Covered Entity Details

CH091014F COMMUNITY HEALTH ALLIANCE OF PASADENA (Terminated) - information as of 6/23/2025 12:33:18 AM

Main Details

Name

COMMUNITY HEALTH ALLIANCE OF PASADENA

Subdivision Name

ChapCare Dental

Type

HRSA-Funded Health Center

Site ID

BPS-H80-002984

340B ID

CH091014F

Grant Number

H80CS04220

Additional Details

Current Program Status

Terminated

Registration Date

10/10/2014

Participating Start Date

1/1/2015

Participating Approval Date

10/23/2014

Last Recertification Date

2/2/2023

Termination Date
Termination Reason

4/1/2024
Loss of qualifying grant/support

Contacts

Authorizing Official

Community Health Alliance of Pasadena
Deyner Zapata, Interim Chief Executive Officer
(626) 993-1260

Primary Contact

Community Health Alliance of Pasadena
Marcy Chavez, Business Operations Director
(626) 993-1238

Addresses

Street Address

1855 N. FAIR OAKS AVE STE G-100
PASADENA, CA 91103-1620

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
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
CA	1447653787	1447653787

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	07/07/2021	10/01/2021	04/01/2024	04/01/2024
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09668	727 S. ARROYO PARKWAY	PASADENA	CA	91105	01/09/2020	04/01/2020	04/01/2024	04/01/2024
Contract Detail	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16319	777 E COLORADO BLVD	PASADENA	CA	91101	01/09/2020	04/01/2020	04/01/2024	04/01/2024
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09788	2315 HUNTINGTON DR	DUARTE	CA	91010	04/14/2020	07/01/2020	04/01/2024	04/01/2024
Contract Detail	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	07/07/2021	10/01/2021	04/01/2024	04/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH0910140	Terminated	BPS-H80-004947	COMMUNITY HEALTH ALLIANCE OF PASADENA	COMMUNITY HEALTH ALLIANCE OF PASADENA	1855 N Fair Oaks Ave	Pasadena	CA
CH091014A	Terminated	BPS-H80-008308	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare Del Mar	3160 E. Del Mar Blvd.	Pasadena	CA
CH091014B	Terminated	BPS-H80-010220	COMMUNITY HEALTH ALLIANCE OF PASADENA	CHAP/Lake Clinic	1800 N. Lake Ave.	Pasadena	CA
CH091014C	Terminated	BPS-H80-012170	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare - Vacco	10408 Vacco St	South El Monte	CA
CH091014D	Terminated	BPS-H80-011422	COMMUNITY HEALTH ALLIANCE OF PASADENA	Foothill Unity Center	415 W Chestnut Ave	Monrovia	CA
CH091014E	Terminated	BPS-H80-006683	COMMUNITY HEALTH ALLIANCE OF PASADENA	UNION STATION-HOMELESS SHELTER	412 S. RAYMOND AVE	PASADENA	CA
CH091014F	Terminated	BPS-H80-002984	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare Dental	1855 N. FAIR OAKS AVE STE G-100	PASADENA	CA
CH091014G	Terminated	BPS-H80-013548	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare Garvey	10127 GARVEY AVE	EL MONTE	CA
CH091014H	Terminated	BPS-H80-017042	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare Lincoln	2055 LINCOLN AVE	PASADENA	CA
CH091014J	Terminated	BPS-H80-017797	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare - Peck	3703 Peck Rd.	El Monte	CA
CH091014K	Terminated	BPS-H80-027060	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare Lime	513 E. Lime Avenue	Monrovia	CA
CH091014L	Terminated	BPS-H80-027191	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare Lincoln	2055 Lincoln Ave	Pasadena	CA
CH091014M	Terminated	BPS-H80-021675	COMMUNITY HEALTH ALLIANCE OF PASADENA	ChapCare Lake/Elizabeth	1595 N Lake Ave	Pasadena	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0910140	COMMUNITY HEALTH ALLIANCE OF PASADENA	PHARMACY	1855 N FAIR OAKS AVE	PASADENA	CA	91103-1620	07/01/2017	04/01/2024
CH0910140	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH091014A	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH091014C	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH091014J	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH091014K	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH091014M	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH091014F	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH091014G	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2021	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09694	900 N. LAKE AVE.	PASADENA	CA	91104	07/01/2017	04/13/2018
