Covered Entity Details

CHC26619-00 KEDREN COMMUNITY HEALTH CENTER, INC. (Active) - information as of 4/25/2025 8:30:58 PM

Main Details

Name

KEDREN COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Kedren Community Care Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013327

340B ID

CHC26619-00

Grant Number

H80CS26619

Additional Details

Current Program Status

Active

Registration Date

5/21/2018

Participating Start Date

7/1/2018

Participating Approval Date

5/23/2018

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

KEDREN COMMUNITY HEALTH CENTER, INC.
MARIA FE V MARFORI, CFO
(323) 802-0308

Primary Contact

Kedren
Kelly Jones, Chief Medical Officer
(323) 234-0616

Addresses

Street Address

4211 Avalon Blvd. Suite A
Los Angeles, CA 90011-5622

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
Participating 7/1/2015 until terminated effective 4/1/2018, reinstated effective 7/1/2018.	05/23/2018
5/11/15 participating 1/1/15 thru 3/31/15, not participating 4/1/15 thru 6/30/15 due to failure to recertify, reinstated based on on-line registration submitted in April 2015	05/11/2015

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	01/15/2016	04/01/2016	04/01/2018	03/30/2024
Contract Detail	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	07/13/2018	10/01/2018		10/01/2018
Contract Detail	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	10/15/2015	01/01/2016	04/01/2018	04/01/2018
Contract Detail	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	07/13/2018	10/01/2018		10/01/2018
Contract Detail	PRIME PHARMACY SERVICES, INC.	4211 SOUTH AVALON BLVD.,		LOS ANGELES	CA	90011	01/10/2025	04/01/2025		04/01/2025
Contract Detail	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	01/15/2016	04/01/2016	04/01/2018	03/30/2024
Contract Detail	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	07/13/2018	10/01/2018		10/01/2018

