340B Drug Pricing Program Database


CHC26608-00 COPPERTOWER FAMILY MEDICAL CENTER INC (Active) - information as of 6/7/2025 4:41:32 AM

Main Details
COPPERTOWER FAMILY MEDICAL CENTER INC
Alexander Valley Regional Medical Center (Medical/Behavioral Health)
HRSA-Funded Health Center
BPS-H80-013385
CHC26608-00
H80CS26608


Additional Details
Active
4/2/2014
7/1/2014
4/11/2014
2/10/2025

Contacts

Coppertower Family Medical Center, Inc. dba: Alexander Valley Healthcare
Deborah Howell, CEO
(707) 894-4229

Coppertower Family Medical Center
Jenine Saunders, CFO
(707) 669-1804

Addresses

6 Tarman Dr
Cloverdale, CA 95425-3932

Alexander Valley Healthcare
106 East First St.
Cloverdale, CA 95425


  • 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
CA10335344661033534466
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCLOVERDALE PHARMACY790 S CLOVERDALE BLVD
CLOVERDALECA95425-401004/14/201407/01/2014 04/30/202010/01/2020
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/15/202407/01/2024  07/01/2024
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 00345 1111 S CLOVERDALE BLVD
CLOVERDALECA9542510/14/201901/01/2020  01/01/2020
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01173 455 CENTER ST
HEALDSBURGCA9544810/14/201901/01/2020  01/01/2020
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09393 2075 MENDOCINO AVE
SANTA ROSACA9540110/14/202001/01/2021  01/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09928 6378 COMMERCE BLVD
ROHNERT PARKCA9492810/14/202001/01/2021  01/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09931 9030 BROOKS RD S
WINDSORCA9549210/14/202001/01/2021  01/01/2021
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC26608-00ActiveBPS-H80-013385COPPERTOWER FAMILY MEDICAL CENTER INCAlexander Valley Regional Medical Center (Medical/Behavioral Health)6 Tarman Dr CloverdaleCA
CHC26608-01ActiveBPS-H80-013396COPPERTOWER FAMILY MEDICAL CENTER INCAlexander Valley Dental Clinic100 W Third St. CloverdaleCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC26608-00CLOVERDALE PHARMACY790 S CLOVERDALE BLVD
CLOVERDALECA95425-401007/01/2014 04/30/2020
CHC26608-01CLOVERDALE PHARMACY790 S CLOVERDALE BLVD
CLOVERDALECA95425-401001/01/2015 04/30/2020
CHC26608-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2024  
CHC26608-01CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2024  
CHC26608-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 00345 1111 S CLOVERDALE BLVD
CLOVERDALECA9542501/01/2020  
CHC26608-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01173 455 CENTER ST
HEALDSBURGCA9544801/01/2020  
CHC26608-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09393 2075 MENDOCINO AVE
SANTA ROSACA9540101/01/2021  
CHC26608-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09928 6378 COMMERCE BLVD
ROHNERT PARKCA9492801/01/2021  
CHC26608-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09931 9030 BROOKS RD S
WINDSORCA9549201/01/2021  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/21/2024 1:31:42 PM2/10/2025 4:40:57 PM2/10/2025 4:40 PM
AddressesBilling AddressUpdateRecertificationAlexander Valley Healthcare 100 W Third St Cloverdale, CA 95425Alexander Valley Healthcare 106 East First St. Cloverdale, CA 954252/21/2024 1:31 PM
DetailsLast Recertification DateUpdateRecertification2/13/2023 12:49:21 PM2/21/2024 1:31:42 PM2/21/2024 1:31 PM
DetailsLast Recertification DateUpdateRecertification2/16/2022 3:21:49 PM2/13/2023 12:49:21 PM2/13/2023 12:49 PM
DetailsLast Recertification DateUpdateRecertification2/16/2021 12:24:43 PM2/16/2022 3:21:49 PM2/16/2022 3:21 PM