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09848	20 E ORANGE GROVE BLVD.	PASADENA	CA	91103	07/01/2017	04/13/2018
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09694	900 N. LAKE AVE.	PASADENA	CA	91104	10/01/2018	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09848	20 E ORANGE GROVE BLVD.	PASADENA	CA	91103	10/01/2018	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09689	950 WEST FOOTHILL BLVD	MONROVIA	CA	91016	01/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16673	3121 E COLORADO BLVD	PASADENA	CA	91107	01/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09668	727 S. ARROYO PARKWAY	PASADENA	CA	91105	01/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16319	777 E COLORADO BLVD	PASADENA	CA	91101	01/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 01778	3883 E. FOOTHILL BLVD (NWC)	PASADENA	CA	91107	01/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16100	1050 HUNTINGTON DR	DUARTE	CA	91010	01/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09721	1401 S. BALDWIN AVE.	ARCADIA	CA	91007	01/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09791	2532 W. VALLEY BLVD.	ALHAMBRA	CA	91803	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17004	7100 SANTA MONICA BLVD	WEST HOLLYWOOD	CA	90046	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09687	702 NORTH AZUSA AVE	WEST COVINA	CA	91791	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09582	3741 CRENSHAW BOULEVARD	LOS ANGELES	CA	90016	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08895	775 E. FOOTHILL BOULEVARD	POMONA	CA	91767	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09645	8225 GARVEY AVENUE	ROSEMEAD	CA	91770	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09639	11940 GARVEY AVENUE	EL MONTE	CA	91732	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09657	44430 CHALLENGER WAY	LANCASTER	CA	93535	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08853	1645 EAST 103RD STREET	LOS ANGELES	CA	90002	07/01/2019	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09629	861 NORTH HACIENDA BOULEVARD	LA PUENTE	CA	91744	07/01/2019	04/01/2024
CH091014J	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09689	950 WEST FOOTHILL BLVD	MONROVIA	CA	91016	01/01/2020	04/01/2024
CH091014K	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16100	1050 HUNTINGTON DR	DUARTE	CA	91010	01/01/2020	04/01/2024
CH091014M	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09668	727 S. ARROYO PARKWAY	PASADENA	CA	91105	01/01/2020	04/01/2024
CH091014M	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 01778	3883 E. FOOTHILL BLVD (NWC)	PASADENA	CA	91107	01/01/2020	04/01/2024
CH091014K	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09689	950 WEST FOOTHILL BLVD	MONROVIA	CA	91016	01/01/2020	04/01/2024
CH091014J	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09639	11940 GARVEY AVENUE	EL MONTE	CA	91732	01/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 01778	3883 E. FOOTHILL BLVD (NWC)	PASADENA	CA	91107	04/01/2020	04/01/2024
CH091014C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09639	11940 GARVEY AVENUE	EL MONTE	CA	91732	04/01/2020	04/01/2024
CH091014G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09645	8225 GARVEY AVENUE	ROSEMEAD	CA	91770	04/01/2020	04/01/2024
CH091014C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09687	702 NORTH AZUSA AVE	WEST COVINA	CA	91791	04/01/2020	04/01/2024
CH091014C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09645	8225 GARVEY AVENUE	ROSEMEAD	CA	91770	04/01/2020	04/01/2024
CH091014C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09629	861 NORTH HACIENDA BOULEVARD	LA PUENTE	CA	91744	04/01/2020	04/01/2024
