Covered Entity Details

CHC28981-01 WESTERN SIERRA MEDICAL CLINIC INC (Active) - information as of 6/27/2025 3:29:36 AM

Main Details

Name

WESTERN SIERRA MEDICAL CLINIC INC

Subdivision Name

Sierra Family Medical Clinic Inc Tyler Foote

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039539

340B ID

CHC28981-01

Grant Number

H80CS08234

Additional Details

Current Program Status

Active

Registration Date

1/8/2016

Participating Start Date

4/1/2016

Participating Approval Date

2/10/2016

Last Recertification Date

2/27/2025

Contacts

Authorizing Official

Western Sierra Medical Clinic
Jennifer Malone, CEO
(530) 273-3819

Primary Contact

Western Sierra Medical Clinic
FRANCINE NOVAK, Chief Operations Officer
(530) 273-4984 Ext: 102

Addresses

Street Address

15301 Tyler Foote Rd
Nevada City, CA 95959-9318

Billing Address

Sierra Family Medical Clinic
844 Old Tunnel Road
Grass Valley, CA 95945

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	Last Updated On
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/16/2023	01/01/2024	01/01/2024
Contract Detail	DEMARTINI SPRING HILL PHCY INC	DEMARTINI'S COMPOUNDING CENTER	102 CATHERINE LANE	GRASS VALLEY	CA	95945-9594	02/10/2016	04/01/2016	02/10/2016
Contract Detail	DOKIMOS NEVADA CITY PHARMACY	737 ZION ST		NEVADA CITY	CA	95959-2920	02/10/2016	04/01/2016	02/10/2016
Contract Detail	DOKIMOS' EAST MAIN PHARMACY	640 E MAIN ST STE 2		GRASS VALLEY	CA	95945-5854	02/10/2016	04/01/2016	02/10/2016
Contract Detail	RALEY'S PHARMACY #213	692 FREEMAN LANE		GRASS VALLEY	CA	95949	04/15/2016	07/01/2016	04/15/2016
Contract Detail	SAVE MART PHARMACY #608		12054 NEVADA CITY HWY	GRASS VALLEY	CA	95945	04/15/2016	07/01/2016	04/15/2016
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #6089	720 SUTTON WAY	GRASS VALLEY	CA	95945	04/22/2016	07/01/2016	04/22/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10881	880 SUTTON WAY	GRASS VALLEY	CA	95945	10/11/2022	11/03/2022	11/03/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02277	602 10TH STREET	MARYSVILLE	CA	95901	10/11/2022	11/03/2022	11/03/2022

