340B Drug Pricing Program Database


FQHCLA048E TULARE, COUNTY OF (Terminated) - information as of 6/21/2025 10:46:30 PM

Main Details
TULARE, COUNTY OF
Tulare Pediatrics Health Care Center
Health Center Program Look-Alike
BPS-LAL-009866
FQHCLA048E
LALCS00070


Additional Details
Terminated
4/11/2013
7/1/2013
5/20/2013
1/25/2017

10/1/2017
Site closure

Contacts

JASON T. BRITT, DIRECTOR OF PUBLIC HEALTH
(559) 624-8481

Tulare County Health and Human Services Agency
ROB STEWART, PUBLIC HEALTH MANAGER
(559) 624-7382

Addresses

1008 N Cherry St
Tulare, CA 93274-2212

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

No
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
FQHCLA048ActiveAdminCounty of TulareTulare County Health Services5957 S. Mooney Blvd VisaliaCA
FQHCLA048AActiveBPS-LAL-009865County of TulareVISALIA HEALTH CENTER2611 N Dinuba Blvd VisaliaCA
FQHCLA048ETerminatedBPS-LAL-009866TULARE, COUNTY OFTulare Pediatrics Health Care Center1008 N Cherry St TulareCA
FQHCLA048FActiveBPS-LAL-009864County of TulareFarmersville Health Care Center660 E Visalia Rd FarmersvilleCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
FQHCLA048AAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282111/22/2022  
FQHCLA048AVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282111/22/2022  
FQHCLA048FAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282111/22/2022  
FQHCLA048AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080811/22/2022  
FQHCLA048AAVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080811/22/2022  
FQHCLA048FAVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080811/22/2022  
FQHCLA048GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 02541 1102 N. DEMAREE ST.
VISALIACA9329110/01/2020  
FQHCLA048GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16928 4247 S MOONEY BLVD
VISALIACA9327710/01/2020  
FQHCLA048GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 00912 2175 E. BARDSLEY AVE.
TULARECA9327410/01/2020  
FQHCLA048GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05551 109 SOUTH WEST ST.
TULARECA9327410/01/2020  
FQHCLA048GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17520 3308 N DINUBA BLVD
VISALIACA9329110/01/2020  
FQHCLA048LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09176 1395 E PROSPERITY AVE
TULARECA9327410/01/2020  
FQHCLA048LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09500 1455 E NOBLE AVE
VISALIACA9329210/01/2020  
FQHCLA048LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09271 3619 W. CALDWELL AVE
VISALIACA9327710/01/2020  
FQHCLA048ALONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245311/22/2022  
FQHCLA048LONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245311/22/2022  
FQHCLA048FLONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245311/22/2022  
FQHCLA048APHARMEDQUEST PHARMACY SERVICESDBA AVITA PHARMACY 1072 26800 CROWN VALLEY PKWY STE 185
MISSION VIEJOCA9269111/22/2022  
FQHCLA048PHARMEDQUEST PHARMACY SERVICESDBA AVITA PHARMACY 1072 26800 CROWN VALLEY PKWY STE 185