Medicaid BillingNPI: StateUpdateRecertification CA2/16/2021 12:24 PM
DetailsLast Recertification DateUpdateRecertification2/4/2020 11:41:09 AM2/16/2021 12:24:43 PM2/16/2021 12:24 PM
DetailsLast Recertification DateUpdateRecertification2/12/2019 12:06:22 PM2/4/2020 11:41:09 AM2/4/2020 11:41 AM
DetailsLast Recertification DateUpdateRecertification2/14/2018 5:40:04 PM2/12/2019 12:06:22 PM2/12/2019 12:06 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/6/2018 3:55 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10335344663/6/2018 3:55 PM
Medicaid BillingMedicaid: StateInsertChange Request CA3/6/2018 3:55 PM
Medicaid BillingNPI: NumberInsertChange Request 10335344663/6/2018 3:55 PM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 3/6/2018 3:55 PM
DetailsLast Recertification DateUpdateRecertification2/2/2017 12:00:00 AM2/14/2018 5:40:04 PM2/14/2018 5:40 PM
ContactsAuthorizing OfficialUpdate Howell, Deborah CEO 7078944229Howell, Deborah CEO Coppertower Family Medical Center, Inc. dba: Alexander Valley Healthcare 70789442292/14/2018 5:27 PM
ContactsSigned ByUpdate Howell, Deborah CEO 7078944229Howell, Deborah CEO Coppertower Family Medical Center, Inc. dba: Alexander Valley Healthcare 70789442292/14/2018 5:27 PM
ContactsPrimary ContactUpdate Saunders, Jenine CFO 7076691804Saunders, Jenine CFO Coppertower Family Medical Center 70766918042/6/2018 5:16 PM
AddressesMain AddressInsert   6 Tarman Dr Cloverdale, CA 95425-39322/2/2017 12:24 PM
ContactsPrimary ContactInsert  Saunders, Jenine CFO 70766918042/2/2017 12:24 PM
ContactsAuthorizing OfficialInsert  Howell, Deborah CEO 70789442292/2/2017 12:24 PM
ContactsSigned ByInsert  Howell, Deborah CEO 70789442292/2/2017 12:24 PM
DetailsLast Recertification DateUpdate 2/29/2016 12:00:00 AM2/2/2017 12:00:00 AM2/2/2017 12:24 PM
DetailsLast Recertification DateUpdate 3/9/2015 12:00:00 AM2/29/2016 12:00:00 AM2/29/2016 3:33 PM
DetailsLast Recertification DateUpdate  3/9/2015 12:00:00 AM3/9/2015 10:22 PM
DetailsIs Authorizing Official EHB DataUpdate  False3/9/2015 10:22 PM
AddressesBilling AddressInsert  Alexander Valley Healthcare 100 W Third St Cloverdale, CA 954254/11/2014 4:41 PM
Details340B IDUpdate ONLINE_REGCHC26608-004/11/2014 4:41 PM
DatesParticipating Approval DateUpdate  4/11/2014 12:00:00 AM4/11/2014 4:41 PM
DetailsStateUpdate PendingActive4/11/2014 4:41 PM
DatesStart DateUpdate  7/1/2014 12:00:00 AM4/11/2014 4:41 PM
DetailsLast Recertification DateInsert   4/2/2014 12:18 PM
DetailsGrant NumberInsert  H80CS266084/2/2014 12:18 PM
Details340B IDInsert  ONLINE_REG4/2/2014 12:18 PM
DetailsIs Authorizing Official EHB DataInsert   4/2/2014 12:18 PM
DatesLast Date That 340B Drugs PurchasedInsert   4/2/2014 12:18 PM
DetailsMedicare Provider NumberInsert   4/2/2014 12:18 PM
DetailsEntity NameInsert  COPPERTOWER FAMILY MEDICAL CENTER INC4/2/2014 12:18 PM
DetailsProgram CodeInsert  CH4/2/2014 12:18 PM
DetailsEntity SubnameInsert  Alexander Valley Regional Medical Center (Medical/Behavioral Health)4/2/2014 12:18 PM
DatesParticipating Approval DateInsert   4/2/2014 12:18 PM
DetailsStateInsert  Pending4/2/2014 12:18 PM
DatesRegistration DateInsert  4/2/2014 12:00:00 AM4/2/2014 12:18 PM
DatesSigned By DateInsert  4/2/2014 12:00:00 AM4/2/2014 12:18 PM
DatesStart DateInsert   4/2/2014 12:18 PM
TerminationsTermination CommentsInsert   4/2/2014 12:18 PM
TerminationsTermination DateInsert   4/2/2014 12:18 PM
TerminationsTermination Effective DateInsert   4/2/2014 12:18 PM
TerminationsTermination ReasonInsert   4/2/2014 12:18 PM