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH0921760	Active	BPS-H80-000052	WESTERN SIERRA MEDICAL CLINIC		209 NEVADA STREET	DOWNIEVILLE	CA
CH092176A	Terminated	BPS-H80-000052	WESTERN SIERRA MEDICAL CLINIC	MOBILE CLINIC SITE	209 NEVADA STREET	DOWNIEVILLE	CA
CH092176B	Active	BPS-H80-014470	WESTERN SIERRA MEDICAL CLINIC INC	Western Sierra Medical Clinic	844 Old Tunnel Rd	Grass Valley	CA
CH092176C	Terminated	BPS-H80-013615	WESTERN SIERRA MEDICAL CLINIC INC	Western Sierra Medical Clinic co-location of services at Community Recovery Resources (CoRR)	180 Sierra College Drive, Suite 100	Grass Valley	CA
CH092176D	Terminated	BPS-H80-018207	WESTERN SIERRA MEDICAL CLINIC INC	Western Sierra Medical Clinic	12183 Locksley Lane Suite #107	Auburn	CA
CH092176E	Terminated	BPS-H80-018726	WESTERN SIERRA MEDICAL CLINIC INC	Western Sierra Medical Clinic	3111 Professional Drive	Auburn	CA
CH092176F	Active	BPS-H80-018578	WESTERN SIERRA MEDICAL CLINIC INC	Western Sierra Medical Clinic	10544 Spenceville Rd	Penn Valley	CA
CH092176G	Active	BPS-H80-019603	Western Sierra Medical Clinic Inc	Western Sierra Medical Clinic - Kings Beach	8665 Salmon Ave	Kings Beach	CA
CH092176H	Active	BPS-H80-037108	WESTERN SIERRA MEDICAL CLINIC, INC.	Western Sierra Medical Clinic - Rock Creek	3257 Professional Dr, Ste C	Auburn	CA
CH092176J	Active	BPS-H80-036865	WESTERN SIERRA MEDICAL CLINIC, INC.	Western Sierra Medical Clinic - Education Street	11720 Education Street STE 3	Auburn	CA
CH092176K	Active	BPS-H80-027902	WESTERN SIERRA MEDICAL CLINIC, INC.	Western Sierra Medical Clinic - Ophthalmology Services	400 Sierra College Dr # A1	Grass Valley	CA
CH092176L	Terminated	BPS-H80-032037	WESTERN SIERRA MEDICAL CLINIC, INC.	Temporary Site - Mobile Site	150 Glasson Way	Grass Valley	CA
CH092176M	Terminated	BPS-H80-032041	WESTERN SIERRA MEDICAL CLINIC, INC.	Temporary Site - Hospitality House	1262 Sutton Way	Grass Valley	CA
CHC28981-00	Active	BPS-H80-039536	WESTERN SIERRA MEDICAL CLINIC INC	Sierra Family Medical Clinic, Oregon House	8676 Marysville Rd.	Oregon House	CA
CHC28981-01	Active	BPS-H80-039539	WESTERN SIERRA MEDICAL CLINIC INC	Sierra Family Medical Clinic Inc Tyler Foote	15301 Tyler Foote Rd	Nevada City	CA
CHC28981-02	Active	BPS-H80-039538	WESTERN SIERRA MEDICAL CLINIC, INC.	Searls Avenue	590 Searls Ave	Nevada City	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0921760	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2024
CH0921760	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	01/01/2020
CH092176B	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	01/01/2020
CH0921760	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	07/01/2025
CH0921760	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	01/01/2020
CH092176B	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	01/01/2020
CH0921760	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2024
CH0921760	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2024
CH0921760	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2024
CH0921760	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2024
CH0921760	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2024
CH0921760	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2024
CH0921760	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2024
CH0921760	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2024
CH0921760	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2024
CH0921760	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2024
CH0921760	CLINIC PHARMACIES III, INC	DBA WESTERN SIERRA PHARMACY	844 OLD TUNNEL RD	GRASS VALLEY	CA	95945	07/01/2017	01/15/2019
CH092176A	CLINIC PHARMACIES III, INC	DBA WESTERN SIERRA PHARMACY	844 OLD TUNNEL RD	GRASS VALLEY	CA	95945	01/01/2016	04/01/2019