CH091014G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09639	11940 GARVEY AVENUE	EL MONTE	CA	91732	04/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16673	3121 E COLORADO BLVD	PASADENA	CA	91107	04/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09668	727 S. ARROYO PARKWAY	PASADENA	CA	91105	04/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16319	777 E COLORADO BLVD	PASADENA	CA	91101	04/01/2020	04/01/2024
CH091014F	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09668	727 S. ARROYO PARKWAY	PASADENA	CA	91105	04/01/2020	04/01/2024
CH091014F	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16319	777 E COLORADO BLVD	PASADENA	CA	91101	04/01/2020	04/01/2024
CH091014L	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16319	777 E COLORADO BLVD	PASADENA	CA	91101	04/01/2020	04/01/2024
CH091014L	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09668	727 S. ARROYO PARKWAY	PASADENA	CA	91105	04/01/2020	04/01/2024
CH091014K	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09788	2315 HUNTINGTON DR	DUARTE	CA	91010	07/01/2020	04/01/2024
CH091014L	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09666	2419 WORKMAN STREET	LOS ANGELES	CA	90031	07/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09788	2315 HUNTINGTON DR	DUARTE	CA	91010	07/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05499	1954 DURFEE AVE.	SOUTH EL MONTE	CA	91733	07/01/2020	04/01/2024
CH091014G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05499	1954 DURFEE AVE.	SOUTH EL MONTE	CA	91733	07/01/2020	04/01/2024
CH091014J	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03968	816 E. MAIN STREET	ALHAMBRA	CA	91801	07/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09666	2419 WORKMAN STREET	LOS ANGELES	CA	90031	07/01/2020	04/01/2024
CH091014G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09666	2419 WORKMAN STREET	LOS ANGELES	CA	90031	07/01/2020	04/01/2024
CH091014G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09857	800 W. WHITTIER BLVD.	MONTEBELLO	CA	90640	07/01/2020	04/01/2024
CH091014G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03968	816 E. MAIN STREET	ALHAMBRA	CA	91801	07/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03968	816 E. MAIN STREET	ALHAMBRA	CA	91801	07/01/2020	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05499	1954 DURFEE AVE.	SOUTH EL MONTE	CA	91733	07/01/2020	04/01/2024
CH091014J	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09857	800 W. WHITTIER BLVD.	MONTEBELLO	CA	90640	07/01/2020	04/01/2024
CH091014A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09857	800 W. WHITTIER BLVD.	MONTEBELLO	CA	90640	07/01/2020	04/01/2024
CH091014J	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09788	2315 HUNTINGTON DR	DUARTE	CA	91010	07/01/2020	04/01/2024
CH091014M	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03968	816 E. MAIN STREET	ALHAMBRA	CA	91801	07/01/2020	04/01/2024
CH091014G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09788	2315 HUNTINGTON DR	DUARTE	CA	91010	07/01/2020	04/01/2024
CH091014L	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03968	816 E. MAIN STREET	ALHAMBRA	CA	91801	07/01/2020	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03968	816 E. MAIN STREET	ALHAMBRA	CA	91801	07/01/2020	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09788	2315 HUNTINGTON DR	DUARTE	CA	91010	07/01/2020	04/01/2024
CH091014M	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09666	2419 WORKMAN STREET	LOS ANGELES	CA	90031	07/01/2020	04/01/2024
CH091014J	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05499	1954 DURFEE AVE.	SOUTH EL MONTE	CA	91733	07/01/2020	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09857	800 W. WHITTIER BLVD.	MONTEBELLO	CA	90640	07/01/2020	04/01/2024
CH0910140	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09666	2419 WORKMAN STREET	LOS ANGELES	CA	90031	07/01/2020	04/01/2024
CH091014F	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09788	2315 HUNTINGTON DR	DUARTE	CA	91010	07/01/2020	04/01/2024
CH091014C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09857	800 W. WHITTIER BLVD.	MONTEBELLO	CA	90640	07/01/2020	04/01/2024