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC26619-00	Active	BPS-H80-013327	KEDREN COMMUNITY HEALTH CENTER, INC.	Kedren Community Care Clinic	4211 Avalon Blvd. Suite A		Los Angeles	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC26619-00	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016	04/01/2018
CHC26619-00	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2018
CHC26619-00	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	01/01/2016	04/01/2018
CHC26619-00	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	10/01/2018
CHC26619-00	PRIME PHARMACY SERVICES, INC.	4211 SOUTH AVALON BLVD.,		LOS ANGELES	CA	90011	04/01/2025
CHC26619-00	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	04/01/2016	04/01/2018
CHC26619-00	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/28/2024 12:08:55 PM	2/11/2025 12:27:58 PM	2/11/2025 12:27 PM
Details	Last Recertification Date	Update	Recertification	2/1/2023 4:29:35 PM	2/28/2024 12:08:55 PM	2/28/2024 12:08 PM
Contacts	Authorizing Official	Update	AO Change Request	polk, gregory CEO Kedren Community Health Center 3238080821	MARFORI, MARIA FE V CFO KEDREN COMMUNITY HEALTH CENTER, INC. 3238020308	2/28/2024 10:19 AM
Contacts	Authorizing Official	Update	AO Change Request	Tran, Sonny Chief Operating Officer Kedren Community Care Clinic 3235157006	polk, gregory CEO Kedren Community Health Center 3238080821	2/22/2024 5:29 PM
Contacts	Authorizing Official	Update	Profile Change Request	Tran, Sonny Chief Operating Officer Kedren Community Care Clinic 3108338324	Tran, Sonny Chief Operating Officer Kedren Community Care Clinic 3235157006	2/1/2023 4:34 PM
Details	Last Recertification Date	Update	Recertification	2/8/2022 10:47:44 PM	2/1/2023 4:29:35 PM	2/1/2023 4:29 PM
Details	Last Recertification Date	Update	Recertification	3/1/2021 12:59:21 PM	2/8/2022 10:47:44 PM	2/8/2022 10:47 PM
Contacts	Authorizing Official	Update	OPA Edit	Ledesma-Davies, Kristina Chief Administrative Officer Kedren Community Health Center - Los Angeles, CA 3235991004-2022766195	Tran, Sonny Chief Operating Officer Kedren Community Care Clinic 3108338324	3/1/2021 1:55 PM
Details	Last Recertification Date	Update	Recertification	2/25/2020 3:52:20 PM	3/1/2021 12:59:21 PM	3/1/2021 12:59 PM
Details	Last Recertification Date	Update	Recertification	2/7/2019 5:26:27 PM	2/25/2020 3:52:20 PM	2/25/2020 3:52 PM
Contacts	Authorizing Official	Update	AO Change Request	Griffith, John H. Chief Executive Officer Kedren Community Health Center, Inc. 3234325080-151	Ledesma-Davies, Kristina Chief Administrative Officer Kedren Community Health Center - Los Angeles, CA 3235991004-2022766195	2/25/2020 2:27 PM
Contacts	Primary Contact	Update	Recertification	vega, miriam COO Kedren Community Clinic 3234325173	Jones, Kelly Chief Medical Officer Kedren 3232340616	2/7/2019 5:26 PM
Details	Last Recertification Date	Update	Recertification	1/26/2017 12:00:00 AM	2/7/2019 5:26:27 PM	2/7/2019 5:26 PM
Terminations	Termination Reason	Update		Failure to recertify		7/21/2018 12:21 PM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Addresses	Main Address	Insert	Reinstatement		4211 Avalon Blvd. Suite A Los Angeles, CA 90011-5622	5/23/2018 2:55 PM
Contacts	Primary Contact	Update	Reinstatement	Griffith, John H. Chief Executive Officer Kedren Community Health Center, Inc. 3234325080-151	vega, miriam COO Kedren Community Clinic 3234325173	5/23/2018 2:55 PM
Details	Is Authorizing Official EHB Data	Update	Reinstatement	False		5/23/2018 2:55 PM
Dates	Participating Approval Date	Update	Reinstatement		5/23/2018 2:55:59 PM	5/23/2018 2:55 PM
Details	State	Update	Reinstatement	Pending	Approved	5/23/2018 2:55 PM
Dates	Signed By Date	Update	Reinstatement	10/7/2014 12:00:00 AM	5/21/2018 1:41:29 PM	5/23/2018 2:55 PM
Dates	Start Date	Update	Reinstatement		7/1/2018 12:00:00 AM	5/23/2018 2:55 PM
Terminations	Termination Reason	Update	Reinstatement		Failure to recertify	5/23/2018 2:55 PM
Details	Comments Public	Insert	Reinstatement		Participating 7/1/2015 until terminated effective 4/1/2018, reinstated effective 7/1/2018.	5/23/2018 1:46 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	4/1/2018 12:00:00 AM		5/21/2018 1:41 PM
Dates	Participating Approval Date	Update	Reinstatement	10/16/2014 12:00:00 AM		5/21/2018 1:41 PM
Details	State	Update	Reinstatement	Terminated	Pending	5/21/2018 1:41 PM
Dates	Registration Date	Update	Reinstatement	10/7/2014 12:00:00 AM	5/21/2018 1:41:26 PM	5/21/2018 1:41 PM
Dates	Start Date	Update	Reinstatement	7/1/2015 12:00:00 AM		5/21/2018 1:41 PM
