340B Drug Pricing Program Database


CH09025K CLINICAS DE SALUD DEL PUEBLO INC (Active) - information as of 6/12/2025 9:47:11 PM

Main Details
CLINICAS DE SALUD DEL PUEBLO INC
Innercare Mecca Dental
HRSA-Funded Health Center
BPS-H80-001565
CH09025K
H80CS00733


Additional Details
Active
4/11/2013
7/1/2013
5/31/2013
2/12/2025

Contacts

Clinicas de Salud del Pueblo, Inc.
YVONNE BELL, CEO
(760) 344-9951 Ext: 10102

Clinicas De Salud Del Pueblo
Dan Kang, Pharmacy Director
(760) 344-6471 Ext: 14117

Addresses

91275 66TH AVE
STE 300
MECCA, CA 92254-6610

Clinicas de Salud del Pueblo, Inc.
852 E Danenberg Dr
El Centro, CA 92243-8511


  • 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 1134623465,1932280633,1023188687
Shipping Addresses

Clinicas de Salud del Pueblo Inc. dba Innercare Pharmacy - Brawley
900 Main Street
Brawley, CA 92227

Clinicas de Salud del Pueblo, Inc. dba Innercare Mecca Dental
91275 66TH AVE
STE 300
Mecca, CA 92254

Clinicas de Salud del Pueblo, Inc. dba Innercare Pharmacy - Mecca
91-275 Avenue 66
STE # 200
Mecca, CA 92254

