Covered Entity Details

CH09718G PEACH TREE CLINIC, THE, INC. (Terminated) - information as of 4/29/2025 11:59:35 PM

Main Details

Name

PEACH TREE CLINIC, THE, INC.

Subdivision Name

Peach Tree Pediatrics

Type

HRSA-Funded Health Center

Site ID

BPS-H80-014382

340B ID

CH09718G

Grant Number

H80CS06629

Additional Details

Current Program Status

Terminated

Registration Date

10/13/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/16/2015

Last Recertification Date

1/25/2017

Termination Date
Termination Reason

4/1/2018
Site closure

Contacts

Authorizing Official

Peach Tree Healthcare
Greg Stone, CEO
(530) 741-6245 Ext: 1363

Primary Contact

Peach Tree Healthcare
Kay Sidhu, CFO
(530) 300-0308 Ext: 1360

Addresses

Street Address

470/480 Del Norte Avenue
Yuba City, CA 95991

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?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH097180	Active	BPS-H80-004755	PEACH TREE CLINIC, THE, INC.	Peach Tree Clinic, Inc	5730 Packard Ave., STE 500		Marysville	CA
CH09718D	Active	BPS-H80-003846	PEACH TREE CLINIC, THE, INC.	LIVE OAK CLINIC	9980 LIVE OAK BLVD.		LIVE OAK	CA
CH09718E	Terminated	BPS-H80-008921	PEACH TREE CLINIC, THE, INC.	Marysville Immediate Care Clinic	724 5th St		Marysville	CA
CH09718F	Terminated	BPS-H80-008955	PEACH TREE CLINIC, THE, INC.	Sutter County Peach Tree Clinic	1445 Veterans Memorial Cir		Yuba City	CA
CH09718G	Terminated	BPS-H80-014382	PEACH TREE CLINIC, THE, INC.	Peach Tree Pediatrics	470/480 Del Norte Avenue		Yuba City	CA
CH09718H	Terminated	BPS-H80-017564	PEACH TREE CLINIC, THE, INC.	Peach Tree Norwood	3911 Norwood Avenue		Sacramento	CA
CH09718J	Terminated	BPS-H80-015801	PEACH TREE CLINIC, THE, INC.	Peach Tree Midtown	1900 T Street		Sacramento	CA
CH09718K	Active	BPS-H80-018261	PEACH TREE HEALTHCARE	Peach Tree North Sacramento	3810 Rosin Court	Suite 100	Sacramento	CA
CH09718L	Active	BPS-H80-019185	PEACH TREE HEALTHCARE	Peach Tree-Yuba City/Colusa	1275 Tharp Road		Yuba City	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH097180	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CH097180	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CH097180	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16109	1153 BUTTE HOUSE RD	YUBA CITY	CA	95991	10/01/2024
CH097180	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #7136	3710 FRANKLIN BLVD	SACRAMENTO	CA	95820	10/01/2024
CH097180	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY # 5225	2636 MARCONI AVE.	SACRAMENTO	CA	95821	10/01/2024
CH097180	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17200	3601 N FREEWAY BLVD	SACRAMENTO	CA	95834	10/01/2024
CH097180	LINDHURST PHARMACY	LINDHURST PHARMACY SERVICES INC	5991 LINDHURST AVE	MARYSVILLE	CA	95901	09/26/2016	09/26/2022
CH09718D	LIVE OAK PHARMACY		9970 LIVE OAK BOULEVARD	LIVE OAK	CA	95953	01/01/2008
CH09718D	LIVE OAK PHARMACY	9970 LIVE OAK BLVD		LIVE OAK	CA	95953	04/01/2017
CH097180	LIVE OAK PHARMACY		9970 LIVE OAK BOULEVARD	LIVE OAK	CA	95953	04/01/2013	07/31/2024
CH097180	LIVE OAK PHARMACY	9970 LIVE OAK BLVD		LIVE OAK	CA	95953	04/01/2017	07/31/2024
CH097180	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 02290	1587 W EL CAMINO AVE	SACRAMENTO	CA	95833	10/01/2024
CH097180	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09322	2085 FAIR OAKS BLVD	SACRAMENTO	CA	95825	10/01/2024
CH097180	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09691	906 E ST.	MARYSVILLE	CA	95901	10/01/2024
CH097180	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09525	260 SPRUCE ST	GRIDLEY	CA	95948	10/01/2024
CH097180	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09826	5333 ELKHORN BLVD	SACRAMENTO	CA	95842	10/01/2024
CH097180	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 04151	2050 CLUB CENTER DR	SACRAMENTO	CA	95835	10/01/2024
CH097180	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09932	1274 STABLER LN	YUBA CITY	CA	95993	10/01/2024
CH09718D	PEACH TREE PHARMACY		5730 PACKARD AVENUE SUITE 620	MARYSVILLE	CA	95901	04/01/2013
