340B Drug Pricing Program Database


CH091110C SAN DIEGO FAMILY CARE (Active) - information as of 6/21/2025 12:10:49 AM

Main Details
SAN DIEGO FAMILY CARE
San Diego Family Care
HRSA-Funded Health Center
BPS-H80-017377
CH091110C
H80CS02319


Additional Details
Active
7/5/2016
10/1/2016
7/5/2016
2/14/2025

Contacts

San Diego Family Care
ROBERTA L. FEINBERG, CHIEF EXECUTIVE OFFICER
(858) 279-9676

San Diego Family Care
Manuel Horacio Quintanar, Chief Financial Officer
(858) 514-2958

Addresses

7011 Linda Vista Road
San Diego, CA 92111-6307

Same as Street Address


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

Yes
StateMedicaid NumberNPI Number
CA14577248581457724858
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH0911100ActiveBPS-H80-001228SAN DIEGO FAMILY CARELINDA VISTA HEALTH CARE CENTER6973 Linda Vista Rd San DiegoCA
CH091110AActiveBPS-H80-000368SAN DIEGO FAMILY CAREMID-CITY COMMUNITY CLINIC4290 Polk Ave San DiegoCA
CH091110BActiveBPS-H80-004528SAN DIEGO FAMILY CAREMID-CITY COMMUNITY CLINIC-PEDIATRICS4305 UNIVERSITY AVE, Suite 150 SAN DIEGOCA
CH091110CActiveBPS-H80-017377SAN DIEGO FAMILY CARESan Diego Family Care7011 Linda Vista Road San DiegoCA
CH091110DActiveBPS-H80-021395San Diego Family CareLinda Vista Health Care Center6985 Linda Vista Road San DiegoCA
CH091110EActiveBPS-H80-021394San Diego Family CareLinda Vista Health Care Center6979 Linda Vista Rd San DiegoCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH0911100CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2022  
CH0911100CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2022  
CH0911100CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2022  
CH0911100CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2022  
CH0911100CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2022  
CH0911100CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2022  
CH0911100CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2022  
CH0911100CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/01/2022  
CH0911100CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2022  
CH0911100CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2022  
CH0911100COMMUNITY MEDICAL CENTER PHARMACY610 GATEWAY CENTER WAY STE A - E
SAN DIEGOCA92102-454807/01/2013 10/28/2021
CH0911100CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2022  
CH0911100CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/01/2022  
CH0911100GALLOWAY'S MEDICAL CENTER PHARMACY2995 NATIONAL AVENUE
SAN DIEGOCA9211307/01/2013 10/28/2021
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04768 510 C STREET
SAN DIEGOCA9210101/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08833 3332 SANDROCK ROAD
SAN DIEGOCA9212301/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08842 426 EAST CHASE AVENUE
EL CAJONCA9202001/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09103 318 W EL NORTE PARKWAY
ESCONDIDOCA9202601/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09105 12358 POWAY ROAD
POWAYCA9206401/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09109 6265 EL CAJON BLVD
SAN DIEGOCA9211501/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09112 7100 BROADWAY
LEMON GROVECA9194501/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09121 4404 EL CAJON BLVD
SAN DIEGOCA9211501/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09137 7393 JACKSON DR.
SAN DIEGOCA9211901/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09138 1201 E. PLAZA BLVD
NATIONAL CITYCA9195001/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09141 3151 UNIVERSITY AVE.
SAN DIEGOCA9210401/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09145 9730 MISSION GORGE RD.
SANTEECA9207101/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09148 313 WASHINGTON ST.
SAN DIEGOCA9210301/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09173 2760 FLETCHER PKY
EL CAJONCA9202001/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09175 4829 CLAIREMONT DR
SAN DIEGOCA9211701/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09192 14589 CAMINO DEL NORTE
SAN DIEGOCA9212801/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09193 1380 43RD ST.
SAN DIEGOCA9211301/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09195 8831 VILLA LA JOLLA DR.
LA JOLLACA9203701/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09196 1376 3RD AVE
CHULA VISTACA9191101/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09479 2510 EL CAMINO REAL
CARLSBADCA9200801/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10919 9665 CAMPO RD.
SPRING VALLEYCA9197701/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.CVSPHARMACY # 17517 5680 BALBOA AVE
SAN DIEGOCA9211101/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09177 8260 MIRA MESA BLVD.
SAN DIEGOCA9212601/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08818 997 WOODLAND PKWY.
SAN MARCOSCA9206907/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09102 10575 SCRIPPS POWAY PRKY
SAN DIEGOCA9213107/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09108 1655 S. CENTRE CITY PKWY.