Clinicas de Salud del Pueblo, Inc. dba Innercare Pharmacy - El Centro
852 E Danenberg Dr
EL CENTRO, CA 92243-8511
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/13/202301/01/2024 02/10/202502/12/2025
Contract DetailTHRIFTY PAYLESS, INC.RITE AID #6515 211 WEST BIRCH STREET
CALEXICOCA9223101/15/202404/01/2024  04/01/2024
Contract DetailTHRIFTY PAYLESS, INC.RITE AID #5680 1501 WEST MAIN STREET
EL CENTROCA9224301/14/202504/01/2025  04/01/2025
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH090250ActiveBPS-H80-003223CLINICAS DE SALUD DEL PUEBLO,Inc.Innercare K Street1166 K St BrawleyCA
CH09025AActiveBPS-H80-001013CLINICAS DE SALUD DEL PUEBLO INCInnercare Brawley900 Main St BrawleyCA
CH09025BActiveBPS-H80-027332CLINICAS DE SALUD DEL PUEBLO INCInnercare El Centro852 E Danenberg Dr El CentroCA
CH09025CActiveBPS-H80-003150CLINICAS DE SALUD DEL PUEBLO INCInnercare Calexico223 W Cole Blvd CalexicoCA
CH09025DActiveBPS-H80-031918CLINICAS DE SALUD DEL PUEBLO INCInnercare Blythe1415 W Hobsonway BLYTHECA
CH09025FActiveBPS-H80-003892CLINICAS DE SALUD DEL PUEBLO INCInnercare Mecca91275 66TH AVE MECCACA
CH09025GActiveBPS-H80-004154CLINICAS DE SALUD DEL PUEBLO INCInnercare Niland8027 HIGHWAY 111 NILANDCA
CH09025IActiveBPS-H80-004224CLINICAS DE SALUD DEL PUEBLO INCInnercare Winterhaven2133 Winterhaven Dr WinterhavenCA
CH09025JActiveBPS-H80-019181CLINICAS DE SALUD DEL PUEBLO INCInnercare Coachella50249 Cesar Chavez St CoachellaCA
CH09025KActiveBPS-H80-001565CLINICAS DE SALUD DEL PUEBLO INCInnercare Mecca Dental91275 66TH AVE MECCACA
CH09025LTerminatedBPS-H80-002219CLINICAS DE SALUD DEL PUEBLO INCCLINICAS DE SALUD DEL PUEBLO, INC. - DENTAL223 W Cole Blvd CalexicoCA
CH09025MActiveBPS-H80-030261CLINICAS DE SALUD DEL PUEBLO INCInnercare West Shores1289 SOUTH MARINA DRIVE SALTON CITYCA
CH09025NTerminatedBPS-H80-009839CLINICAS DE SALUD DEL PUEBLO INCEhman Women's Center197 W Legion Rd BrawleyCA
CH09025PTerminatedBPS-H80-016842CLINICAS DE SALUD DEL PUEBLO INCBrawley Open Access Health Center283 Main Street, #102 BrawleyCA
CH09025QTerminatedBPS-H80-013247CLINICAS DE SALUD DEL PUEBLO INCIndio Health Center83791 Date Avenue IndioCA
CH09025RTerminatedBPS-H80-013975CLINICAS DE SALUD DEL PUEBLO, INC.Referral Center502 West Aten Road, Suite D - 101 ImperialCA
CH09025SActiveBPS-H80-017135CLINICAS DE SALUD DEL PUEBLO, INC.Innercare Hemet1023 E Florida Ave HemetCA
CH09025TActiveBPS-H80-038588CLINICAS DE SALUD DEL PUEBLO, INCInnercare Brawley Dental283 Main Street, Suite 102 BrawleyCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH090250ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310210/01/2017 01/01/2025
CH09025IACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310201/01/2024 01/01/2025
CH090250ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884909/09/2020 02/01/2024
CH090250ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201009/09/2020  
CH090250ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750209/09/2020 02/01/2024
CH090250AMERI MEX PHARMACY196 W LEGION RD SUITE A
BRAWLEYCA9222704/01/2017 05/21/2018
CH090250AMERI MEX PHARMACY196 W LEGION RD SUITE A
BRAWLEYCA9222706/16/2020 08/08/2022
CH090250ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09334 2800 S 4TH AVE
YUMAAZ8536408/04/2020  
CH090250ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09278 1555 S AVENUE B
YUMAAZ8536408/04/2020  
CH090250AUSTINS PHARMACY INCAUSTIN'S PHARMACY 1345 W HOBSONWAY
BLYTHECA9222510/01/2023 12/01/2024
CH090250BLYTHE DRUG JS INCBLYTHE DRUG 301 W HOBSONWAY
BLYTHECA9222507/01/2014 05/14/2018