CH091014C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09788	2315 HUNTINGTON DR	DUARTE	CA	91010	07/01/2020	04/01/2024
CH091014C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05499	1954 DURFEE AVE.	SOUTH EL MONTE	CA	91733	07/01/2020	04/01/2024
CH091014C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03968	816 E. MAIN STREET	ALHAMBRA	CA	91801	07/01/2020	04/01/2024
CH0910140	GWLW PHARMACY INC		BERRY & SWEENEY PHARMACY 1377 N FAIR OAKS AVENUE	PASADENA	CA	91103-2101	04/01/2006	10/13/2017
CH091014J	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH0910140	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH091014A	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH091014G	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH091014M	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH091014F	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH091014C	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH091014K	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2021	04/01/2024
CH0910140	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2020	04/01/2024
CH0910140	WAL-MART PHARMACY 10-2401	1600 SOUTH MOUNTAIN AVE		DUARTE	CA	91010	10/01/2019	04/01/2024
CH0910140	WAL-MART PHARMACY 10-3522	3250 BIG DALTON AVE		BALDWIN PARK	CA	91706	10/01/2019	04/01/2024
CH0910140	WAL-MART PHARMACY 10-5154	1827 WALNUT GROVE AVE		ROSEMEAD	CA	91770	10/01/2019	04/01/2024
CH0910140	WALGREEN CO	DBA: WALGREENS #7575	3643 PECK RD	EL MONTE	CA	91731-3530	10/01/2013	05/20/2020
CH0910140	WALGREEN CO	DBA: WALGREENS #11442	310 S LAKE AVE 1ST FL	PASADENA	CA	91101	10/01/2013	05/20/2020
CH0910140	WALGREEN CO.	DBA: WALGREENS # 02156	2551 WEST MAIN STREET	ALHAMBRA	CA	91801	10/01/2013	05/20/2020
CH0910140	WALGREEN CO.	DBA: WALGREENS # 07598	11907 VALLEY BLVD	EL MONTE	CA	91732-3113	10/01/2013	05/20/2020
CH0910140	WALGREEN CO.	DBA: WALGREENS # 09139	670 NORTH LAKE AVENUE	PASADENA	CA	91101-1220	10/01/2013	05/20/2020
CH0910140	WALGREEN CO.	DBA: WALGREENS #10764	2376 E COLORADO BLVD	PASADENA	CA	91107	10/01/2013	05/20/2020
CH0910140	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	07/22/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		10/31/2023 12:00:00 AM	2/23/2024 2:28 PM
Details	State	Update	Recertification	Active	To Be Terminated	2/23/2024 2:28 PM
Terminations	Termination Comments	Update	Recertification		Transfer of Grant to AltaMed Health Services through SII agreement	2/23/2024 2:28 PM
Terminations	Termination Date	Update	Recertification		4/1/2024 12:00:00 AM	2/23/2024 2:28 PM
Terminations	Termination Effective Date	Update	Recertification		11/1/2023 12:00:00 AM	2/23/2024 2:28 PM
Terminations	Termination Reason	Update	Recertification		Loss of qualifying grant/support	2/23/2024 2:28 PM
Contacts	Primary Contact	Update	Profile Change Request	Chavez, Marcy Business Operation Director Community Health Alliance of Pasadena 6269931238	Chavez, Marcy Business Operations Director Community Health Alliance of Pasadena 6269931238	2/8/2023 11:14 AM
Contacts	Authorizing Official	Update	Change Request	MARTINEZ, MARGARET B. Chief Executive Officer Community Health Alliance of Pasadena (ChapCare) 6269931227	Zapata, Deyner Interim Chief Executive Officer Community Health Alliance of Pasadena 6269931260	2/8/2023 7:33 AM
Contacts	Primary Contact	Update	Recertification	Zapata, Deyner Chief Administrative Officer Community Health Alliance of Pasadena 6269931260	Chavez, Marcy Business Operation Director Community Health Alliance of Pasadena 6269931238	2/2/2023 10:38 AM
Details	Last Recertification Date	Update	Recertification	2/25/2022 2:01:47 PM	2/2/2023 10:38:10 AM	2/2/2023 10:38 AM
Details	Last Recertification Date	Update	Recertification	2/6/2021 4:32:24 PM	2/25/2022 2:01:47 PM	2/25/2022 2:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/6/2021 4:32 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1447653787	2/6/2021 4:32 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	2/6/2021 4:32 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/6/2021 4:32 PM
