340B Drug Pricing Program Database


STD921261 Planned Parenthood of the Pacific Southwest (Active) - information as of 6/27/2025 12:31:16 AM

Main Details
Planned Parenthood of the Pacific Southwest
Mira Mesa
Sexually Transmitted Diseases
STD921261
1H25PS005127


In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.
Chlamydia and gonorrhea EPT medication and condoms
1/1/2019 - 2/28/2026


Additional Details
Active
10/12/2015
1/1/2016
11/18/2015
5/12/2025
PS19-1901

Contacts

Planned Parenthood of the Pacific Southwest
Janeen Burlison, VP of Clinical Services and Quality
(619) 881-4662 Ext: 6198814662

Planned Parenthood of the Pacific Southwest
Sara S Standerford, Compliance and Privacy Manager
(619) 881-4647

Addresses

10717 Camino Ruiz
Suite #258
San Diego, CA 92126

PLANNED PARENTHOOD OF THE PACIFIC SOUTHWEST - PURCHASING DEPARTMENT
1075 CAMINO DEL RIO SOUTH
SAN DIEGO, CA 92108


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CACMM70393F1124053111
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailAHF PHARMACYAIDS HEALTHCARE FOUNDATION 120 UNIVERSITY AVE
SAN DIEGOCA92103-300701/14/202104/01/2021  04/01/2021
Contract DetailAHF PHARMACYAIDS HEALTHCARE FOUNDATION 1988 HACIENDA DR
VISTACA92081-602601/14/202104/01/2021  04/01/2021
Contract DetailAHF PHARMACYAIDS HEALTHCARE FOUNDATION 4630 BORDER VILLAGE RD STE K
SAN YSIDROCA92173-312101/12/202204/01/2022  04/01/2022
Contract DetailAIDS HEALTHCARE FOUNDATIONAHF PHARMACY 3580 5TH AVE STE 200
SAN DIEGOCA9210301/14/202104/01/2021  04/01/2021
Contract DetailAIDS HEALTHCARE FOUNDATIONDBA AHF PHARMACY 19300 S. HAMILTON AVE #170/180
GARDENACA90248-440001/14/202104/01/2021  04/01/2021
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/11/202101/01/2022  01/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/11/202101/01/2022  01/01/2022
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/11/202101/01/2022  01/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09166 734 S. RANCHO SANTA FE RD.
SAN MARCOSCA9207804/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08897 3361 MARKET ST.
RIVERSIDECA9250104/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16094 3333 ARLINGTON AVE
RIVERSIDECA9250604/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09524 3350 PALM AVE.
SAN DIEGOCA9215404/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10954 402 5TH AVENUE
SAN DIEGOCA9210104/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10819 1850 5TH AVENUE
SAN DIEGOCA9210104/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09112 7100 BROADWAY
LEMON GROVECA9194504/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09610 12280 PERRIS BLVD
MORENO VALLEYCA9255704/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09197 9225 TWIN TRAILS DRIVE
SAN DIEGOCA9212904/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09799 6215 RIVERSIDE AVE.
RIVERSIDECA9250604/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16937 2295 N IMPERIAL AVE
EL CENTROCA9224304/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09148 313 WASHINGTON ST.
SAN DIEGOCA9210304/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09574 883 S. SANTA FE AVENUE
VISTACA9208304/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17668 17170 CAMINO DEL SUR
SAN DIEGOCA9212704/15/202207/01/2022  07/01/2022
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09195 8831 VILLA LA JOLLA DR.
LA JOLLACA9203704/16/202407/01/2024  07/01/2024
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09177 8260 MIRA MESA BLVD.
SAN DIEGOCA9212604/16/202407/01/2024  07/01/2024
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09558 320 S TWIN OAKS VALLEY RD
SAN MARCOSCA9207804/15/202207/01/2022  07/01/2022
