340B Drug Pricing Program Database


CH09123A LA CLINICA DE LA RAZA, INC. (Active) - information as of 6/18/2025 1:15:40 AM

Main Details
LA CLINICA DE LA RAZA, INC.
SAN ANTONIO NEIGHBORHOOD HEALTH CENTER
HRSA-Funded Health Center
BPS-H80-000255
CH09123A
H80CS00631


Additional Details
Active
12/1/1992
12/1/1992
6/8/2010
2/11/2025

Contacts

La Clinica de La Raza
Jane Garcia, CEO
(510) 535-4000

La Clinica de La Raza
Dolly Davar, Pharmacy Director
(510) 535-3382

Addresses

1030 INTERNATIONAL BLVD
OAKLAND, CA 94606-3730

LA CLINICA DE LA RAZA
P.O. BOX 22210
OAKLAND, CA 94623


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
6/8/10 UPDATED BILL TO (WAS 1515 FRUITVALE AVE, 94601)06/08/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA 1730476110,1427070374,1184194482
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailWALGREEN CO.DBA: WALGREENS # 01537 3232 FOOTHILL BLVD
OAKLANDCA9460110/04/202301/01/2024  01/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH091230ActiveADMINLA CLINICA DE LA RAZA, INC. 1450 FRUITVALE AVE,3RD FLOOROAKLANDCA
CH09123AActiveBPS-H80-000255LA CLINICA DE LA RAZA, INC.SAN ANTONIO NEIGHBORHOOD HEALTH CENTER1030 INTERNATIONAL BLVD OAKLANDCA
CH09123AAActiveBPS-H80-001208LA CLINICA DE LA RAZA, INC.LA CLINICA VALLEJO GREAT BEGINNINGS/NORTH VALLEJO SUPPORT SERVICES190 Hospital Dr VallejoCA
CH09123ABActiveBPS-H80-009941LA CLINICA DE LA RAZA, INC.Casa del Sol III1415-1423 Fruitvale Avenue OaklandCA
CH09123ACActiveBPS-H80-006980LA CLINICA DE LA RAZA, INC.TECHNICLINIC (aka Oakland Technical School-Based Clinic)4351 BROADWAY OAKLANDCA
CH09123ADActiveBPS-H80-006252LA CLINICA DE LA RAZA, INC.TIGER HEALTH CLINIC (aka Fremont High School-Based Clinic)4610 FOOTHILL BLVD OAKLANDCA
CH09123AEActiveBPS-H80-007183LA CLINICA DE LA RAZA, INC.SAN LORENZO HIGH HEALTH CENTER (aka San Lorenzo High School-Based Clinic)50 E. LEWELLING BLVDRoom S5SAN LORENZOCA
CH09123AFTerminatedBPS-H80-017192LA CLINICA DE LA RAZA, INC.La Clinica Dental at Elsa Widenmann Health Center100 Whitney Ave VallejoCA
CH09123AGActiveBPS-H80-018924LA CLINICA DE LA RAZA, INC.La Clinica Julian R. Davis Pediatrics5461 Foothill Blvd OaklandCA
CH09123AHActiveBPS-H80-036968LA CLINICA DE LA RAZA, INC.La Clinica at 95th Avenue9475 International Blvd OaklandCA
CH09123AJActiveBPS-H80-008905LA CLINICA DE LA RAZA, INC.La Clinica TRUCHA1525 Fruitvale Ave OaklandCA
CH09123BActiveBPS-H80-000944LA CLINICA DE LA RAZA, INC.LA CLINICA PITTSBURG DENTAL 339 E. LELAND RD PITTSBURGCA
CH09123CActiveBPS-H80-003054LA CLINICA DE LA RAZA, INC.LA CLINICA PITTSBURG - MEDICAL2240 Gladstone Dr STE 4 PittsburgCA
CH09123EActiveBPS-H80-002390LA CLINICA DE LA RAZA, INC.LA CLINICA DE LA RAZA 3451 E 12th St OaklandCA
CH09123IActiveBPS-H80-001152LA CLINICA DE LA RAZA, INC.LA CLINICA VALLEJO GREAT BEGINNINGS210 HOSPITAL DRIVE VALLEJOCA
CH09123JTerminatedBPS-H80-000392LA CLINICA DE LA RAZA, INC.LA CLINICA VALLEJO DENTAL2920-A SONOMA BLVD VALLEJOCA
CH09123KActiveBPS-H80-032191LA CLINICA DE LA RAZA, INC.LA CLINICA VALLEJO415 GEORGIA STREET VALLEJOCA
CH09123LActiveBPS-H80-007592LA CLINICA DE LA RAZA, INC.LA CLINICA NORTH VALLEJO220 HOSPITAL DRIVE VALLEJOCA
CH09123MActiveBPS-H80-006808LA CLINICA DE LA RAZA, INC.Hawthorne Elementary School-Based Clinic1700 28th Avenue OaklandCA
CH09123NActiveBPS-H80-011034LA CLINICA DE LA RAZA, INC.La Clinica Oakley2021 Main Street OakleyCA