CH092176B	CLINIC PHARMACIES III, INC	DBA WESTERN SIERRA PHARMACY	844 OLD TUNNEL RD	GRASS VALLEY	CA	95945	10/01/2015
CH0921760	CLINIC PHARMACIES III, LLC DBA	WESTERN SIERRA PHARMACY	844 OLD TUNNEL RD, SUITE A	GRASS VALLEY	CA	95945-8524	01/16/2019
CH0921760	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2023
CH0921760	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2023
CHC28981-02	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CHC28981-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CHC28981-01	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CH0921760	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2024
CH0921760	DEMARTINI SPRING HILL PHCY INC	DEMARTINI'S COMPOUNDING CENTER	102 CATHERINE LANE	GRASS VALLEY	CA	95945-9594	01/01/2014	05/31/2016
CH092176A	DEMARTINI SPRING HILL PHCY INC	DEMARTINI'S COMPOUNDING CENTER	102 CATHERINE LANE	GRASS VALLEY	CA	95945-9594	01/01/2014	05/31/2016
CH092176B	DEMARTINI SPRING HILL PHCY INC	DEMARTINI'S COMPOUNDING CENTER	102 CATHERINE LANE	GRASS VALLEY	CA	95945-9594	01/01/2014	05/31/2016
CHC28981-01	DEMARTINI SPRING HILL PHCY INC	DEMARTINI'S COMPOUNDING CENTER	102 CATHERINE LANE	GRASS VALLEY	CA	95945-9594	04/01/2016
CHC28981-00	DEMARTINI SPRING HILL PHCY INC	DEMARTINI'S COMPOUNDING CENTER	102 CATHERINE LANE	GRASS VALLEY	CA	95945-9594	07/01/2016
CH0921760	DOKIMOS NEVADA CITY PHARMACY	737 ZION ST		NEVADA CITY	CA	95959-2920	01/01/2016	04/01/2019
CH092176B	DOKIMOS NEVADA CITY PHARMACY	737 ZION ST		NEVADA CITY	CA	95959-2920	02/25/2011	01/01/2021
CHC28981-01	DOKIMOS NEVADA CITY PHARMACY	737 ZION ST		NEVADA CITY	CA	95959-2920	04/01/2016
CHC28981-00	DOKIMOS NEVADA CITY PHARMACY	737 ZION ST		NEVADA CITY	CA	95959-2920	07/01/2016
CH0921760	DOKIMOS' EAST MAIN PHARMACY	640 E MAIN ST STE 2		GRASS VALLEY	CA	95945-5854	01/01/2016	04/01/2019
CH092176B	DOKIMOS' EAST MAIN PHARMACY	640 E MAIN ST STE 2		GRASS VALLEY	CA	95945-5854	04/05/2010	01/01/2021
CHC28981-01	DOKIMOS' EAST MAIN PHARMACY	640 E MAIN ST STE 2		GRASS VALLEY	CA	95945-5854	04/01/2016
CHC28981-00	DOKIMOS' EAST MAIN PHARMACY	640 E MAIN ST STE 2		GRASS VALLEY	CA	95945-5854	07/01/2016
CHC28981-00	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16109	1153 BUTTE HOUSE RD	YUBA CITY	CA	95991	10/01/2019
CH0921760	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16080	1925 DOUGLAS BLVD	ROSEVILLE	CA	95661	10/01/2023
CH0921760	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16473	2700 BELL RD	AUBURN	CA	95603	10/01/2023
CH0921760	GARFIELD BEACH CVS, L.L.C.	CVS/PHARMACY #17882	111 W. MCKNIGHT WAY	GRASS VALLEY	CA	95949	10/01/2023
CH0921760	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY # 5091	1771 PLEASANT GROVE BLVD. SUITE 100	ROSEVILLE	CA	95747	10/01/2023
CH0921760	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16833	10451 FAIRWAY DR	ROSEVILLE	CA	95678	10/01/2023
CH0921760	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16109	1153 BUTTE HOUSE RD	YUBA CITY	CA	95991	04/01/2025
CH0921760	GREATER PLACER PHARMACY, INC.	GREATER PLACER PHARMACY	3133 PROFESSIONAL DR STE 17	AUBURN	CA	95603-2463	07/01/2017
CH0921760	K MART PHARMACY #9746	111 MCKNIGHT WAY		GRASS VALLEY	CA	95949	01/01/2018	07/01/2024
CH092176B	K MART PHARMACY #9746	111 MCKNIGHT WAY		GRASS VALLEY	CA	95949	01/01/2018	12/31/2023
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09155	1005 SUTTON WAY	GRASS VALLEY	CA	95945	01/01/2016	08/01/2017
CHC28981-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03947	10045 COMBIE RD	AUBURN	CA	95602	10/01/2019
CHC28981-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09155	1005 SUTTON WAY	GRASS VALLEY	CA	95945	10/01/2019
CHC28981-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09174	11411 DEERFIELD DR	TRUCKEE	CA	96161	10/01/2019
CHC28981-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09691	906 E ST.	MARYSVILLE	CA	95901	10/01/2019