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06368 635 S MELROSE DR
VISTACA9208104/15/202207/01/2022  07/01/2022
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09538 1792 GARNET AVE
SAN DIEGOCA9210904/15/202207/01/2022  07/01/2022
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09937 4445 MISSION BLVD
SAN DIEGOCA9210904/15/202207/01/2022  07/01/2022
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09963 5644 MISSION CENTER RD
SUITE 201
SAN DIEGOCA9210804/16/202407/01/2024  07/01/2024
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06332 645 MARKET ST
SAN DIEGOCA9210104/16/202407/01/2024  07/01/2024
Contract DetailMI FARMACIA SAN YSIDRO4630 BORDER VILLAGE RD STE K-L
SAN YSIDROCA92173-312101/14/202104/01/2021 01/06/202201/12/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/11/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 1010 UNIVERSITY AVENUE
SAN DIEGOCA9210310/11/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/11/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/11/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681310/11/202101/01/2022  01/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 445 CASTRO STREET
SAN FRANCISCOCA9411410/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CODBA: WALGREENS #07751 3507 CANNON RD
OCEANSIDECA92056-497704/13/202107/01/2021  07/01/2021
Contract DetailWALGREEN CODBA: WALGREENS #12143 5504 BALBOA AVE
SAN DIEGOCA9211110/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #13435 555 S SUNRISE WAY STE 112-113
PALM SPRINGSCA9226404/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05455 111 W WASHINGTON AVE
ESCONDIDOCA9202504/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 07262 6600 MAGNOLIA AVE
RIVERSIDECA92506-290304/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 02623 1111 THIRD AVE
CHULA VISTACA91911-310504/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS #11654 10787 CAMINO RUIZ
SAN DIEGOCA92126-230404/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS #13161 4029 43RD ST. STE 700
SAN DIEGOCA9210504/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS #13834 602 EUCLID AVE
SAN DIEGOCA9211404/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16490 4130 LA JOLLA VILLAGE DR STE 103
LA JOLLACA9203704/15/202007/01/2020  07/01/2020
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #13434 640 UNIVERSITY AVE
SAN DIEGOCA9210304/13/202107/01/2021  07/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 05456 1510 N SANTA FE AVE
VISTACA9208304/13/202107/01/2021  07/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 09389 310 SYCAMORE AVENUE
VISTACA92083-770204/13/202107/01/2021 04/08/202407/22/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 07867 1430 EASTLAKE PKWY
CHULA VISTACA9191510/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06656 3222 UNIVERSITY AVENUE
SAN DIEGOCA92104-201010/11/202101/01/2022 11/15/202304/16/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #11990 9728 WINTER GARDENS BLVD
LAKESIDECA9204010/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #11653 1320 ENCINITAS BLVD
ENCINITASCA9202410/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07176 8766 NAVAJO RD
SAN DIEGOCA92119-272210/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06094 3005 MIDWAY DRIVE
SAN DIEGOCA92110-450210/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07869 885 EUCLID AVE
NATIONAL CITYCA9195010/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #13859 925 ORANGE AVE.
CORONADOCA92118-260901/12/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #12421 13390 POWAY RD
POWAYCA9206401/12/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 05844 215 NORTH 2ND STREET