CH09123PActiveBPS-H80-010550LA CLINICA DE LA RAZA, INC.LA CLINICA MONUMENT2000 Sierra Rd ConcordCA
CH09123QActiveBPS-H80-004188LA CLINICA DE LA RAZA, INC.Family Optical I3060 East 9th StreetSTE BOaklandCA
CH09123RActiveBPS-H80-001899LA CLINICA DE LA RAZA, INC.La Clinica de La Raza-Dental3050 East 16th Street OaklandCA
CH09123SActiveBPS-H80-024681LA CLINICA DE LA RAZA, INC.La Clinica Dental at Children's Hospital Oakland4881 Telegraph Ave OaklandCA
CH09123TActiveBPS-H80-001726LA CLINICA DE LA RAZA, INC.Casa del Sol1501 Fruitvale Avenue OaklandCA
CH09123UActiveBPS-H80-000076LA CLINICA DE LA RAZA, INC.Casa del Sol II1450 Fruitvale AvenueSuite-EOaklandCA
CH09123VActiveBPS-H80-010973LA CLINICA DE LA RAZA, INC.Havenscourt Health Center1390 66th Ave OaklandCA
CH09123WActiveBPS-H80-000970LA CLINICA DE LA RAZA, INC.CLINICA ALTA VISTA1515 FRUITVALE AVE OAKLANDCA
CH09123XActiveBPS-H80-012140LA CLINICA DE LA RAZA, INC.Youth Heart Health Center286 East 10th Street OaklandCA
CH09123YActiveBPS-H80-006025LA CLINICA DE LA RAZA, INC.ROOSEVELT HEALTH CENTER (AKA ROOSEVELT MIDDLE SCHOOL-BASED CLINIC)1926 E 19th St OaklandCA
CH09123ZActiveBPS-H80-012661LA CLINICA DE LA RAZA, INC.Fuente Wellness Center16335 E 14th St San LeandroCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH091230GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 8431 7200 BANCROFT AVE.
OAKLANDCA9460501/01/2022  
CH091230GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16764 15555 E 14TH ST STE 400
SAN LEANDROCA9457801/01/2022  
CH09123AGGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 8431 7200 BANCROFT AVE.
OAKLANDCA9460501/01/2024  
CH09123UGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16764 15555 E 14TH ST STE 400
SAN LEANDROCA9457801/01/2024  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450101/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461101/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460201/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450101/01/2022 02/06/2023
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457701/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09832 3678 SONOMA BLVD
VALLEJOCA9459001/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09876 699 LEWELLING BLVD
SAN LEANDROCA9457901/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09927 1193 ADMIRAL CALLAGHAN LANE
VALLEJOCA9459101/01/2022  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09957 344 THOMAS L. BERKLEY WAY
OAKLANDCA9461201/01/2022 03/04/2022
CH09123XLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450101/01/2024  
CH09123ELONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461101/01/2024  
CH09123MLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460201/01/2024  
CH09123ZLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457701/01/2024  
CH09123TLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09876 699 LEWELLING BLVD
SAN LEANDROCA9457901/01/2024  
CH09123ILONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09832 3678 SONOMA BLVD
VALLEJOCA9459001/01/2024  
CH09123KLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09927 1193 ADMIRAL CALLAGHAN LANE
VALLEJOCA9459101/01/2024  
CH091230LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09761 2100 COLUMBUS PKWY
BENICIACA9451007/01/2025  
CH091230WALGREEN CODBA: WALGREENS #09978 6570 LONE TREE WAY
BRENTWOODCA9451309/14/2012  
CH09123CWALGREEN CODBA: WALGREENS #09978 6570 LONE TREE WAY