CHC28981-00	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09932	1274 STABLER LN	YUBA CITY	CA	95993	10/01/2019
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09174	11411 DEERFIELD DR	TRUCKEE	CA	96161	10/01/2023
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09155	1005 SUTTON WAY	GRASS VALLEY	CA	95945	10/01/2023
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03947	10045 COMBIE RD	AUBURN	CA	95602	10/01/2023
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09535	63 LINCOLN BLVD	LINCOLN	CA	95648	10/01/2023
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09150	388 ELM ST.	AUBURN	CA	95603	10/01/2023
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 02661	4785 GRANITE DR	ROCKLIN	CA	95677	10/01/2023
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09914	2140 GRASS VALLEY HWY	AUBURN	CA	95603	10/01/2023
CHC28981-02	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09155	1005 SUTTON WAY	GRASS VALLEY	CA	95945	01/01/2024
CHC28981-02	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03947	10045 COMBIE RD	AUBURN	CA	95602	01/01/2024
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09691	906 E ST.	MARYSVILLE	CA	95901	04/01/2025
CH0921760	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09932	1274 STABLER LN	YUBA CITY	CA	95993	04/01/2025
CH0921760	LOYALTON PHARMACY	60801 HIGHWAY 49	PO BOX 36	LOYALTON	CA	96118	01/22/2009	09/30/2015
CH092176A	LOYALTON PHARMACY	60801 HIGHWAY 49	PO BOX 36	LOYALTON	CA	96118	01/22/2009	09/30/2015
CH092176B	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2020
CH0921760	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2020
CH0921760	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	04/01/2020
CH0921760	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2020
CH092176B	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2020
CH0921760	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2024
CH0921760	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2024
CH0921760	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2024
CHC28981-01	RALEY'S PHARMACY #213	692 FREEMAN LANE		GRASS VALLEY	CA	95949	07/01/2016
CHC28981-00	RALEY'S PHARMACY #213	692 FREEMAN LANE		GRASS VALLEY	CA	95949	07/01/2016
CH0921760	RALEY'S PHARMACY #213	692 FREEMAN LANE		GRASS VALLEY	CA	95949	04/01/2024
CH0921760	SAVE MART PHARMACY #608		12054 NEVADA CITY HWY	GRASS VALLEY	CA	95945	01/01/2016	07/01/2024
CH092176A	SAVE MART PHARMACY #608		12054 NEVADA CITY HWY	GRASS VALLEY	CA	95945	01/01/2014	04/01/2019
CH092176B	SAVE MART PHARMACY #608		12054 NEVADA CITY HWY	GRASS VALLEY	CA	95945	01/01/2014	07/01/2024
CHC28981-01	SAVE MART PHARMACY #608		12054 NEVADA CITY HWY	GRASS VALLEY	CA	95945	07/01/2016
CHC28981-00	SAVE MART PHARMACY #608		12054 NEVADA CITY HWY	GRASS VALLEY	CA	95945	07/01/2016
CH0921760	THRIFTY PAYLESS, INC.	RITE AID #6089	720 SUTTON WAY	GRASS VALLEY	CA	95945	09/19/2012
CH0921760	THRIFTY PAYLESS, INC.	RITE AID #6043	2805 BELL ROAD	AUBURN	CA	95603	07/01/2017
CHC28981-01	THRIFTY PAYLESS, INC.	RITE AID #6089	720 SUTTON WAY	GRASS VALLEY	CA	95945	07/01/2016
CHC28981-00	THRIFTY PAYLESS, INC.	RITE AID #6089	720 SUTTON WAY	GRASS VALLEY	CA	95945	07/01/2016
CH092176G	THRIFTY PAYLESS, INC.	RITE AID #6106	8245 NORTH LAKE BOULEVARD PO BOX 1175	KINGS BEACH	CA	96143	01/01/2018	11/01/2024
CH0921760	THRIFTY PAYLESS, INC.	RITE AID #6106	8245 NORTH LAKE BOULEVARD PO BOX 1175	KINGS BEACH	CA	96143	01/01/2018	11/01/2024
CH092176B	THRIFTY PAYLESS, INC.	RITE AID #6106	8245 NORTH LAKE BOULEVARD PO BOX 1175	KINGS BEACH	CA	96143	01/01/2018	11/01/2024
CH0921760	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	04/01/2020
CH0921760	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2024
CH0921760	WAL-MART PHARMACY 10-3090	5609 PACIFIC ST		ROCKLIN	CA	95677	04/01/2024