MISSION VIEJOCA9269111/22/2022  
FQHCLA048FPHARMEDQUEST PHARMACY SERVICESDBA AVITA PHARMACY 1072 26800 CROWN VALLEY PKWY STE 185
MISSION VIEJOCA9269111/22/2022  
FQHCLA048SIERRA VISTA PHARMACY, INC.650 E VISALIA RD
FARMERSVILLECA9322304/01/2020  
FQHCLA048FSIERRA VISTA PHARMACY, INC.650 E VISALIA RD
FARMERSVILLECA9322304/01/2020  
FQHCLA048ASIERRA VISTA PHARMACY, INC.650 E VISALIA RD
FARMERSVILLECA9322304/01/2020  
FQHCLA048THRIFTY PAYLESS, INC.RITE AID #5795 1051 W VISALIA RD
EXETERCA9322110/01/2014  
FQHCLA048THRIFTY PAYLESS, INC.RITE AID #6459 1735 E WALNUT AVENUE
VISALIACA9329210/01/2014  
FQHCLA048THRIFTY PAYLESS, INC.RITE AID #5806 5212 WEST WALNUT AVENUE
VISALIACA9327710/01/2014  
FQHCLA048THRIFTY PAYLESS, INC.RITE AID #6454 1645 E TULARE AVENUE
TULARECA9327410/01/2014  
FQHCLA048THRIFTY PAYLESS, INC.RITE AID #5798 262 NORTH HIGHWAY 65
LINDSAYCA9324710/01/2014  
FQHCLA048THRIFTY PAYLESS, INC.RITE AID #6522 875 NORTH ALTA AVENUE
DINUBACA9361810/01/2014  
FQHCLA048VISALIA PHARMACYVISALIA PHARMACY 444 NW 3RD AVE
VISALIACA9329112/13/2022  
FQHCLA048AVISALIA PHARMACYVISALIA PHARMACY 444 NW 3RD AVE
VISALIACA9329101/01/2023  
FQHCLA048FVISALIA PHARMACYVISALIA PHARMACY 444 NW 3RD AVE
VISALIACA9329101/01/2023  
FQHCLA048WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2021  
FQHCLA048WAL-MART PHARMACY 10-18261819 EAST NOBLE AVE.
VISALIACA9329204/01/2021  
FQHCLA048WAL-MART PHARMACY 10-25361110 EAST PROSPERITY AVE
TULARECA9327404/01/2021  
FQHCLA048WAL-MART PHARMACY 10-5394770 WEST EL MONTE WAY
DINUBACA9361804/01/2021  
FQHCLA048WAL-MART PHARMACY 10-56351320 N DEMAREE ST
VISALIACA9329104/01/2021  
FQHCLA048WAL-MART PHARMACY 10-59563750 S MOONEY BLVD.
VISALIACA9327704/01/2021  
FQHCLA048WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2021  
FQHCLA048WALGREEN CO.DBA: WALGREENS # 02869 1407 N DINUBA BLVD
VISALIACA9329104/01/2015 06/05/2018
FQHCLA048WALGREEN CO.DBA: WALGREENS # 03476 100 W WALNUT AVE
VISALIACA9327704/01/2015  
FQHCLA048WALGREEN CO.DBA: WALGREENS # 06298 49 W TULARE AVE
TULARECA9327404/01/2015 10/15/2020
FQHCLA048WALGREEN CO.DBA: WALGREENS # 06683 5328 W CYPRESS AVENUE
VISALIACA9327704/01/2015  
FQHCLA048WALGREEN CO.DBA: WALGREENS # 10002 1418 EAST PROSPERITY AVENUE
TULARECA93274-805404/01/2015  
FQHCLA048WALGREEN CO.DBA: WALGREENS # 10201 170 W EL MONTE WAY
DINUBACA93618-156104/01/2015 03/19/2025
FQHCLA048WALGREEN CO.DBA: WALGREENS #11407 3010 N DEMAREE ST
VISALIACA93291-714704/01/2015  
FQHCLA048WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16382 2323 16TH ST STE 100
BAKERSFIELDCA9330101/01/2021  
FQHCLA048WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904904/01/2015 02/02/2016
FQHCLA048WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528404/01/2015 02/02/2016
FQHCLA048WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275601/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateRecertificationSTEWART, ROB PUBLIC HEALTH MANAGER 5596247382STEWART, ROB PUBLIC HEALTH MANAGER Tulare County Health and Human Services Agency 55962473822/14/2018 5:16 PM