Details	Last Recertification Date	Update	Recertification	2/4/2020 2:44:11 PM	2/6/2021 4:32:24 PM	2/6/2021 4:32 PM
Contacts	Authorizing Official	Update	Change Request	Bautista, Sergio Executive Deputy Director Community Health Alliance of Pasadena 6269931215	MARTINEZ, MARGARET B. Chief Executive Officer Community Health Alliance of Pasadena (ChapCare) 6269931227	2/7/2020 5:17 PM
Details	Last Recertification Date	Update	Recertification	2/19/2019 12:23:15 PM	2/4/2020 2:44:11 PM	2/4/2020 2:44 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1447653787	2/19/2019 12:23 PM
Details	Last Recertification Date	Update	Recertification	2/14/2018 7:10:56 PM	2/19/2019 12:23:15 PM	2/19/2019 12:23 PM
Contacts	Primary Contact	Update	Recertification	Bautista, Sergio Executive Deputy Director Community Health Alliance of Pasadena 6269931215	Zapata, Deyner Chief Administrative Officer Community Health Alliance of Pasadena 6269931260	2/14/2018 7:10 PM
Details	Last Recertification Date	Update	Recertification	2/15/2017 12:00:00 AM	2/14/2018 7:10:56 PM	2/14/2018 7:10 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/14/2018 7:10 PM
Contacts	Authorizing Official	Update		Bautista, Sergio Executive Deputy Director 6269931215	Bautista, Sergio Executive Deputy Director Community Health Alliance of Pasadena 6269931215	2/13/2018 8:18 PM
Contacts	Primary Contact	Update		Bautista, Sergio Executive Deputy Director 6269931215	Bautista, Sergio Executive Deputy Director Community Health Alliance of Pasadena 6269931215	2/13/2018 8:18 PM
Contacts	Signed By	Update		Bautista, Sergio Executive Deputy Director 6269931215	Bautista, Sergio Executive Deputy Director Community Health Alliance of Pasadena 6269931215	2/13/2018 8:18 PM
Contacts	Authorizing Official	Insert			Bautista, Sergio Executive Deputy Director 6269931215	4/17/2017 3:44 PM
Contacts	Primary Contact	Insert			Bautista, Sergio Executive Deputy Director 6269931215	4/17/2017 3:44 PM
Contacts	Signed By	Insert			Bautista, Sergio Executive Deputy Director 6269931215	4/17/2017 3:44 PM
Addresses	Main Address	Insert			1855 N. FAIR OAKS AVE STE G-100 PASADENA, CA 91103-1620	2/15/2017 10:36 AM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	2/15/2017 12:00:00 AM	2/15/2017 10:36 AM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 12:48 PM
Details	Last Recertification Date	Update			3/4/2015 12:00:00 AM	3/4/2015 12:20 PM
Dates	Participating Approval Date	Update			10/23/2014 12:00:00 AM	10/23/2014 2:11 PM
Details	State	Update		Pending	Active	10/23/2014 2:11 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	10/23/2014 2:11 PM
Details	340B ID	Update		ONLINE_REG_47058	CH091014F	10/21/2014 10:49 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_47058	10/10/2014 5:31 PM
Details	Last Recertification Date	Insert				10/10/2014 5:31 PM
Details	Grant Number	Insert			H80CS04220	10/10/2014 5:31 PM
Details	340B ID	Insert			ONLINE_REG	10/10/2014 5:31 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/10/2014 5:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/10/2014 5:31 PM
Details	Medicare Provider Number	Insert				10/10/2014 5:31 PM
Details	Entity Name	Insert			COMMUNITY HEALTH ALLIANCE OF PASADENA	10/10/2014 5:31 PM
Details	Program Code	Insert			CH	10/10/2014 5:31 PM
Details	Entity Subname	Insert			ChapCare Dental	10/10/2014 5:31 PM
Dates	Participating Approval Date	Insert				10/10/2014 5:31 PM
Details	State	Insert			Pending	10/10/2014 5:31 PM
Dates	Registration Date	Insert			10/10/2014 12:00:00 AM	10/10/2014 5:31 PM
Dates	Signed By Date	Insert			10/10/2014 12:00:00 AM	10/10/2014 5:31 PM
Dates	Start Date	Insert				10/10/2014 5:31 PM
Terminations	Termination Comments	Insert				10/10/2014 5:31 PM
Terminations	Termination Date	Insert				10/10/2014 5:31 PM
Terminations	Termination Effective Date	Insert				10/10/2014 5:31 PM
Terminations	Termination Reason	Insert				10/10/2014 5:31 PM

340B Drug Pricing Program Database