CH0921760	WAL-MART PHARMACY 10-3587	5454 CROSSING DR.		ROCKLIN	CA	95677	04/01/2024
CH0921760	WAL-MART PHARMACY 10-4309	8961 GREENBACK LANE		ORANGEVALE	CA	95662	04/01/2024
CH0921760	WAL-MART PHARMACY 10-5136	1131 N BEALE RD		MARYSVILLE	CA	95901	04/01/2024
CH0921760	WAL-MART PHARMACY 10-5979	255 LINCOLN BLVD.		LINCOLN	CA	95648	04/01/2024
CH0921760	WAL-MART PHARMACY 10-5980	4080 DOUGLAS BLVD.		GRANITE BAY	CA	95746	04/01/2024	07/01/2024
CH0921760	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2024
CH0921760	WAL-MART PHARMACY WHSE #45	2250 NORTH 8TH STREET	SUITE 102-A	ROGERS	AR	72756	04/01/2024
CH0921760	WALGREEN CO.	DBA: WALGREENS #10881	880 SUTTON WAY	GRASS VALLEY	CA	95945	07/01/2015
CHC28981-01	WALGREEN CO.	DBA: WALGREENS #10881	880 SUTTON WAY	GRASS VALLEY	CA	95945	11/03/2022
CHC28981-01	WALGREEN CO.	DBA: WALGREENS # 02277	602 10TH STREET	MARYSVILLE	CA	95901	11/03/2022
CHC28981-00	WALGREEN CO.	DBA: WALGREENS #10881	880 SUTTON WAY	GRASS VALLEY	CA	95945	11/03/2022
CHC28981-00	WALGREEN CO.	DBA: WALGREENS # 02277	602 10TH STREET	MARYSVILLE	CA	95901	11/03/2022
CHC28981-02	WALGREEN CO.	DBA: WALGREENS # 02277	602 10TH STREET	MARYSVILLE	CA	95901	01/01/2024
CHC28981-02	WALGREEN CO.	DBA: WALGREENS #10881	880 SUTTON WAY	GRASS VALLEY	CA	95945	01/01/2024
CH0921760	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024
CH0921760	WESTERN PHARMACY GROUP LLC	DBA COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY SUITES A--E	SAN DIEGO	CA	92102	10/01/2019	10/31/2019
CH092176B	WESTERN PHARMACY GROUP LLC	DBA COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY SUITES A--E	SAN DIEGO	CA	92102	10/01/2019	10/31/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Lawson, Jenny Administration Sierra Family Medical Clinic 5302923478-223	NOVAK, FRANCINE Chief Operations Officer Western Sierra Medical Clinic 5302734984-102	3/18/2025 6:08 AM
Contacts	Authorizing Official	Update	Change Request	Lance, Jessica CFO Sierra Family Health Center 5302923478	Malone, Jennifer CEO Western Sierra Medical Clinic 5302733819	3/18/2025 6:08 AM
Addresses	Billing Address	Update	Recertification	Sierra Family Medical Clinic PO Box 995 Grass Valley, CA 95945	Sierra Family Medical Clinic 844 Old Tunnel Road Grass Valley, CA 95945	2/27/2025 9:07 AM
Details	Last Recertification Date	Update	Recertification	2/21/2024 11:08:22 AM	2/27/2025 9:07:33 AM	2/27/2025 9:07 AM
Details	Grant Number	Update	Recertification	H80CS28981	H80CS08234	2/27/2025 9:07 AM
Details	Entity Name	Update	Recertification	SIERRA FAMILY MEDICAL CLINIC INC	WESTERN SIERRA MEDICAL CLINIC INC	2/27/2025 9:07 AM
Details	Entity Subname	Update	Recertification	Sierra Family Medical Clinic Inc	Sierra Family Medical Clinic Inc Tyler Foote	2/27/2025 9:07 AM
Details	Last Recertification Date	Update	Recertification	2/27/2023 1:50:06 PM	2/21/2024 11:08:22 AM	2/21/2024 11:08 AM
Details	Last Recertification Date	Update	Recertification	2/28/2022 2:30:50 PM	2/27/2023 1:50:06 PM	2/27/2023 1:50 PM
Contacts	Authorizing Official	Update	AO Change Request	Conroy, Rachel Accountant Sierra Family Medical Clinic, Inc 5302923478-303	Lance, Jessica CFO Sierra Family Health Center 5302923478	2/27/2023 1:47 PM
Contacts	Authorizing Official	Update	AO Change Request	Bailey, Christy Katherine Controller Sierra Family Medical Clinic - Grass Valley, CA 5302923478-304	Conroy, Rachel Accountant Sierra Family Medical Clinic, Inc 5302923478-303	2/2/2023 4:06 PM
Details	Last Recertification Date	Update	Recertification	2/2/2021 8:11:05 PM	2/28/2022 2:30:50 PM	2/28/2022 2:30 PM
Contacts	Authorizing Official	Update	AO Change Request	Knoll, Victoria W CFO Sierra Family Medical Clinic 5302720201	Bailey, Christy Katherine Controller Sierra Family Medical Clinic - Grass Valley, CA 5302923478-304	2/25/2022 8:38 PM
