Covered Entity Details

CHC24196-01 FRIENDS OF FAMILY HEALTH CENTER (Active) - information as of 4/25/2025 6:34:45 PM

Main Details

Name

FRIENDS OF FAMILY HEALTH CENTER

Subdivision Name

Friends of Family Health Center - Tustin

Type

HRSA-Funded Health Center

Site ID

BPS-H80-016822

340B ID

CHC24196-01

Grant Number

H80CS24196

Additional Details

Current Program Status

Active

Registration Date

4/4/2016

Participating Start Date

7/1/2016

Participating Approval Date

4/12/2016

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Friends of Family Health Center
Bahram Bahremand, CEO
(562) 690-0400 Ext: 1700

Primary Contact

Friends of Family Health Center - La Habra, CA
Dawn Ta, CFO
(562) 501-1701

Addresses

Street Address

13152 Newport Avenue Suite B
Tustin, CA 92780-3469

Billing Address

Friends of Family Health Center
501 S. Idaho Street
Suite 260
La Habra, CA 90631

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	1922489665	1922489665

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
CHC24196-00	Active	BPS-H80-011738	FRIENDS OF FAMILY HEALTH CENTER	Friends of Family Health Center	501 S Idaho St	STE 100	La Habra	CA
CHC24196-01	Active	BPS-H80-016822	FRIENDS OF FAMILY HEALTH CENTER	Friends of Family Health Center - Tustin	13152 Newport Avenue Suite B		Tustin	CA
CHC24196-02	Active	BPS-H80-033589	Friends Of Family Health Center	Friends of Family Health Center - 1129 W. 4th Street, Ontario	1129 W 4th St		Ontario	CA
CHC24196-03	Active	BPS-H80-034913	Friends Of Family Health Center	Friends of Family Health Center - La Puente	565 S Azusa Way		La Puente	CA
CHC24196-04	Active	BPS-H80-034911	Friends Of Family Health Center	Friends of Family Health Center - Pico Rivera	5062 Rosemead Blvd		Pico Rivera	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Carve-In Effective Date	Termination Date
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/6/2024 1:22:22 PM	2/12/2025 4:20:36 PM	2/12/2025 4:20 PM
Details	Last Recertification Date	Update	Recertification	2/9/2023 1:18:13 PM	2/6/2024 1:22:22 PM	2/6/2024 1:22 PM
Details	Last Recertification Date	Update	Recertification	2/16/2022 6:38:11 PM	2/9/2023 1:18:13 PM	2/9/2023 1:18 PM
Details	Last Recertification Date	Update	Recertification	2/9/2021 2:13:50 PM	2/16/2022 6:38:11 PM	2/16/2022 6:38 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/9/2021 2:13 PM
Details	Last Recertification Date	Update	Recertification	1/30/2020 7:19:28 PM	2/9/2021 2:13:50 PM	2/9/2021 2:13 PM
Details	Last Recertification Date	Update	Recertification	2/21/2019 2:36:36 PM	1/30/2020 7:19:28 PM	1/30/2020 7:19 PM
Contacts	Primary Contact	Update	Recertification	Kort, Kandy Contracts Administrator Friends of Family Health Center 5626900400-1720	Ta, Dawn CFO Friends of Family Health Center - La Habra, CA 5625011701	2/21/2019 2:36 PM
Details	Last Recertification Date	Update	Recertification	2/8/2018 1:32:30 PM	2/21/2019 2:36:36 PM	2/21/2019 2:36 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/21/2019 2:36 PM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/8/2018 1:32:30 PM	2/8/2018 1:32 PM
Contacts	Authorizing Official	Update		Bahremand, Bahram CEO 5626900400-1700	Bahremand, Bahram CEO Friends of Family Health Center 5626900400-1700	2/2/2018 7:34 PM
Contacts	Signed By	Update		Bahremand, Bahram CEO 5626900400-1700	Bahremand, Bahram CEO Friends of Family Health Center 5626900400-1700	2/2/2018 7:34 PM
Contacts	Primary Contact	Update		Kort, Kandy Contracts Administrator 5626900400-1720	Kort, Kandy Contracts Administrator Friends of Family Health Center 5626900400-1720	2/2/2018 7:30 PM
Addresses	Main Address	Insert			13152 Newport Avenue Suite B Tustin, CA 92780-3469	1/25/2017 5:29 PM
Contacts	Primary Contact	Insert			Kort, Kandy Contracts Administrator 5626900400-1720	1/25/2017 5:29 PM
Contacts	Authorizing Official	Insert			Bahremand, Bahram CEO 5626900400-1700	1/25/2017 5:29 PM
Contacts	Signed By	Insert			Bahremand, Bahram CEO 5626900400-1700	1/25/2017 5:29 PM
Medicaid Billing	Medicaid: Number	Update		FHCX10068	1922489665	1/25/2017 5:29 PM
Details	Last Recertification Date	Update			1/25/2017 12:00:00 AM	1/25/2017 5:29 PM
Addresses	Billing Address	Insert			Friends of Family Health Center 501 S. Idaho Street Suite 260 La Habra, CA 90631	4/14/2016 6:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/14/2016 6:52 PM
Medicaid Billing	Medicaid: Number	Insert			FHCX10068	4/14/2016 6:52 PM
Medicaid Billing	Medicaid: State	Insert			CA	4/14/2016 6:52 PM
Medicaid Billing	NPI: Number	Insert			1922489665	4/14/2016 6:52 PM
Dates	Participating Approval Date	Update			4/12/2016 12:00:00 AM	4/12/2016 1:14 PM
Details	State	Update		Pending	Active	4/12/2016 1:14 PM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	4/12/2016 1:14 PM
Details	340B ID	Update		ONLINE_REG_58949	CHC24196-01	4/6/2016 1:52 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_58949	4/4/2016 9:23 PM
Details	Last Recertification Date	Insert				4/4/2016 9:23 PM
Details	Grant Number	Insert			H80CS24196	4/4/2016 9:23 PM
Details	340B ID	Insert			ONLINE_REG	4/4/2016 9:23 PM
Details	Is Authorizing Official EHB Data	Insert			False	4/4/2016 9:23 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/4/2016 9:23 PM
Details	Medicare Provider Number	Insert				4/4/2016 9:23 PM
Details	Entity Name	Insert			FRIENDS OF FAMILY HEALTH CENTER	4/4/2016 9:23 PM
Details	Program Code	Insert			CH	4/4/2016 9:23 PM
Details	Entity Subname	Insert			Friends of Family Health Center - Tustin	4/4/2016 9:23 PM
Dates	Participating Approval Date	Insert				4/4/2016 9:23 PM
Details	State	Insert			Pending	4/4/2016 9:23 PM
Dates	Registration Date	Insert			4/4/2016 12:00:00 AM	4/4/2016 9:23 PM
Dates	Signed By Date	Insert			4/4/2016 12:00:00 AM	4/4/2016 9:23 PM
Dates	Start Date	Insert				4/4/2016 9:23 PM
Terminations	Termination Comments	Insert				4/4/2016 9:23 PM
Terminations	Termination Date	Insert				4/4/2016 9:23 PM
Terminations	Termination Effective Date	Insert				4/4/2016 9:23 PM
Terminations	Termination Reason	Insert				4/4/2016 9:23 PM

340B Drug Pricing Program Database