340B Drug Pricing Program Database


CHC12875-00 HURTT FAMILY HEALTH CLINIC, INC. (Active) - information as of 6/15/2025 6:04:57 AM

Main Details
HURTT FAMILY HEALTH CLINIC, INC.
Hurtt Family Health Clinic - Village of Hope
HRSA-Funded Health Center
BPS-H80-008358
CHC12875-00
H80CS12875


Additional Details
Active
11/24/2010
1/1/2011
12/6/2010
3/5/2025

Contacts

Hurtt Family Health Clinic
Jina 714-914-6551 Lawler, President & CEO
(714) 247-8044

Hurtt Family Health Clinic
Mercedes Wagner, Pharmacist
(714) 397-1224

Addresses

1 Hope Drive
Tustin, CA 92782

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA 1306965587,1235546995,1619384369
Shipping Addresses

Same as Street Address
Contract Pharmacies
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC12875-00ActiveBPS-H80-008358HURTT FAMILY HEALTH CLINIC, INC.Hurtt Family Health Clinic - Village of Hope1 Hope Drive TustinCA
CHC12875-01ActiveBPS-H80-015079HURTT FAMILY HEALTH CLINIC, INC.Hurtt Family Health Clinic - Santa Ana Medical1100 N Tustin Ave. Santa AnaCA
CHC12875-02ActiveBPS-H80-018395HURTT FAMILY HEALTH CLINIC, INC.Hurtt Family Health Clinic - Santa Ana BH1100 N Tustin Ave Ste F Santa AnaCA
CHC12875-03ActiveBPS-H80-019545HURTT FAMILY HEALTH CLINIC, INC.Hurtt Family Health Clinic - Anaheim947 S. Anaheim Blvd AnaheimCA
CHC12875-04ActiveBPS-H80-008359HURTT FAMILY HEALTH CLINIC, INC.Hurtt Family Health Clinic - Mobile Clinic 11 Hope Drive TustinCA
CHC12875-05ActiveBPS-H80-013293HURTT FAMILY HEALTH CLINIC, INC.Hurtt Family Health Clinic - Santa Ana Dental1100 N Tustin Ave Ste D Santa AnaCA
CHC12875-06ActiveBPS-H80-032292HURTT FAMILY HEALTH CLINIC, INC.Hurtt Family Health Clinic - Medical and Dental14642 Newport Ave TustinCA
CHC12875-07ApprovedBPS-H80-011067HURTT FAMILY HEALTH CLINIC, INC.Hurtt Family Health Clinic - Pediatric Mobile Clinic 21 Hope Drive TustinCA
Grantee Sites Contract Pharmacies
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateNew RegistrationLawler, Jina President & CEO Hurtt Family Health Clinic 7142478044Lawler, Jina 714-914-6551 President & CEO Hurtt Family Health Clinic 71424780444/1/2025 12:31 PM
DetailsLast Recertification DateUpdateRecertification1/31/2024 5:34:50 PM3/5/2025 7:14:14 AM3/5/2025 7:14 AM
DetailsEntity SubnameUpdateRecertificationHurtt Family Health Clinic Hurtt Family Health Clinic - Village of Hope3/5/2025 7:14 AM
DetailsLast Recertification DateUpdateRecertification2/13/2023 11:41:24 AM1/31/2024 5:34:50 PM1/31/2024 5:34 PM
ContactsPrimary ContactUpdateChange RequestGwilt, Larry CFO Hurtt Family Health Clinic 7142474306Wagner, Mercedes Pharmacist Hurtt Family Health Clinic 71439712241/8/2024 3:35 PM
ContactsAuthorizing OfficialUpdateChange RequestGonzalez, Joey Interim Executive Director Hurtt Family Health Clinic 7142474309Lawler, Jina President & CEO Hurtt Family Health Clinic 71424780441/8/2024 3:35 PM
AddressesMain AddressUpdateChange Request ONE HOPE DRIVE TUSTIN, CA 92782 1 Hope Drive Tustin, CA 9278210/26/2023 8:51 AM
DetailsEntity NameUpdateChange RequestHurtt Family Health ClinicHURTT FAMILY HEALTH CLINIC, INC.10/26/2023 8:51 AM
Medicaid BillingNPI: NumberInsertChange Request 13069655879/15/2023 8:20 PM
Medicaid BillingNPI: StateInsertChange Request CA9/15/2023 8:20 PM
Medicaid BillingNPI: NumberInsertChange Request 12355469959/15/2023 8:20 PM
Medicaid BillingNPI: StateInsertChange Request CA9/15/2023 8:20 PM
Medicaid BillingNPI: NumberInsertChange Request 16193843699/15/2023 8:20 PM
Medicaid BillingNPI: StateInsertChange Request CA9/15/2023 8:20 PM
DetailsLast Recertification DateUpdateRecertification2/22/2022 7:34:25 PM2/13/2023 11:41:24 AM2/13/2023 11:41 AM
ContactsPrimary ContactUpdateChange RequestCarter, Rebecca Lynn Executive Director Hurtt Family Health Clinic, Inc. 7144418044Gwilt, Larry CFO Hurtt Family Health Clinic 714247430611/15/2022 12:58 PM