Details	Last Recertification Date	Update	Recertification	1/29/2020 12:18:44 PM	2/2/2021 8:11:05 PM	2/2/2021 8:11 PM
Addresses	Billing Address	Insert	Recertification		Sierra Family Medical Clinic PO Box 995 Grass Valley, CA 95945	1/29/2020 12:18 PM
Details	Last Recertification Date	Update	Recertification	1/30/2019 2:47:04 PM	1/29/2020 12:18:44 PM	1/29/2020 12:18 PM
Contacts	Authorizing Official	Update	AO Change Request	Graeber, Gary Senior Accountant Sierra Family Medical Clinic 5302923478-219	Knoll, Victoria W CFO Sierra Family Medical Clinic 5302720201	9/23/2019 6:46 AM
Details	Last Recertification Date	Update	Recertification	2/7/2018 7:07:15 PM	1/30/2019 2:47:04 PM	1/30/2019 2:47 PM
Details	Last Recertification Date	Update	Recertification	2/9/2017 12:00:00 AM	2/7/2018 7:07:15 PM	2/7/2018 7:07 PM
Contacts	Primary Contact	Update	Change Request	Graeber, Gary CFO 5302923478-209	Lawson, Jenny Administration Sierra Family Medical Clinic 5302923478-223	9/29/2017 5:54 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		9/29/2017 5:54 PM
Contacts	Authorizing Official	Update	Profile Change Request	Graeber, Gary CFO Sierra Family Medical Clinic 5302923478-209	Graeber, Gary Senior Accountant Sierra Family Medical Clinic 5302923478-219	9/29/2017 5:42 PM
Contacts	Signed By	Update	Profile Change Request	Graeber, Gary CFO Sierra Family Medical Clinic 5302923478-209	Graeber, Gary Senior Accountant Sierra Family Medical Clinic 5302923478-219	9/29/2017 5:42 PM
Contacts	Authorizing Official	Update		Graeber, Gary CFO 5302923478-209	Graeber, Gary CFO Sierra Family Medical Clinic 5302923478-209	9/29/2017 5:40 PM
Contacts	Signed By	Update		Graeber, Gary CFO 5302923478-209	Graeber, Gary CFO Sierra Family Medical Clinic 5302923478-209	9/29/2017 5:40 PM
Addresses	Main Address	Insert			15301 Tyler Foote Rd Nevada City, CA 95959-9318	2/9/2017 2:23 PM
Contacts	Authorizing Official	Update		Weber, Steve CEO 5302923478-230	Graeber, Gary CFO 5302923478-209	2/9/2017 2:23 PM
Contacts	Primary Contact	Insert			Graeber, Gary CFO 5302923478-209	2/9/2017 2:23 PM
Contacts	Signed By	Insert			Graeber, Gary CFO 5302923478-209	2/9/2017 2:23 PM
Details	Last Recertification Date	Update			2/9/2017 12:00:00 AM	2/9/2017 2:23 PM
Contacts	Authorizing Official	Insert			Weber, Steve CEO 5302923478-230	4/22/2016 12:30 PM
Dates	Participating Approval Date	Update			2/10/2016 12:00:00 AM	2/10/2016 5:38 PM
Details	State	Update		Pending	Active	2/10/2016 5:38 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	2/10/2016 5:38 PM
Details	340B ID	Update		ONLINE_REG_56976	CHC28981-01	2/9/2016 7:38 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_56976	1/8/2016 4:44 PM
Details	Last Recertification Date	Insert				1/8/2016 4:44 PM
Details	Grant Number	Insert			H80CS28981	1/8/2016 4:44 PM
Details	340B ID	Insert			ONLINE_REG	1/8/2016 4:44 PM
Details	Is Authorizing Official EHB Data	Insert			False	1/8/2016 4:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/8/2016 4:44 PM
Details	Medicare Provider Number	Insert				1/8/2016 4:44 PM
Details	Entity Name	Insert			SIERRA FAMILY MEDICAL CLINIC INC	1/8/2016 4:44 PM
Details	Program Code	Insert			CH	1/8/2016 4:44 PM
Details	Entity Subname	Insert			Sierra Family Medical Clinic Inc	1/8/2016 4:44 PM
Dates	Participating Approval Date	Insert				1/8/2016 4:44 PM
Details	State	Insert			Pending	1/8/2016 4:44 PM
Dates	Registration Date	Insert			1/8/2016 12:00:00 AM	1/8/2016 4:44 PM
Dates	Signed By Date	Insert			1/8/2016 12:00:00 AM	1/8/2016 4:44 PM
Dates	Start Date	Insert				1/8/2016 4:44 PM
Terminations	Termination Comments	Insert				1/8/2016 4:44 PM
Terminations	Termination Date	Insert				1/8/2016 4:44 PM
Terminations	Termination Effective Date	Insert				1/8/2016 4:44 PM
Terminations	Termination Reason	Insert				1/8/2016 4:44 PM

340B Drug Pricing Program Database