Terminations	Termination Date	Update	Reinstatement	4/1/2018 12:00:00 AM		5/21/2018 1:41 PM
Terminations	Termination Effective Date	Update	Reinstatement	4/1/2018 12:00:00 AM		5/21/2018 1:41 PM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		5/21/2018 1:41 PM
Contacts	Authorizing Official	Update		Griffith, John H. Chief Executive Officer 3234325080-151	Griffith, John H. Chief Executive Officer Kedren Community Health Center, Inc. 3234325080-151	5/18/2018 5:35 PM
Contacts	Primary Contact	Update		Griffith, John H. Chief Executive Officer 3234325080-151	Griffith, John H. Chief Executive Officer Kedren Community Health Center, Inc. 3234325080-151	5/18/2018 5:35 PM
Contacts	Signed By	Update		Griffith, John H. Chief Executive Officer 3234325080-151	Griffith, John H. Chief Executive Officer Kedren Community Health Center, Inc. 3234325080-151	5/18/2018 5:35 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 2:37 PM
Details	State	Update	Recertification	Active	To Be Terminated	3/8/2018 2:37 PM
Terminations	Termination Date	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 2:37 PM
Terminations	Termination Effective Date	Update	Recertification		4/1/2018 12:00:00 AM	3/8/2018 2:37 PM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	3/8/2018 2:37 PM
Addresses	Main Address	Insert			4211 Avalon Blvd. Suite A Los Angeles, CA 90011-5622	1/26/2017 11:10 AM
Contacts	Authorizing Official	Insert			Griffith, John H. Chief Executive Officer 3234325080-151	1/26/2017 11:10 AM
Contacts	Primary Contact	Insert			Griffith, John H. Chief Executive Officer 3234325080-151	1/26/2017 11:10 AM
Contacts	Signed By	Insert			Griffith, John H. Chief Executive Officer 3234325080-151	1/26/2017 11:10 AM
Details	Last Recertification Date	Update		3/7/2016 12:00:00 AM	1/26/2017 12:00:00 AM	1/26/2017 11:10 AM
Details	Last Recertification Date	Update		3/12/2015 12:00:00 AM	3/7/2016 12:00:00 AM	3/7/2016 2:53 PM
Dates	Last Date That 340B Drugs Purchased	Update		4/1/2015 12:00:00 AM		5/11/2015 4:27 PM
Details	State	Update		Terminated	Active	5/11/2015 4:27 PM
Dates	Start Date	Update		1/1/2015 12:00:00 AM	7/1/2015 12:00:00 AM	5/11/2015 4:27 PM
Terminations	Termination Date	Update		4/1/2015 12:00:00 AM		5/11/2015 4:27 PM
Terminations	Termination Effective Date	Update		4/1/2015 12:00:00 AM		5/11/2015 4:27 PM
Terminations	Termination Reason	Update		Failure to recertify		5/11/2015 4:27 PM
Details	Comments Public	Insert			5/11/15 participating 1/1/15 thru 3/31/15, not participating 4/1/15 thru 6/30/15 due to failure to recertify, reinstated based on on-line registration submitted in April 2015	5/11/2015 4:27 PM
Details	Last Recertification Date	Update			3/12/2015 12:00:00 AM	3/12/2015 9:19 AM
Dates	Last Date That 340B Drugs Purchased	Update			4/1/2015 12:00:00 AM	3/12/2015 9:19 AM
Details	State	Update		Active	Terminated	3/12/2015 9:19 AM
Terminations	Termination Date	Update			4/1/2015 12:00:00 AM	3/12/2015 9:19 AM
Terminations	Termination Effective Date	Update			4/1/2015 12:00:00 AM	3/12/2015 9:19 AM
Terminations	Termination Reason	Update			Failure to recertify	3/12/2015 9:19 AM
Dates	Participating Approval Date	Update			10/16/2014 12:00:00 AM	10/16/2014 1:25 PM
Details	State	Update		Pending	Active	10/16/2014 1:25 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	10/16/2014 1:25 PM
Details	340B ID	Update		ONLINE_REG_46679	CHC26619-00	10/8/2014 9:17 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_46679	10/7/2014 6:43 PM
Details	Last Recertification Date	Insert				10/7/2014 6:43 PM
Details	Grant Number	Insert			H80CS26619	10/7/2014 6:43 PM
Details	340B ID	Insert			ONLINE_REG	10/7/2014 6:43 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/7/2014 6:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/7/2014 6:43 PM
Details	Medicare Provider Number	Insert				10/7/2014 6:43 PM
Details	Entity Name	Insert			KEDREN COMMUNITY HEALTH CENTER, INC.	10/7/2014 6:43 PM
Details	Program Code	Insert			CH	10/7/2014 6:43 PM
Details	Entity Subname	Insert			Kedren Community Care Clinic	10/7/2014 6:43 PM
Dates	Participating Approval Date	Insert				10/7/2014 6:43 PM
Details	State	Insert			Pending	10/7/2014 6:43 PM
Dates	Registration Date	Insert			10/7/2014 12:00:00 AM	10/7/2014 6:43 PM
Dates	Signed By Date	Insert			10/7/2014 12:00:00 AM	10/7/2014 6:43 PM
Dates	Start Date	Insert				10/7/2014 6:43 PM
Terminations	Termination Comments	Insert				10/7/2014 6:43 PM
Terminations	Termination Date	Insert				10/7/2014 6:43 PM
Terminations	Termination Effective Date	Insert				10/7/2014 6:43 PM
Terminations	Termination Reason	Insert				10/7/2014 6:43 PM

340B Drug Pricing Program Database