CH090250BLYTHE MART PHARMACYDESERT HILLS RX LLC 301 W HOBSONWAY
BLYTHECA9222501/23/2025  
CH09025DBLYTHE MART PHARMACYDESERT HILLS RX LLC 301 W HOBSONWAY
BLYTHECA9222504/01/2025  
CH090250C&S PHARMACYDBA: LA BOTICA PHARMACY 49281 GRAPEFRUIT BLVD STE 2
COACHELLACA9223604/01/2014 08/31/2016
CH090250C&S PHARMACYDBA: LA BOTICA PHARMACY 49281 GRAPEFRUIT BLVD STE 2
COACHELLACA9223606/16/2020 08/08/2022
CH090250C&S PHARMACYDBA: LA BOTICA PHARMACY 49281 GRAPEFRUIT BLVD STE 2
COACHELLACA9223601/01/2024  
CH09025JC&S PHARMACYDBA: LA BOTICA PHARMACY 49281 GRAPEFRUIT BLVD STE 2
COACHELLACA9223601/01/2024  
CH090250CALEXICO PHARMACYCALEXICO PHARMACY 420 E. 2ND STREET
CALEXICOCA9223104/01/2017 07/31/2018
CH090250CALEXICO RX INCDBA: CALEXICO PHARMACY 420 E. 2ND STREET
CALEXICOCA9223107/31/2018 08/22/2019
CH090250CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361409/09/2020  
CH090250CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005609/09/2020  
CH090250CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621909/09/2020  
CH090250CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175709/09/2020  
CH090250CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808309/09/2020  
CH090250CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700409/09/2020  
CH090250CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761709/09/2020  
CH090250CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813309/09/2020  
CH090250CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237409/09/2020  
CH09025KCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/01/2024 02/10/2025
CH090250CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911909/09/2020  
CH09025SCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/01/2024 02/10/2025
CH090250CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502809/09/2020  
CH090250EL CENTRO PHARMACY325 WAKE AVE
EL CENTROCA92243-965110/01/2023 02/10/2025
CH090250FARMACIA DEL PUEBLO1692 S 4TH ST STE F
EL CENTROCA9224301/01/2018 02/10/2025
CH090250FARMACIA DEL PUEBLO801 E BIRCH ST STE #4
CALEXICOCA9223101/01/2018  
CH09025SFARMACIA DEL PUEBLO801 E BIRCH ST STE #4
CALEXICOCA9223104/01/2025  
CH090250GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 10931 1745 S. IMPERIAL AVE
EL CENTROCA9224307/01/2016  
CH090250GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16937 2295 N IMPERIAL AVE
EL CENTROCA9224301/01/2019  
CH090250GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05497 84010 AVE 50
COACHELLACA9223601/01/2019  
CH090250GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY #11141 420 E 2ND ST
CALEXICOCA9223112/17/2019  
CH090250GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09648 82-270 HIGHWAY 111
INDIOCA9220108/04/2020  
CH09025CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY #11141 420 E 2ND ST
CALEXICOCA9223101/01/2024  
CH09025IGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 10931 1745 S. IMPERIAL AVE
EL CENTROCA9224304/01/2024  
CH09025JGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05497 84010 AVE 50
COACHELLACA9223604/01/2025  
CH090250HOPE PHARMACY420 HEFFERNAN AVE STE A
CALEXICOCA92231-471810/01/2023  
CH09025BHOPE PHARMACY420 HEFFERNAN AVE STE A
CALEXICOCA92231-471801/01/2024  
CH090250J&R UNITY INCDBA BLYTHE MART PHARMACY 301 W HOBSONWAY
BLYTHECA92225-163910/01/2018 12/01/2024
CH090250LA BUENA VIDA PHARMACY INCDBA LA BUENA VIDA PHARMACY 51-335 CESAR CHAVEZ ST STE 116
COACHELLACA9223601/01/2014 03/21/2016
CH090250LA BUENA VIDA PHARMACY INCDBA LA BUENA VIDA PHARMACY 51-335 CESAR CHAVEZ ST STE 116