BRENTWOODCA9451301/01/2024  
CH091230WALGREEN CO.DBA: WALGREENS # 01537 3232 FOOTHILL BLVD
OAKLANDCA9460111/25/2011  
CH091230WALGREEN CO.DBA: WALGREENS # 03295 8102 INTERNATIONAL BLVD
OAKLANDCA9462111/25/2011 07/30/2021
CH091230WALGREEN CO.DBA: WALGREENS # 09248 2300 OTIS DRIVE
ALAMEDACA9450111/25/2011  
CH091230WALGREEN CO.DBA: WALGREENS #11706 301 E. 18TH STREET
OAKLANDCA94606-181311/25/2011 02/24/2025
CH091230WALGREEN CO.DBA: WALGREENS # 02426 15500 WASHINGTON AVE
SAN LEANDROCA9457911/25/2011  
CH091230WALGREEN CO.DBA: WALGREENS # 01536 3434 HIGH STREET
OAKLANDCA9461911/25/2011 01/22/2025
CH091230WALGREEN CO.DBA: WALGREENS # 03171 1050 REDWOOD STREET
VALLEJOCA9459009/14/2012 02/25/2025
CH091230WALGREEN CO.DBA: WALGREENS # 04724 3416 DEER VALLEY RD.
ANTIOCHCA94531-665009/14/2012 11/07/2024
CH091230WALGREEN CO.DBA: WALGREENS # 07376 2901 RAILROAD AVE
PITTSBURGCA94565-522409/14/2012  
CH091230WALGREEN CO.DBA: WALGREENS #15003 1990 MONUMENT BLVD.
CONCORDCA94520-380009/14/2012  
CH091230WALGREEN CO.DBA: WALGREENS # 02575 2647 SPRINGS ROAD
VALLEJOCA9459107/01/2013 02/27/2025
CH091230WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16477 3009 BROADWAY
OAKLANDCA9461107/01/2018  
CH091230WALGREEN CO.DBA: WALGREENS # 07274 1456 136TH AVE
SAN LEANDROCA94578-255207/01/2022 03/27/2025
CH091230WALGREEN CO.DBA: WALGREENS #11365 210 AMERICAN CANYON RD.
AMERICAN CANYONCA9450307/01/2022  
CH091230WALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460507/01/2022 01/30/2025
CH09123WWALGREEN CO.DBA: WALGREENS # 09248 2300 OTIS DRIVE
ALAMEDACA9450101/01/2024  
CH09123BWALGREEN CO.DBA: WALGREENS #11365 210 AMERICAN CANYON RD.
AMERICAN CANYONCA9450301/01/2024  
CH09123PWALGREEN CO.DBA: WALGREENS #15003 1990 MONUMENT BLVD.
CONCORDCA94520-380001/01/2024  
CH09123AWALGREEN CO.DBA: WALGREENS # 01537 3232 FOOTHILL BLVD
OAKLANDCA9460101/01/2024  
CH09123ABWALGREEN CO.DBA: WALGREENS #11706 301 E. 18TH STREET
OAKLANDCA94606-181301/01/2024  
CH09123ACWALGREEN CO.DBA: WALGREENS # 01536 3434 HIGH STREET
OAKLANDCA9461901/01/2024  
CH09123ADWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16477 3009 BROADWAY
OAKLANDCA9461101/01/2024  
CH09123QWALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460501/01/2024  
CH09123RWALGREEN CO.DBA: WALGREENS # 07376 2901 RAILROAD AVE
PITTSBURGCA94565-522401/01/2024  
CH09123SWALGREEN CO.DBA: WALGREENS # 02426 15500 WASHINGTON AVE
SAN LEANDROCA9457901/01/2024  
CH09123VWALGREEN CO.DBA: WALGREENS # 07274 1456 136TH AVE
SAN LEANDROCA94578-255201/01/2024  
CH09123LWALGREEN CO.DBA: WALGREENS # 02575 2647 SPRINGS ROAD
VALLEJOCA9459101/01/2024  
CH091230WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904907/01/2013 07/22/2015
CH091230WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528407/01/2013 07/22/2015
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/30/2024 2:09:52 PM2/11/2025 5:46:19 PM2/11/2025 5:46 PM
Medicaid BillingNPI: NumberInsertChange Request 11841944823/25/2024 5:42 PM
Medicaid BillingNPI: StateInsertChange Request CA3/25/2024 5:42 PM
Medicaid BillingNPI: NumberInsertChange Request 14270703743/20/2024 5:02 PM
Medicaid BillingNPI: StateInsertChange Request CA3/20/2024 5:02 PM
DetailsLast Recertification DateUpdateRecertification2/7/2023 5:06:12 PM1/30/2024 2:09:52 PM1/30/2024 2:09 PM
DetailsLast Recertification DateUpdateRecertification2/1/2022 6:12:45 PM2/7/2023 5:06:12 PM2/7/2023 5:06 PM