CH097180	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	04/01/2019	05/31/2024
CH097180	SUTTER PHARMACY	470 PLUMAS BOULEVARD	SUITE 103	YUBA CITY	CA	95991	07/01/2013	12/01/2019
CH09718L	SUTTER PHARMACY	470 PLUMAS BLVD.	STE. 103	YUBA CITY	CA	95991	04/01/2020
CH097180	THRIFTY PAYLESS, INC.	RITE AID #6342	1590 BUTTE HOUSE ROAD	YUBA CITY	CA	95993	10/01/2024
CH097180	THRIFTY PAYLESS, INC.	RITE AID #6228	4221 NORWOOD AVENUE	SACRAMENTO	CA	95838	10/01/2024
CH097180	THRIFTY PAYLESS, INC.	RITE AID #6090	1583 HIGHWAY 99	GRIDLEY	CA	95948	10/01/2024
CH097180	THRIFTY PAYLESS, INC.	RITE AID #6448	2751 DEL PASO ROAD	SACRAMENTO	CA	95835	10/01/2024
CH097180	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2024
CH097180	WAL-MART PHARMACY 10-1903	1150 HARTER ROAD		YUBA CITY	CA	95993	10/01/2024
CH097180	WAL-MART PHARMACY 10-5136	1131 N BEALE RD		MARYSVILLE	CA	95901	10/01/2024
CH097180	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2024
CH097180	WAL-MART PHARMACY WHSE #45	2250 NORTH 8TH STREET	SUITE 102-A	ROGERS	AR	72756	10/01/2024	10/01/2024
CH097180	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2024
CH097180	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		2/1/2018 12:00:00 AM	2/21/2018 12:45 PM
Details	State	Update	Recertification	Active	To Be Terminated	2/21/2018 12:45 PM
Terminations	Termination Date	Update	Recertification		4/1/2018 12:00:00 AM	2/21/2018 12:45 PM
Terminations	Termination Effective Date	Update	Recertification		2/1/2018 12:00:00 AM	2/21/2018 12:45 PM
Terminations	Termination Reason	Update	Recertification		Site closure	2/21/2018 12:45 PM
Contacts	Primary Contact	Update	Recertification	Sidhu, Kay CFO 5307416245-1360	Sidhu, Kay CFO Peach Tree Healthcare 5303000308-1360	2/20/2018 11:37 AM
Contacts	Authorizing Official	Update		Stone, Greg CEO 5307416245-1363	Stone, Greg CEO Peach Tree Healthcare 5307416245-1363	1/17/2018 3:33 PM
Contacts	Signed By	Update		Stone, Greg CEO 5307416245-1363	Stone, Greg CEO Peach Tree Healthcare 5307416245-1363	1/17/2018 3:33 PM
Contacts	Primary Contact	Insert			Sidhu, Kay CFO 5307416245-1360	7/13/2017 2:12 PM
Contacts	Authorizing Official	Insert			Stone, Greg CEO 5307416245-1363	2/23/2017 4:40 PM
Contacts	Signed By	Insert			Stone, Greg CEO 5307416245-1363	2/23/2017 4:40 PM
Addresses	Main Address	Insert			470/480 Del Norte Avenue Yuba City, CA 95991	1/25/2017 10:13 AM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 10:13 AM
Details	Last Recertification Date	Update			2/12/2016 12:00:00 AM	2/12/2016 2:20 PM
Dates	Participating Approval Date	Update			10/16/2015 12:00:00 AM	10/16/2015 1:41 PM
Details	State	Update		Pending	Active	10/16/2015 1:41 PM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/16/2015 1:41 PM
Details	340B ID	Update		ONLINE_REG_55259	CH09718G	10/16/2015 12:48 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_55259	10/13/2015 1:12 PM
Details	Last Recertification Date	Insert				10/13/2015 1:12 PM
Details	Grant Number	Insert			H80CS06629	10/13/2015 1:12 PM
Details	340B ID	Insert			ONLINE_REG	10/13/2015 1:12 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/13/2015 1:12 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/13/2015 1:12 PM
Details	Medicare Provider Number	Insert				10/13/2015 1:12 PM
Details	Entity Name	Insert			PEACH TREE CLINIC, THE, INC.	10/13/2015 1:12 PM
Details	Program Code	Insert			CH	10/13/2015 1:12 PM
Details	Entity Subname	Insert			Peach Tree Pediatrics	10/13/2015 1:12 PM
Dates	Participating Approval Date	Insert				10/13/2015 1:12 PM
Details	State	Insert			Pending	10/13/2015 1:12 PM
Dates	Registration Date	Insert			10/13/2015 12:00:00 AM	10/13/2015 1:12 PM
Dates	Signed By Date	Insert			10/13/2015 12:00:00 AM	10/13/2015 1:12 PM
Dates	Start Date	Insert				10/13/2015 1:12 PM
Terminations	Termination Comments	Insert				10/13/2015 1:12 PM
Terminations	Termination Date	Insert				10/13/2015 1:12 PM
Terminations	Termination Effective Date	Insert				10/13/2015 1:12 PM
Terminations	Termination Reason	Insert				10/13/2015 1:12 PM

340B Drug Pricing Program Database