COACHELLACA9223606/16/2020 08/08/2022
CH090250MECCA COMMUNITY PHARMACY  91275 AVENUE 66
SUITE 200 		MECCACA9225408/01/2012 05/07/2017
CH090250NILKANTH AMS INCDBA: CHOICE PHARMACY 2451 ROCKWOOD AVE STE 120
CALEXICOCA9223110/01/2023  
CH09025ANILKANTH AMS INCDBA: CHOICE PHARMACY 2451 ROCKWOOD AVE STE 120
CALEXICOCA9223101/01/2024  
CH09025SNILKANTH AMS INCDBA: CHOICE PHARMACY 2451 ROCKWOOD AVE STE 120
CALEXICOCA9223104/01/2024  
CH090250OPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191309/09/2020 10/23/2020
CH090250OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713009/09/2020  
CH09025FOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/01/2024  
CH090250OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140109/09/2020 02/01/2024
CH090250OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/01/2021 10/10/2023
CH090250OPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161809/09/2020 10/10/2023
CH090250PARKERS PHARMACY102 W 5TH ST
HOLTVILLECA9225006/16/2020 04/01/2021
CH090250PARKERS PHARMACY102 W 5TH ST
HOLTVILLECA9225010/01/2023 02/10/2025
CH090250PREFERRED PHARMACY1601 N IMPERIAL AVE STE B
EL CENTROCA9224304/01/2017 12/20/2018
CH090250PREFERRED PHARMACY1601 N IMPERIAL AVE STE B
EL CENTROCA9224304/01/2020 07/01/2021
CH090250PREFERRED PHARMACY1601 N IMPERIAL AVE STE B
EL CENTROCA9224310/01/2023 12/01/2024
CH090250PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514609/09/2020  
CH090250PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681309/09/2020  
CH090250PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920309/09/2020  
CH090250PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523309/09/2020  
CH090250PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 1010 UNIVERSITY AVENUE
SAN DIEGOCA9210304/01/2025  
CH090250RELIANCE BEST PHARMACY LLCDBA FARMACIA DEL PUEBLO 653 MAIN ST
BRAWLEYCA9222701/01/2018 02/10/2025
CH090250THE VONS COMPANIES INCVONS PHARMACY #1767 475 WEST MAIN STREET
BRAWLEYCA9222709/05/2012  
CH090250THE VONS COMPANIES INCVONS PHARMACY #2406 750 NORTH IMPERIAL AVENUE
EL CENTROCA9224309/05/2012  
CH09025TTHE VONS COMPANIES INCVONS PHARMACY #2406 750 NORTH IMPERIAL AVENUE
EL CENTROCA9224304/01/2025  
CH090250THRIFTY PAYLESS, INC.RITE AID #6515 211 WEST BIRCH STREET
CALEXICOCA9223101/01/2013  
CH090250THRIFTY PAYLESS, INC.RITE AID #5674 405 WEST MAIN STREET
BRAWLEYCA9222704/01/2013  
CH090250THRIFTY PAYLESS, INC.RITE AID #5673 616 EAST HOBSONWAY
BLYTHECA9222507/01/2013  
CH090250THRIFTY PAYLESS, INC.RITE AID #5680 1501 WEST MAIN STREET
EL CENTROCA9224307/01/2013  
CH090250THRIFTY PAYLESS, INC.RITE AID #5678 51101 CESAR CHAVEZ ST
COACHELLACA9223607/01/2013  
CH09025DTHRIFTY PAYLESS, INC.RITE AID #5673 616 EAST HOBSONWAY
BLYTHECA9222501/01/2024  
CH09025FTHRIFTY PAYLESS, INC.RITE AID #6515 211 WEST BIRCH STREET
CALEXICOCA9223101/01/2024  
CH09025KTHRIFTY PAYLESS, INC.RITE AID #6515 211 WEST BIRCH STREET
CALEXICOCA9223104/01/2024  
CH09025KTHRIFTY PAYLESS, INC.RITE AID #5680 1501 WEST MAIN STREET
EL CENTROCA9224304/01/2025  
CH090250VALLEY MEDICAL PHARMACY630 MAIN ST
BRAWLEYCA92227-254804/01/2017 08/08/2022
CH090250VALLEY MEDICAL PHARMACY630 MAIN ST
BRAWLEYCA92227-254810/01/2023  
CH09025GVALLEY MEDICAL PHARMACY630 MAIN ST
BRAWLEYCA92227-254801/01/2024  
CH090250VALLEY MEDICAL PHARMACY #2112 E MAIN ST
CALIPATRIACA9223310/01/2023  
CH09025GVALLEY MEDICAL PHARMACY #2112 E MAIN ST
CALIPATRIACA9223304/01/2025  
CH090250WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2020  
CH090250WAL-MART PHARMACY 10-14742900 SOUTH PACIFIC AVENUE
