340B Drug Pricing Program Database


CHC26624-01 POMONA COMMUNITY HEALTH CENTER (Active) - information as of 6/21/2025 10:43:20 PM

Main Details
POMONA COMMUNITY HEALTH CENTER
Pomona Community Health Center
HRSA-Funded Health Center
BPS-H80-013210
CHC26624-01
H80CS26624


Additional Details
Active
1/9/2014
4/1/2014
1/13/2014
2/14/2025

Contacts

Pomona Community Health Center
David M Kadar, Chief Executive Officer
(909) 630-7939

Parktree Community Health Center
Juliet V Dominguez, Director of Risk Management & Compliance
(909) 469-9013 Ext: 6037

Addresses

1450 E. Holt Blvd.
Pomona, CA 91767-5822

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
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCBC MISSION PHARMACYCBC PHARMACY 716 E MISSION BLVD SUITE A
POMONACA9176601/16/201504/01/2015 01/31/201711/11/2020
Contract DetailCBC MISSION PHARMACY716 E MISSION BLVD STE A
POMONACA9176601/07/202504/01/2025  04/01/2025
Contract DetailCOUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260201/15/201604/01/2016  01/15/2016
Contract DetailDEV PHARMA INCDBA EZRX PHARMACY 731 INDIAN HILL BLVD
POMONACA9176711/22/201601/01/2017  11/22/2016
Contract DetailRX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135501/15/201604/01/2016  01/15/2016
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC26624-00ActiveBPS-H80-013167POMONA COMMUNITY HEALTH CENTERPomona Community Health Center750 South Park Avenue, Room 101 PomonaCA
CHC26624-01ActiveBPS-H80-013210POMONA COMMUNITY HEALTH CENTERPomona Community Health Center1450 E. Holt Blvd. PomonaCA
CHC26624-02TerminatedBPS-H80-013215POMONA COMMUNITY HEALTH CENTERWinter Shelter600 S. Park Ave. PomonaCA
CHC26624-03ActiveBPS-H80-017360POMONA COMMUNITY HEALTH CENTEROntario1556 S. Sultana Avenue OntarioCA
CHC26624-04ActiveBPS-H80-019265POMONA COMMUNITY HEALTH CENTEROntario Archibald2680 E. Riverside Drive OntarioCA
CHC26624-05ActiveBPS-H80-027265POMONA COMMUNITY HEALTH CENTERHolt Dental1448 E Holt Ave PomonaCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC26624-00CBC MISSION PHARMACYCBC PHARMACY 716 E MISSION BLVD SUITE A
POMONACA9176604/01/2015 01/31/2017
CHC26624-01CBC MISSION PHARMACYCBC PHARMACY 716 E MISSION BLVD SUITE A
POMONACA9176604/01/2015 01/31/2017
CHC26624-01CBC MISSION PHARMACY716 E MISSION BLVD STE A
POMONACA9176604/01/2025  
CHC26624-03CBC MISSION PHARMACY716 E MISSION BLVD STE A
POMONACA9176604/01/2025  
CHC26624-04CBC MISSION PHARMACY716 E MISSION BLVD STE A
POMONACA9176604/01/2025  
CHC26624-05CBC MISSION PHARMACY716 E MISSION BLVD STE A
POMONACA9176604/01/2025  
CHC26624-00COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260204/01/2016  
CHC26624-01COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260204/01/2016  
CHC26624-02COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260204/01/2016 04/01/2022
CHC26624-03COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260204/01/2017  
CHC26624-00DEV PHARMA INCDBA EZRX PHARMACY 731 INDIAN HILL BLVD
POMONACA9176701/01/2017  
CHC26624-01DEV PHARMA INCDBA EZRX PHARMACY 731 INDIAN HILL BLVD
POMONACA9176701/01/2017  
CHC26624-02DEV PHARMA INCDBA EZRX PHARMACY 731 INDIAN HILL BLVD
POMONACA9176701/01/2017 04/01/2022
CHC26624-03DEV PHARMA INCDBA EZRX PHARMACY 731 INDIAN HILL BLVD
POMONACA9176701/01/2017  
CHC26624-04DEV PHARMA INCDBA EZRX PHARMACY 731 INDIAN HILL BLVD
POMONACA9176707/01/2017  
CHC26624-00RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135504/01/2016  
CHC26624-01RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135504/01/2016  
CHC26624-02RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135504/01/2016 04/01/2022
CHC26624-03RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135504/01/2017  
CHC26624-00WALGREEN CO.DBA: WALGREENS # 07230 495 E HOLT AVE
POMONACA91767-553910/01/2017  
CHC26624-00WALGREEN CO.DBA: WALGREENS # 04382 795 E. FOOTHILL
POMONACA9176710/01/2017  
CHC26624-00WALGREEN CO.DBA: WALGREENS # 06438 12490 CENTRAL AVENUE
CHINOCA9171010/01/2017  
CHC26624-00WALGREEN CO.DBA: WALGREENS #10202 2245 S EUCLID AVE
ONTARIOCA9176210/01/2017  
CHC26624-00WALGREEN CO.DBA: WALGREENS # 06147 2950 S ARCHIBALD AVE
