Recertification	2/14/2018 9:27:57 AM	2/15/2019 11:57:27 AM	2/15/2019 11:57 AM
Contacts	Primary Contact	Update	Change Request	Chen, Kelly Pharmacy Director Los Angeles Christian Health Centers 3232688391	Rivera, Elaine Pharmacy Director Los Angeles Christian Health Centers 3232688391	8/21/2018 12:58 PM
Addresses	Main Address	Update	Recertification	311 Winston St Los Angeles, CA 90013-1519	311 Winston Street Los Angeles, CA 90013	2/14/2018 9:27 AM
Addresses	Billing Address	Insert	Recertification		Los Angeles Christian Health Centers 202 W 1st Street 4-0435 Los Angeles, CA 90012	2/14/2018 9:27 AM
Addresses	Shipping Address	Insert	Recertification		Los Angeles Christian Health Centers 1625 E 4th Street Los Angeles, CA 90033	2/14/2018 9:27 AM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/14/2018 9:27:57 AM	2/14/2018 9:27 AM
Contacts	Primary Contact	Update	Profile Change Request	Chang, Kelly Pharmacy Director Los Angeles Christian Health Centers 3232688391	Chen, Kelly Pharmacy Director Los Angeles Christian Health Centers 3232688391	2/13/2018 1:59 PM
Contacts	Authorizing Official	Insert	AO Change Request		Lewis, Bettina Chief Operations Officer Los Angeles Christian Health Centers 2138931960	10/13/2017 9:57 AM
Contacts	Primary Contact	Update	Contract Pharmacy Registration	Chang, Kelly Pharmacy Director 3232688391	Chang, Kelly Pharmacy Director Los Angeles Christian Health Centers 3232688391	10/10/2017 4:43 PM
Contacts	Primary Contact	Insert			Chang, Kelly Pharmacy Director 3232688391	5/23/2017 10:22 AM
Addresses	Main Address	Insert			311 Winston St Los Angeles, CA 90013-1519	2/14/2017 12:40 AM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	2/13/2017 12:00:00 AM	2/14/2017 12:40 AM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 6:44 PM
Details	Last Recertification Date	Update		3/14/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	3/14/2014 6:26 AM
Medicaid Billing	Medicaid: Number	Insert			1942398367	3/14/2014 6:26 AM
Medicaid Billing	Medicaid: State	Insert			CA	3/14/2014 6:26 AM
Medicaid Billing	NPI: Number	Insert			1942398367	3/14/2014 6:26 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/14/2014 12:00:00 AM	3/14/2014 6:26 AM
Details	Entity Subname	Update		LOS ANGELES CHRISTIAN HEALTH CENTERS	JOSHUA HOUSE CLINIC	3/14/2014 6:26 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/20/2013 8:57 AM
Details	Last Recertification Date	Insert				2/19/2009 12:10 PM
Details	Grant Number	Insert			H80CS06674	2/19/2009 12:10 PM
Details	340B ID	Insert			CH0921430	2/19/2009 12:10 PM
Details	Is Authorizing Official EHB Data	Insert				2/19/2009 12:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert				2/19/2009 12:10 PM
Details	Medicare Provider Number	Insert				2/19/2009 12:10 PM
Details	Entity Name	Insert			LOS ANGELES CHRISTIAN HEALTH CENTERS	2/19/2009 12:10 PM
Details	Program Code	Insert			CH	2/19/2009 12:10 PM
Details	Entity Subname	Insert			LOS ANGELES CHRISTIAN HEALTH CENTERS	2/19/2009 12:10 PM
Dates	Participating Approval Date	Insert			11/29/2007 12:00:00 AM	2/19/2009 12:10 PM
Details	State	Insert			Active	2/19/2009 12:10 PM
Dates	Registration Date	Insert			11/29/2007 12:00:00 AM	2/19/2009 12:10 PM
Dates	Signed By Date	Insert				2/19/2009 12:10 PM
Dates	Start Date	Insert			1/1/2005 12:00:00 AM	2/19/2009 12:10 PM
Terminations	Termination Comments	Insert				2/19/2009 12:10 PM
Terminations	Termination Date	Insert				2/19/2009 12:10 PM
Terminations	Termination Effective Date	Insert				2/19/2009 12:10 PM
Terminations	Termination Reason	Insert				2/19/2009 12:10 PM

340B Drug Pricing Program Database