YUMAAZ8536509/05/2012 03/21/2016
CH090250WAL-MART PHARMACY 10-15552150 N. WATERMAN AVE
EL CENTROCA9224309/05/2012  
CH09025CWAL-MART PHARMACY 10-15552150 N. WATERMAN AVE
EL CENTROCA9224304/01/2025  
CH090250WAL-MART PHARMACY 10-180579295 HWY 111
LAQUINTACA9225309/05/2012 09/29/2017
CH090250WAL-MART PHARMACY 10-18592540 ROCKWOOD AVENUE
CALEXICOCA9223109/05/2012  
CH09025IWAL-MART PHARMACY 10-18592540 ROCKWOOD AVENUE
CALEXICOCA9223104/01/2025  
CH090250WAL-MART PHARMACY 10-4543100 RIVERSIDE DRIVE
PARKERAZ8534409/05/2012 03/21/2016
CH090250WAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281909/14/2020 02/01/2024
CH090250WAL-MART PHARMACY 10-5335250 WILDCAT DRIVE
BRAWLEYCA9222709/05/2012  
CH09025MWAL-MART PHARMACY 10-5335250 WILDCAT DRIVE
BRAWLEYCA9222704/01/2025  
CH090250WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2020  
CH090250WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02611 1150 W 8TH ST STE A
YUMAAZ8536406/01/2012  
CH090250WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02219 2801 S 4TH AVE
YUMAAZ8536406/01/2012 10/23/2017
CH090250WALGREEN CODBA: WALGREENS #09781 82-955 AVENUE 48, BLDG B
INDIOCA9220106/01/2012 10/23/2017
CH090250WALGREEN CO.DBA: WALGREENS # 06856 100 N IMPERIAL AVE
EL CENTROCA9224306/01/2012  
CH090250WALGREEN CO.DBA: WALGREENS # 04757 42010 WASHINGTON ST.
BERMUDA DUNESCA9220306/01/2012 03/21/2016
CH090250WALGREEN CO.DBA: WALGREENS # 04756 44840 MONTEREY AVE.
PALM DESERTCA9226006/01/2012 03/21/2016
CH090250WALGREEN CO.DBA: WALGREENS # 05301 33975 DATE PALM DR
CATHEDRAL CITYCA9223406/01/2012 03/21/2016
CH090250WALGREEN CO.DBA: WALGREENS #11611 50040 CESAR CHAVEZ ST
COACHELLACA9223606/01/2012  
CH090250WALGREEN CO.DBA: WALGREENS # 01254 44100 JEFFERSON ST
INDIOCA9220106/01/2012 03/21/2016
CH090250WALGREEN CO.DBA: WALGREENS # 05037 14001 PALM DR
DESERT HOT SPRINGSCA9224006/01/2012 03/21/2016
CH090250WALGREEN CO.DBA: WALGREENS # 07765 47900 WASHINGTON STREET
LA QUINTACA9225306/01/2012 03/21/2016
CH090250WALGREEN CO.DBA: WALGREENS # 05349 1311 E. FLORIDA AVE.
HEMETCA9254404/01/2020  
CH09025TWALGREEN CO.DBA: WALGREENS # 06856 100 N IMPERIAL AVE
EL CENTROCA9224304/01/2025  
CH090250WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/2025  
CH090250WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/2025  
CH090250WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/01/2023  
CH090250Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
CH090250WHITE CROSS PHARMACY602 MAIN ST
BRAWLEYCA92227-254804/01/2018 10/01/2023
CH090250WHITE CROSS PHARMACYLS RX LLC 602 MAIN ST
BRAWLEYCA9222710/13/2023  
CH09025MWHITE CROSS PHARMACYLS RX LLC 602 MAIN ST
BRAWLEYCA9222701/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/5/2024 12:57:37 PM2/12/2025 1:56:33 PM2/12/2025 1:56 PM
DetailsLast Recertification DateUpdateRecertification2/2/2023 5:57:07 PM2/5/2024 12:57:37 PM2/5/2024 12:57 PM
DetailsLast Recertification DateUpdateRecertification2/7/2022 8:10:07 PM2/2/2023 5:57:07 PM2/2/2023 5:57 PM
AddressesShipping AddressUpdateChange RequestClinicas de Salud del Pueblo Inc. dba Clinica Pharmacy 900 Main Street Brawley, CA 92227Clinicas de Salud del Pueblo Inc. dba Innercare Pharmacy - Brawley 900 Main Street Brawley, CA 922278/22/2022 11:47 AM
AddressesShipping AddressUpdateChange RequestClinicas de Salud del Pueblo, Inc. dba Mecca Dental Clinic 91275 66TH AVE STE 300 Mecca, CA 92254Clinicas de Salud del Pueblo, Inc. dba Innercare Mecca Dental 91275 66TH AVE STE 300 Mecca, CA 922548/22/2022 11:47 AM