EL CAJONCA9202101/12/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #12915 7195 BROADWAY
LEMON GROVECA91945-140801/12/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #10948 33060 ANTELOPE RD
MURRIETACA9256307/22/202410/01/2024  10/01/2024
Contract DetailWALGREEN CO.WALGREENS #09884 40663 CALIFORNIA OAKS RD
MURRIETACA92562-572907/22/202410/01/2024  10/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09105 1280 W FOOTHILL BLVD
RIALTOCA92376-468607/22/202410/01/2024  10/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 05700 1574 E VALLEY PKWY
ESCONDIDOCA9202707/22/202410/01/2024  10/01/2024
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsNature of Support: Support Received To DateUpdateRecertification1/31/2026 12:00:00 AM2/28/2026 12:00:00 AM5/12/2025 6:11 PM
DetailsLast Recertification DateUpdateRecertification5/21/2024 8:32:27 PM5/12/2025 6:11:44 PM5/12/2025 6:11 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestJohnson, Darrah CEO Planned Parenthood of the Pacific Southwest 6198815050-6198815050Burlison, Janeen VP of Clinical Services and Quality Planned Parenthood of the Pacific Southwest 6198814662-61988146622/5/2025 6:57 AM
ContactsPrimary ContactUpdateGroup Change RequestBurlison, Janeen VP of Clinical Services and Quality Planned Parenthood of the Pacific Southwest 6198814662-6198814662Standerford, Sara S Compliance and Privacy Manager Planned Parenthood of the Pacific Southwest 61988146472/5/2025 6:57 AM
DetailsNature of Support: In Kind Support DescriptionUpdateRecertificationChlamydia and gonorrhea partner treatment medications from the free CT/GC PDPT programChlamydia and gonorrhea EPT medication and condoms5/21/2024 8:32 PM
DetailsNature of Support: Support Received To DateUpdateRecertification1/31/2025 12:00:00 AM1/31/2026 12:00:00 AM5/21/2024 8:32 PM
DetailsLast Recertification DateUpdateRecertification5/22/2023 9:01:03 AM5/21/2024 8:32:27 PM5/21/2024 8:32 PM
DetailsGrant NumberUpdateChange RequestNH25PS0051271H25PS0051275/26/2023 6:52 AM
DetailsNature of Support: Support Received To DateUpdateRecertification12/31/2023 12:00:00 AM1/31/2025 12:00:00 AM5/22/2023 9:01 AM
DetailsLast Recertification DateUpdateRecertification5/24/2022 8:41:12 PM5/22/2023 9:01:03 AM5/22/2023 9:01 AM
DetailsGrant NumberUpdateRecertification1H25PS005127NH25PS0051275/22/2023 9:01 AM
DetailsLast Recertification DateUpdateRecertification5/24/2021 10:41:41 PM5/24/2022 8:41:12 PM5/24/2022 8:41 PM
ContactsPrimary ContactUpdateProfile Change RequestBurlison, Janeen Senior Director of Quality Management Planned Parenthood of the Pacific Southwest 6198814662-6198814662Burlison, Janeen VP of Clinical Services and Quality Planned Parenthood of the Pacific Southwest 6198814662-61988146627/7/2021 10:42 PM
DetailsNature of Support: In Kind Support DescriptionUpdateRecertification Chlamydia and gonorrhea partner treatment medications from the free CT/GC PDPT program5/24/2021 10:41 PM
DetailsNature of Support: Support Received From DateUpdateRecertification 1/1/2019 12:00:00 AM5/24/2021 10:41 PM
DetailsNature of Support: Support Received To DateUpdateRecertification 12/31/2023 12:00:00 AM5/24/2021 10:41 PM
Medicaid BillingNPI: StateUpdateRecertification CA5/24/2021 10:41 PM
DetailsLast Recertification DateUpdateRecertification5/8/2020 2:00:37 PM5/24/2021 10:41:41 PM5/24/2021 10:41 PM
DetailsNOFO NumberUpdateRecertification PS19-19015/24/2021 10:41 PM
Medicaid BillingNPI: NumberInsertRecertification 11240531115/8/2020 2:00 PM
DetailsLast Recertification DateUpdateRecertification6/5/2019 6:20:58 AM5/8/2020 2:00:37 PM5/8/2020 2:00 PM
DetailsLast Recertification DateUpdateRecertification4/27/2018 11:24:26 AM6/5/2019 6:20:58 AM6/5/2019 6:20 AM