DetailsLast Recertification DateUpdateRecertification2/3/2021 2:04:30 PM2/1/2022 6:12:45 PM2/1/2022 6:12 PM
Medicaid BillingNPI: StateUpdateRecertification CA2/3/2021 2:04 PM
DetailsLast Recertification DateUpdateRecertification1/28/2020 3:16:29 PM2/3/2021 2:04:30 PM2/3/2021 2:04 PM
ContactsPrimary ContactUpdateProfile Change RequestDavar, Dolly Pharmacy Manager La Clinica de La Raza 5105353382Davar, Dolly Pharmacy Director La Clinica de La Raza 51053533827/17/2020 2:54 PM
DetailsLast Recertification DateUpdateRecertification2/6/2019 5:07:43 PM1/28/2020 3:16:29 PM1/28/2020 3:16 PM
Medicaid BillingNPI: NumberUpdateChange Request142707037417304761107/17/2019 1:13 PM
DetailsLast Recertification DateUpdateRecertification2/15/2018 2:47:44 PM2/6/2019 5:07:43 PM2/6/2019 5:07 PM
DetailsLast Recertification DateUpdateRecertification1/31/2017 12:00:00 AM2/15/2018 2:47:44 PM2/15/2018 2:47 PM
ContactsAuthorizing OfficialUpdate Garcia, Jane CEO 5105354000Garcia, Jane CEO La Clinica de La Raza 51053540002/15/2018 2:32 PM
ContactsPrimary ContactUpdate Davar, Dolly Pharmacy Manager 5105353382Davar, Dolly Pharmacy Manager La Clinica de La Raza 51053533829/29/2017 1:28 PM
ContactsAuthorizing OfficialInsert  Garcia, Jane CEO 51053540005/16/2017 2:52 PM
ContactsPrimary ContactInsert  Davar, Dolly Pharmacy Manager 51053533825/16/2017 2:52 PM
DetailsLast Recertification DateUpdate 2/23/2016 12:00:00 AM1/31/2017 12:00:00 AM1/31/2017 4:29 PM
AddressesMain AddressInsert   1030 INTERNATIONAL BLVD OAKLAND, CA 94606-37301/31/2017 4:29 PM
DetailsLast Recertification DateUpdate 2/12/2015 12:00:00 AM2/23/2016 12:00:00 AM2/23/2016 5:18 PM
DetailsLast Recertification DateUpdate 3/17/2014 12:00:00 AM2/12/2015 12:00:00 AM2/12/2015 10:59 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/17/2014 12:00:00 AM3/17/2014 11:07 PM
AddressesBilling AddressInsert  LA CLINICA DE LA RAZA P.O. BOX 22210 OAKLAND, CA 946234/17/2013 5:20 PM
DetailsEntity NameUpdate LA CLINICA DE LA RAZALA CLINICA DE LA RAZA, INC.4/12/2013 10:43 AM
Medicaid BillingNPI: NumberInsert  14270703742/27/2013 7:48 AM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/27/2013 7:48 AM
DetailsEntity SubnameUpdate SAN ANTONIO HEALTH CENTERSAN ANTONIO NEIGHBORHOOD HEALTH CENTER2/27/2013 7:48 AM
DetailsLast Recertification DateInsert   6/8/2010 1:42 PM
DetailsGrant NumberInsert  H80CS006316/8/2010 1:42 PM
Details340B IDInsert  CH09123A6/8/2010 1:42 PM
DetailsIs Authorizing Official EHB DataInsert   6/8/2010 1:42 PM
DatesLast Date That 340B Drugs PurchasedInsert   6/8/2010 1:42 PM
DetailsMedicare Provider NumberInsert   6/8/2010 1:42 PM
DetailsEntity NameInsert  LA CLINICA DE LA RAZA6/8/2010 1:42 PM
DetailsProgram CodeInsert  CH6/8/2010 1:42 PM
DetailsEntity SubnameInsert  SAN ANTONIO HEALTH CENTER6/8/2010 1:42 PM
DatesParticipating Approval DateInsert  6/8/2010 12:00:00 AM6/8/2010 1:42 PM
DetailsStateInsert  Active6/8/2010 1:42 PM
DatesRegistration DateInsert  12/1/1992 12:00:00 AM6/8/2010 1:42 PM
DatesSigned By DateInsert   6/8/2010 1:42 PM
DatesStart DateInsert  12/1/1992 12:00:00 AM6/8/2010 1:42 PM
TerminationsTermination CommentsInsert   6/8/2010 1:42 PM
TerminationsTermination DateInsert   6/8/2010 1:42 PM
TerminationsTermination Effective DateInsert   6/8/2010 1:42 PM
TerminationsTermination ReasonInsert   6/8/2010 1:42 PM
DetailsComments PublicInsert  6/8/10 UPDATED BILL TO (WAS 1515 FRUITVALE AVE, 94601)6/8/2010 1:42 PM