ContactsAuthorizing OfficialUpdateChange RequestGwilt, Larry CFO Hurtt Family Health Clinic 7142474306Gonzalez, Joey Interim Executive Director Hurtt Family Health Clinic 714247430911/15/2022 12:58 PM
DetailsLast Recertification DateUpdateRecertification2/17/2021 1:03:16 PM2/22/2022 7:34:25 PM2/22/2022 7:34 PM
DetailsLast Recertification DateUpdateRecertification2/3/2020 2:54:08 PM2/17/2021 1:03:16 PM2/17/2021 1:03 PM
ContactsPrimary ContactUpdateRecertificationPounds, Jason Clinic Manager Hurtt Family Health Clinic 7142474324Carter, Rebecca Lynn Executive Director Hurtt Family Health Clinic, Inc. 71444180442/3/2020 2:54 PM
DetailsLast Recertification DateUpdateRecertification2/5/2019 3:26:25 PM2/3/2020 2:54:08 PM2/3/2020 2:54 PM
ContactsAuthorizing OfficialUpdateAO Change RequestLoff, Jewel CEO Hurtt Family Health Clinic 7142474398Gwilt, Larry CFO Hurtt Family Health Clinic 714247430611/24/2019 8:43 PM
ContactsPrimary ContactUpdateRecertificationShroeder, Chelci Clinic Administrator Hurtt Family Health Clinic 7142474380Pounds, Jason Clinic Manager Hurtt Family Health Clinic 71424743242/5/2019 3:26 PM
DetailsLast Recertification DateUpdateRecertification2/12/2018 12:08:40 PM2/5/2019 3:26:25 PM2/5/2019 3:26 PM
ContactsPrimary ContactUpdateRecertificationLoff, Jewel CEO Hurtt Family Health Clinic 7142474398Shroeder, Chelci Clinic Administrator Hurtt Family Health Clinic 71424743802/12/2018 12:08 PM
DetailsLast Recertification DateUpdateRecertification1/25/2017 12:00:00 AM2/12/2018 12:08:40 PM2/12/2018 12:08 PM
ContactsAuthorizing OfficialUpdate Loff, Jewel CEO 7142474398Loff, Jewel CEO Hurtt Family Health Clinic 71424743982/5/2018 12:11 PM
ContactsPrimary ContactUpdate Loff, Jewel CEO 7142474398Loff, Jewel CEO Hurtt Family Health Clinic 71424743982/5/2018 12:11 PM
AddressesMain AddressInsert   ONE HOPE DRIVE TUSTIN, CA 927821/25/2017 12:21 PM
ContactsAuthorizing OfficialUpdate PALMER, JIM PRESIDENT 7142474300Loff, Jewel CEO 71424743981/25/2017 12:21 PM
ContactsPrimary ContactUpdate AMAVIZCA, GLADY DIRECTOR 7142474348Loff, Jewel CEO 71424743981/25/2017 12:21 PM
DetailsLast Recertification DateUpdate 2/25/2016 12:00:00 AM1/25/2017 12:00:00 AM1/25/2017 12:21 PM
DetailsLast Recertification DateUpdate 3/2/2015 12:00:00 AM2/25/2016 12:00:00 AM2/25/2016 2:26 PM
DetailsEntity NameUpdate CASA DE SALUDHurtt Family Health Clinic10/16/2015 9:54 AM
DetailsLast Recertification DateUpdate 3/8/2014 12:00:00 AM3/2/2015 12:00:00 AM3/2/2015 3:08 PM
ContactsAuthorizing OfficialInsert  PALMER, JIM PRESIDENT 71424743004/30/2014 10:39 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/8/2014 12:00:00 AM3/8/2014 12:22 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/25/2013 9:08 AM
DetailsEntity SubnameUpdate OCRM HEALTH CARE SERVICES INC.Hurtt Family Health Clinic 2/25/2013 9:08 AM
ContactsPrimary ContactInsert  AMAVIZCA, GLADY DIRECTOR 714247434812/6/2010 3:52 PM
DetailsLast Recertification DateInsert   12/6/2010 3:52 PM
DetailsGrant NumberInsert  H80CS1287512/6/2010 3:52 PM
Details340B IDInsert  CHC12875-0012/6/2010 3:52 PM
DetailsIs Authorizing Official EHB DataInsert   12/6/2010 3:52 PM
DatesLast Date That 340B Drugs PurchasedInsert   12/6/2010 3:52 PM
DetailsMedicare Provider NumberInsert   12/6/2010 3:52 PM
DetailsEntity NameInsert  CASA DE SALUD12/6/2010 3:52 PM
DetailsProgram CodeInsert  CH12/6/2010 3:52 PM
DetailsEntity SubnameInsert  OCRM HEALTH CARE SERVICES INC.12/6/2010 3:52 PM
DatesParticipating Approval DateInsert  12/6/2010 12:00:00 AM12/6/2010 3:52 PM
DetailsStateInsert  Active12/6/2010 3:52 PM
DatesRegistration DateInsert  11/24/2010 12:00:00 AM12/6/2010 3:52 PM
DatesSigned By DateInsert  11/12/2010 12:00:00 AM12/6/2010 3:52 PM
DatesStart DateInsert  1/1/2011 12:00:00 AM12/6/2010 3:52 PM
TerminationsTermination CommentsInsert   12/6/2010 3:52 PM
TerminationsTermination DateInsert   12/6/2010 3:52 PM
TerminationsTermination Effective DateInsert   12/6/2010 3:52 PM
TerminationsTermination ReasonInsert   12/6/2010 3:52 PM