ONTARIOCA91761-730310/01/2017  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/14/2024 12:43:21 PM2/14/2025 4:16:41 AM2/14/2025 4:16 AM
DetailsLast Recertification DateUpdateRecertification2/6/2023 11:12:47 AM2/14/2024 12:43:21 PM2/14/2024 12:43 PM
DetailsLast Recertification DateUpdateRecertification2/7/2022 11:58:51 AM2/6/2023 11:12:47 AM2/6/2023 11:12 AM
DetailsLast Recertification DateUpdateRecertification2/10/2021 6:48:17 PM2/7/2022 11:58:51 AM2/7/2022 11:58 AM
DetailsLast Recertification DateUpdateRecertification2/5/2020 8:23:52 AM2/10/2021 6:48:17 PM2/10/2021 6:48 PM
ContactsPrimary ContactUpdateProfile Change RequestDominguez, Juliet V HR & Compliance Manager Parktree Community Health Center 9094699013-6037Dominguez, Juliet V Director of Risk Management & Compliance Parktree Community Health Center 9094699013-603711/11/2020 3:19 PM
ContactsAuthorizing OfficialUpdateAO Change RequestSilver, Ellen Chief Executive Officer Pomona Community Health Center 9096307939Kadar, David M Chief Executive Officer Pomona Community Health Center 90963079392/5/2020 3:35 PM
DetailsLast Recertification DateUpdateRecertification1/31/2019 11:48:07 AM2/5/2020 8:23:52 AM2/5/2020 8:23 AM
ContactsPrimary ContactUpdateRecertificationDominguez, Juliet HR & Compliance Manager Pomona Community Helath Center 9094699013-6037Dominguez, Juliet V HR & Compliance Manager Parktree Community Health Center 9094699013-60371/31/2019 11:48 AM
DetailsLast Recertification DateUpdateRecertification2/8/2018 12:13:26 PM1/31/2019 11:48:07 AM1/31/2019 11:48 AM
ContactsAuthorizing OfficialUpdateAO Change RequestSilver, Ellen R. CEO Pomona Community Health Center 9098659501-7939Silver, Ellen Chief Executive Officer Pomona Community Health Center 90963079391/30/2019 1:12 PM
DetailsLast Recertification DateUpdateRecertification1/30/2017 12:00:00 AM2/8/2018 12:13:26 PM2/8/2018 12:13 PM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 2/8/2018 12:13 PM
ContactsPrimary ContactUpdateRecertificationWang, Alex MD, CMO 9098659501-5316Dominguez, Juliet HR & Compliance Manager Pomona Community Helath Center 9094699013-60372/8/2018 12:13 PM
ContactsAuthorizing OfficialUpdate Silver, Ellen R. CEO 9098659501-7939Silver, Ellen R. CEO Pomona Community Health Center 9098659501-79392/8/2018 12:10 PM
ContactsAuthorizing OfficialInsert  Silver, Ellen R. CEO 9098659501-79397/12/2017 5:03 PM
ContactsPrimary ContactInsert  Wang, Alex MD, CMO 9098659501-53161/31/2017 2:38 PM
AddressesMain AddressInsert   1450 E. Holt Blvd. Pomona, CA 91767-58221/30/2017 2:30 PM
ContactsSigned ByInsert  Ibarra, Carmen CEO 9098659501-62551/30/2017 2:30 PM
DetailsLast Recertification DateUpdate 2/25/2016 12:00:00 AM1/30/2017 12:00:00 AM1/30/2017 2:30 PM
DetailsLast Recertification DateUpdate 2/10/2015 12:00:00 AM2/25/2016 12:00:00 AM2/25/2016 12:36 PM
DetailsLast Recertification DateUpdate  2/10/2015 12:00:00 AM2/10/2015 3:25 PM
DetailsIs Authorizing Official EHB DataUpdate  False1/8/2015 2:54 PM
Details340B IDUpdate ONLINE_REGCHC26624-011/13/2014 11:12 AM
DatesParticipating Approval DateUpdate  1/13/2014 12:00:00 AM1/13/2014 11:12 AM
DetailsStateUpdate PendingActive1/13/2014 11:12 AM
DatesStart DateUpdate  4/1/2014 12:00:00 AM1/13/2014 11:12 AM
DetailsLast Recertification DateInsert   1/9/2014 1:11 AM
DetailsGrant NumberInsert  H80CS266241/9/2014 1:11 AM
Details340B IDInsert  ONLINE_REG1/9/2014 1:11 AM
DetailsIs Authorizing Official EHB DataInsert   1/9/2014 1:11 AM
DatesLast Date That 340B Drugs PurchasedInsert   1/9/2014 1:11 AM
DetailsMedicare Provider NumberInsert   1/9/2014 1:11 AM
DetailsEntity NameInsert  POMONA COMMUNITY HEALTH CENTER1/9/2014 1:11 AM
DetailsProgram CodeInsert  CH1/9/2014 1:11 AM
DetailsEntity SubnameInsert  Pomona Community Health Center1/9/2014 1:11 AM
DatesParticipating Approval DateInsert   1/9/2014 1:11 AM
DetailsStateInsert  Pending1/9/2014 1:11 AM
DatesRegistration DateInsert  1/9/2014 12:00:00 AM1/9/2014 1:11 AM
DatesSigned By DateInsert  1/9/2014 12:00:00 AM1/9/2014 1:11 AM
DatesStart DateInsert   1/9/2014 1:11 AM
TerminationsTermination CommentsInsert   1/9/2014 1:11 AM
TerminationsTermination DateInsert   1/9/2014 1:11 AM
TerminationsTermination Effective DateInsert   1/9/2014 1:11 AM
TerminationsTermination ReasonInsert   1/9/2014 1:11 AM