DetailsGrant NumberUpdateRecertification1H25PS0043171H25PS0051276/5/2019 6:20 AM
AddressesMain AddressUpdateChange Request 10737 Camino Ruiz Suite #220 San Diego, CA 92126 10717 Camino Ruiz Suite #258 San Diego, CA 921263/28/2019 5:51 PM
AddressesMain AddressUpdateChange Request 10717 Camino Ruiz Suite 258 San Diego, CA 92126 10737 Camino Ruiz Suite #220 San Diego, CA 921261/14/2019 8:23 AM
AddressesMain AddressUpdateChange Request 10737 Camino Ruiz Medical Mall #220 San Diego, CA 92126 10717 Camino Ruiz Suite 258 San Diego, CA 9212612/19/2018 3:13 PM
DetailsLast Recertification DateUpdateRecertification4/26/2017 12:00:00 AM4/27/2018 11:24:26 AM4/27/2018 11:24 AM
ContactsAuthorizing OfficialUpdate Johnson, Darrah CEO 6198815050Johnson, Darrah CEO Planned Parenthood of the Pacific Southwest 6198815050-61988150504/26/2018 1:47 PM
ContactsSigned ByUpdate Johnson, Darrah CEO 6198815050Johnson, Darrah CEO Planned Parenthood of the Pacific Southwest 6198815050-61988150504/26/2018 1:47 PM
ContactsPrimary ContactUpdate Burlison, Janeen Senior Director of Quality Management 6198814662Burlison, Janeen Senior Director of Quality Management Planned Parenthood of the Pacific Southwest 6198814662-61988146624/26/2018 1:45 PM
ContactsPrimary ContactInsert  Burlison, Janeen Senior Director of Quality Management 61988146624/27/2017 2:26 PM
ContactsAuthorizing OfficialInsert  Johnson, Darrah CEO 61988150504/27/2017 2:26 PM
ContactsSigned ByInsert  Johnson, Darrah CEO 61988150504/27/2017 2:26 PM
AddressesMain AddressInsert   10737 Camino Ruiz Medical Mall #220 San Diego, CA 921264/26/2017 5:00 PM
AddressesBilling AddressInsert  PLANNED PARENTHOOD OF THE PACIFIC SOUTHWEST - PURCHASING DEPARTMENT 1075 CAMINO DEL RIO SOUTH SAN DIEGO, CA 921084/26/2017 5:00 PM
DetailsLast Recertification DateUpdate 2/16/2016 12:00:00 AM4/26/2017 12:00:00 AM4/26/2017 4:59 PM
DetailsLast Recertification DateUpdate  2/16/2016 12:00:00 AM2/16/2016 4:33 PM
DatesParticipating Approval DateUpdate  11/18/2015 12:00:00 AM11/18/2015 3:30 PM
DetailsStateUpdate PendingActive11/18/2015 3:30 PM
DatesStart DateUpdate  1/1/2016 12:00:00 AM11/18/2015 3:30 PM
DetailsGrant NumberUpdate  1H25PS00431710/26/2015 11:28 AM
Details340B IDUpdate ONLINE_REG_55052STD92126110/26/2015 11:28 AM
Details340B IDUpdate ONLINE_REGONLINE_REG_5505210/12/2015 2:05 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/12/2015 2:05 PM
Medicaid BillingMedicaid: NumberInsert  CMM70393F10/12/2015 2:05 PM
Medicaid BillingMedicaid: StateInsert  CA10/12/2015 2:05 PM
DetailsNature Of SupportInsert  In-Kind products or services (see note below; must have been purchased with section 318 funds)10/12/2015 2:05 PM
DetailsLast Recertification DateInsert   10/12/2015 2:05 PM
DetailsGrant NumberInsert   10/12/2015 2:05 PM
Details340B IDInsert  ONLINE_REG10/12/2015 2:05 PM
DetailsIs Authorizing Official EHB DataInsert   10/12/2015 2:05 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/12/2015 2:05 PM
DetailsMedicare Provider NumberInsert   10/12/2015 2:05 PM
DetailsEntity NameInsert  Planned Parenthood of the Pacific Southwest10/12/2015 2:05 PM
DetailsProgram CodeInsert  STD10/12/2015 2:05 PM
DetailsEntity SubnameInsert  Mira Mesa10/12/2015 2:05 PM
DatesParticipating Approval DateInsert   10/12/2015 2:05 PM
DetailsStateInsert  Pending10/12/2015 2:05 PM
DatesRegistration DateInsert  10/12/2015 12:00:00 AM10/12/2015 2:05 PM
DatesSigned By DateInsert  10/12/2015 12:00:00 AM10/12/2015 2:05 PM
DatesStart DateInsert   10/12/2015 2:05 PM
TerminationsTermination CommentsInsert   10/12/2015 2:05 PM
TerminationsTermination DateInsert   10/12/2015 2:05 PM
TerminationsTermination Effective DateInsert   10/12/2015 2:05 PM
TerminationsTermination ReasonInsert   10/12/2015 2:05 PM