AddressesShipping AddressUpdateChange RequestClinicas de Salud del Pueblo, Inc. dba Mecca Pharmacy 91-275 Avenue 66 STE # 200 Mecca, CA 92254Clinicas de Salud del Pueblo, Inc. dba Innercare Pharmacy - Mecca 91-275 Avenue 66 STE # 200 Mecca, CA 922548/22/2022 11:47 AM
AddressesShipping AddressUpdateChange RequestClinicas de Salud del Pueblo, Inc. dba InnerCare Pharmacy 852 E Danenberg Dr EL CENTRO, CA 92243-8511Clinicas de Salud del Pueblo, Inc. dba Innercare Pharmacy - El Centro 852 E Danenberg Dr EL CENTRO, CA 92243-85118/22/2022 11:47 AM
DetailsEntity SubnameUpdateChange RequestMECCA DENTAL CLINICInnercare Mecca Dental8/22/2022 11:47 AM
DetailsLast Recertification DateUpdateRecertification2/19/2021 2:18:03 PM2/7/2022 8:10:07 PM2/7/2022 8:10 PM
Medicaid BillingNPI: StateUpdateRecertification CA2/19/2021 2:18 PM
Medicaid BillingNPI: StateUpdateRecertification CA2/19/2021 2:18 PM
Medicaid BillingNPI: StateUpdateRecertification CA2/19/2021 2:18 PM
DetailsLast Recertification DateUpdateRecertification1/31/2020 2:15:15 PM2/19/2021 2:18:03 PM2/19/2021 2:18 PM
DetailsLast Recertification DateUpdateRecertification2/21/2019 8:15:58 AM1/31/2020 2:15:15 PM1/31/2020 2:15 PM
AddressesShipping AddressInsertChange Request Clinicas de Salud del Pueblo, Inc. dba InnerCare Pharmacy 852 E Danenberg Dr EL CENTRO, CA 92243-851110/25/2019 11:58 AM
AddressesBilling AddressUpdateRecertificationClinicas de Salud del Pueblo, Inc. 1166 K Street Brawley, CA 92227-2737Clinicas de Salud del Pueblo, Inc. 852 E Danenberg Dr El Centro, CA 92243-85112/21/2019 8:15 AM
AddressesShipping AddressDeleteRecertificationClinicas de Salud del Pueblo, Inc. dba Mecca Dental Clinic 91275 66th Avenue Suite 300 Mecca, CA 92254 2/21/2019 8:15 AM
AddressesShipping AddressInsertRecertification Clinicas de Salud del Pueblo, Inc. dba Mecca Dental Clinic 91275 66TH AVE STE 300 Mecca, CA 922542/21/2019 8:15 AM
AddressesShipping AddressInsertRecertification Clinicas de Salud del Pueblo, Inc. dba Mecca Pharmacy 91-275 Avenue 66 STE # 200 Mecca, CA 922542/21/2019 8:15 AM
AddressesMain AddressUpdateRecertification 91275 66TH AVE STE 300 MECCA, CA 92254-6610 91275 66TH AVE STE 300 MECCA, CA 92254-66102/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1124115431 ( ) 2/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1649269747 ( ) 2/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1962599266 ( ) 2/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1932381605 ( ) 2/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1487741773 ( ) 2/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1033593108 ( ) 2/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1679654750 ( ) 2/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1124109202 ( ) 2/21/2019 8:15 AM
Medicaid BillingNPI: NumberInsertRecertification 11346234652/21/2019 8:15 AM
DetailsLast Recertification DateUpdateRecertification2/9/2018 1:46:59 PM2/21/2019 8:15:58 AM2/21/2019 8:15 AM
Medicaid BillingNPI: NumberDeleteChange Request1710237029 ( ) 8/31/2018 5:42 PM
Medicaid BillingNPI: NumberDeleteChange Request1063684207 ( ) 2/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 11241154312/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 17102370292/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 16492697472/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 19625992662/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 19323816052/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 14877417732/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 10335931082/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 19322806332/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 10231886872/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 16796547502/12/2018 4:41 PM