AddressesMain AddressInsert   1008 N Cherry St Tulare, CA 93274-22127/7/2017 11:05 AM
ContactsAuthorizing OfficialInsert  BRITT, JASON T. DIRECTOR OF PUBLIC HEALTH 55962484817/7/2017 11:05 AM
ContactsPrimary ContactUpdate BOULOS, SAMEH Director of Pharmacy Services 5596230838STEWART, ROB PUBLIC HEALTH MANAGER 55962473827/7/2017 11:05 AM
ContactsSigned ByInsert  Duerksen, Cheryl Agency director 55962480007/7/2017 11:05 AM
DetailsGrant NumberUpdate LAL000070LALCS000707/7/2017 11:05 AM
DetailsStateUpdate To Be TerminatedTerminated7/7/2017 11:05 AM
DatesLast Date That 340B Drugs PurchasedUpdate  5/4/2016 12:00:00 AM7/7/2017 11:04 AM
DetailsStateUpdate ActiveTo Be Terminated7/7/2017 11:04 AM
TerminationsTermination CommentsUpdate  The site is now being administered by another entity. 7/7/2017 11:04 AM
TerminationsTermination DateUpdate  10/1/2017 12:00:00 AM7/7/2017 11:04 AM
TerminationsTermination Effective DateUpdate  6/30/2016 12:00:00 AM7/7/2017 11:04 AM
TerminationsTermination ReasonUpdate  Site closure7/7/2017 11:04 AM
DetailsLast Recertification DateUpdate 2/12/2016 12:00:00 AM1/25/2017 12:00:00 AM1/25/2017 10:20 AM
DetailsLast Recertification DateUpdate 3/4/2015 12:00:00 AM2/12/2016 12:00:00 AM2/12/2016 2:29 PM
DetailsLast Recertification DateUpdate 3/17/2014 12:00:00 AM3/4/2015 12:00:00 AM3/4/2015 8:06 AM
DetailsIs Authorizing Official EHB DataUpdate  False3/4/2015 8:06 AM
ContactsPrimary ContactInsert  BOULOS, SAMEH Director of Pharmacy Services 55962308383/4/2015 8:06 AM
DetailsLast Recertification DateUpdate  3/17/2014 12:00:00 AM3/17/2014 4:49 PM
Details340B IDUpdate IS-FN-FQHCLA048EFQHCLA048E5/20/2013 5:30 PM
DatesParticipating Approval DateUpdate  5/20/2013 12:00:00 AM5/20/2013 5:30 PM
DetailsStateUpdate PendingActive5/20/2013 5:30 PM
DatesStart DateUpdate  7/1/2013 12:00:00 AM5/20/2013 5:30 PM
Details340B IDUpdate ONLINE_REGIS-FN-FQHCLA048E5/2/2013 4:46 PM
DetailsLast Recertification DateInsert   4/11/2013 1:33 PM
DetailsGrant NumberInsert  LAL0000704/11/2013 1:33 PM
Details340B IDInsert  ONLINE_REG4/11/2013 1:33 PM
DetailsIs Authorizing Official EHB DataInsert   4/11/2013 1:33 PM
DatesLast Date That 340B Drugs PurchasedInsert   4/11/2013 1:33 PM
DetailsMedicare Provider NumberInsert   4/11/2013 1:33 PM
DetailsEntity NameInsert  TULARE, COUNTY OF4/11/2013 1:33 PM
DetailsProgram CodeInsert  FQHCLA4/11/2013 1:33 PM
DetailsEntity SubnameInsert  Tulare Pediatrics Health Care Center4/11/2013 1:33 PM
DatesParticipating Approval DateInsert   4/11/2013 1:33 PM
DetailsStateInsert  Pending4/11/2013 1:33 PM
DatesRegistration DateInsert  4/11/2013 12:00:00 AM4/11/2013 1:33 PM
DatesSigned By DateInsert  4/11/2013 12:00:00 AM4/11/2013 1:33 PM
DatesStart DateInsert   4/11/2013 1:33 PM
TerminationsTermination CommentsInsert   4/11/2013 1:33 PM
TerminationsTermination DateInsert   4/11/2013 1:33 PM
TerminationsTermination Effective DateInsert   4/11/2013 1:33 PM
TerminationsTermination ReasonInsert   4/11/2013 1:33 PM