Medicaid BillingNPI: NumberInsertChange Request 11241092022/12/2018 4:41 PM
DetailsLast Recertification DateUpdateRecertification1/26/2017 12:00:00 AM2/9/2018 1:46:59 PM2/9/2018 1:46 PM
Medicaid BillingNPI: NumberInsertChange Request 106368420712/8/2017 5:22 PM
AddressesBilling AddressInsertChange Request Clinicas de Salud del Pueblo, Inc. 1166 K Street Brawley, CA 92227-273711/28/2017 10:50 AM
AddressesShipping AddressInsertChange Request Clinicas de Salud del Pueblo Inc. dba Clinica Pharmacy 900 Main Street Brawley, CA 9222711/28/2017 10:50 AM
AddressesShipping AddressInsertChange Request Clinicas de Salud del Pueblo, Inc. dba Mecca Dental Clinic 91275 66th Avenue Suite 300 Mecca, CA 9225411/28/2017 10:50 AM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 11/28/2017 10:50 AM
ContactsAuthorizing OfficialUpdate BELL, YVONNE CEO 7603449951BELL, YVONNE CEO Clinicas de Salud del Pueblo, Inc. 7603449951-1010210/9/2017 1:14 PM
ContactsSigned ByUpdate BELL, YVONNE CEO 7603449951BELL, YVONNE CEO Clinicas de Salud del Pueblo, Inc. 7603449951-1010210/9/2017 1:14 PM
ContactsPrimary ContactUpdate Kang, Dan Pharmacy Director 7603446471Kang, Dan Pharmacy Director Clinicas De Salud Del Pueblo 7603446471-141179/29/2017 5:52 PM
ContactsAuthorizing OfficialInsert  BELL, YVONNE CEO 76034499517/31/2017 5:09 PM
ContactsSigned ByInsert  BELL, YVONNE CEO 76034499517/31/2017 5:09 PM
ContactsPrimary ContactInsert  Kang, Dan Pharmacy Director 76034464714/20/2017 2:48 PM
AddressesMain AddressInsert   91275 66TH AVE STE 300 MECCA, CA 92254-66101/26/2017 5:51 PM
DetailsLast Recertification DateUpdate 3/3/2016 12:00:00 AM1/26/2017 12:00:00 AM1/26/2017 5:51 PM
DetailsLast Recertification DateUpdate 1/28/2015 12:00:00 AM3/3/2016 12:00:00 AM3/4/2016 1:24 PM
DetailsLast Recertification DateUpdate 3/17/2014 12:00:00 AM1/28/2015 12:00:00 AM1/28/2015 3:19 PM
DetailsIs Authorizing Official EHB DataUpdate  False1/28/2015 3:19 PM
DetailsLast Recertification DateUpdate  3/17/2014 12:00:00 AM3/17/2014 8:39 PM
Details340B IDUpdate IS-FN-CH09025KCH09025K5/31/2013 4:39 PM
DatesParticipating Approval DateUpdate  5/31/2013 12:00:00 AM5/31/2013 4:39 PM
DetailsStateUpdate PendingActive5/31/2013 4:39 PM
DatesStart DateUpdate  7/1/2013 12:00:00 AM5/31/2013 4:39 PM
Details340B IDUpdate ONLINE_REGIS-FN-CH09025K5/2/2013 11:59 AM
DetailsLast Recertification DateInsert   4/11/2013 11:50 AM
DetailsGrant NumberInsert  H80CS007334/11/2013 11:50 AM
Details340B IDInsert  ONLINE_REG4/11/2013 11:50 AM
DetailsIs Authorizing Official EHB DataInsert   4/11/2013 11:50 AM
DatesLast Date That 340B Drugs PurchasedInsert   4/11/2013 11:50 AM
DetailsMedicare Provider NumberInsert   4/11/2013 11:50 AM
DetailsEntity NameInsert  CLINICAS DE SALUD DEL PUEBLO INC4/11/2013 11:50 AM
DetailsProgram CodeInsert  CH4/11/2013 11:50 AM
DetailsEntity SubnameInsert  MECCA DENTAL CLINIC4/11/2013 11:50 AM
DatesParticipating Approval DateInsert   4/11/2013 11:50 AM
DetailsStateInsert  Pending4/11/2013 11:50 AM
DatesRegistration DateInsert  4/11/2013 12:00:00 AM4/11/2013 11:50 AM
DatesSigned By DateInsert  4/11/2013 12:00:00 AM4/11/2013 11:50 AM
DatesStart DateInsert   4/11/2013 11:50 AM
TerminationsTermination CommentsInsert   4/11/2013 11:50 AM
TerminationsTermination DateInsert   4/11/2013 11:50 AM
TerminationsTermination Effective DateInsert   4/11/2013 11:50 AM
TerminationsTermination ReasonInsert   4/11/2013 11:50 AM