ESCONDIDOCA9202507/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09111 16773 BERNARDO CENTER DR
RANCHO BERNARDOCA9212807/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09113 645 E. PALOMAR ST.
CHULA VISTACA9191107/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09131 10560-4S COMMONS DR.
SAN DIEGOCA9212707/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09197 9225 TWIN TRAILS DRIVE
SAN DIEGOCA9212907/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10954 402 5TH AVENUE
SAN DIEGOCA9210107/01/2022  
CH0911100GARFIELD BEACH CVS, L.L.C.CVS/PHARMACY # 11018 1023 FOURTH AVE
SAN DIEGOCA9210107/01/2022  
CH0911100LINDA VISTA PHARMACY2361 ULRIC ST
SAN DIEGOCA9211110/01/2013  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03068 10776 WESTVIEW PKWY
SAN DIEGOCA9212601/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07962 5685 BALBOA AVE
SAN DIEGOCA9211101/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09154 10350 FRIARS RD
SAN DIEGOCA9212001/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09191 5019 S MCCARRAN BLVD
RENONV8950201/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09538 1792 GARNET AVE
SAN DIEGOCA9210901/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09922 3950 W POINT LOMA BLVD
SAN DIEGOCA9211001/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09937 4445 MISSION BLVD
SAN DIEGOCA9210901/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09963 5644 MISSION CENTER RD
SUITE 201 		SAN DIEGOCA9210801/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09169 5500 GROSSMONT CENTER DR BLDG P
LA MESACA9194207/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09240 380 E H ST
CHULA VISTACA9191007/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09783 1730 SWEETWATER RD
NATIONAL CITYCA9195007/01/2022  
CH0911100LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09918 31021 TEMECULA PARKWAY
TEMECULACA9259207/01/2022  
CH0911100MEDICAL CENTER PHARMACY3904 PARK BLVD
SAN DIEGOCA9210307/01/2013 10/28/2021
CH0911100MEDICAL CENTER PHARMACY4074 FAIRMONT AVENUE
SAN DIEGOCA9210507/01/2013 10/28/2021
CH0911100PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999201/01/2022  
CH0911100PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2022  
CH0911100PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2022  
CH0911100PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681307/01/2022  
CH0911100PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2022  
CH0911100THRIFTY PAYLESS, INC.RITE AID #5649 6939 LINDA VISTA ROAD
SAN DIEGOCA9211107/01/2013  
CH0911100THRIFTY PAYLESS, INC.RITE AID #5644 535 ROBINSON AVENUE
SAN DIEGOCA9210310/01/2018  
CH0911100THRIFTY PAYLESS, INC.RITE AID #5653 5270 BALBOA AVENUE
SAN DIEGOCA9211710/01/2018  
CH0911100THRIFTY PAYLESS, INC.RITE AID #5652 3650 ADAMS AVENUE
SAN DIEGOCA9211610/01/2018  
CH0911100THRIFTY PAYLESS, INC.RITE AID #5657 6505 MISSION GORGE ROAD
SAN DIEGOCA9212007/01/2019  
CH0911100THRIFTY PAYLESS, INC.RITE AID #5660 10631 TIERRASANTA BOULEVARD
SAN DIEGOCA9212407/01/2019  
CH0911100THRIFTY PAYLESS, INC.RITE AID #5654 3081-B CLAIREMONT DRIVE
SAN DIEGOCA9211707/01/2019  
CH0911100WAL-MART PHARMACY 10-21773382 MURPHY CANYON RD
SAN DIEGO (C)CA9212310/01/2014  
CH0911100WAL-MART PHARMACY 10-24793412 COLLEGE AVENUE
SAN DIEGO (E)CA9211510/01/2014  
CH0911100WAL-MART PHARMACY 10-53384840 SHAWLINE ST
SAN DIEGOCA9211110/01/2014  
CH0911100WALGREEN CODBA: WALGREENS #12143 5504 BALBOA AVE
SAN DIEGOCA9211110/01/2013  
CH0911100WALGREEN CO.DBA: WALGREENS # 05844 215 NORTH 2ND STREET
EL CAJONCA9202110/01/2013  
CH0911100WALGREEN CO.DBA: WALGREENS # 06094 3005 MIDWAY DRIVE
SAN DIEGOCA92110-450210/01/2013  
CH0911100WALGREEN CO.DBA: WALGREENS # 06656 3222 UNIVERSITY AVENUE
SAN DIEGOCA92104-201010/01/2013  
CH0911100WALGREEN CO.DBA: WALGREENS # 07869 885 EUCLID AVE
NATIONAL CITYCA9195010/01/2013  
CH0911100WALGREEN CO.DBA: WALGREENS #11654 10787 CAMINO RUIZ
SAN DIEGOCA92126-230410/01/2013  
CH0911100WALGREEN CO.DBA: WALGREENS #13161 4029 43RD ST. STE 700
SAN DIEGOCA9210507/01/2014  
CH0911100WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #13434 640 UNIVERSITY AVE
SAN DIEGOCA9210304/01/2017  
CH0911100WALGREEN CO.DBA: WALGREENS #13834 602 EUCLID AVE
SAN DIEGOCA9211407/01/2018  
CH0911100WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16490 4130 LA JOLLA VILLAGE DR STE 103
LA JOLLACA9203710/01/2020  
CH0911100WALGREEN CO.DBA: WALGREENS #09817 9305 MISSION GORGE RD
SANTEECA92071-381501/01/2022  
CH0911100WALGREEN CO.DBA: WALGREENS #12915 7195 BROADWAY
LEMON GROVECA91945-140801/01/2022  
CH0911100WALGREEN CO.DBA: WALGREENS # 07867 1430 EASTLAKE PKWY
CHULA VISTACA9191504/01/2022  
CH0911100WALGREEN CO.DBA: WALGREENS #12421 13390 POWAY RD
POWAYCA9206404/01/2022  
CH0911100WALGREEN CO.DBA: WALGREENS #15388 301 UNIVERSITY AVE
SAN DIEGOCA9210304/01/2022  
CH0911100WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528410/01/2013 07/07/2015
CH0911100WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/01/2022  
CH0911100WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/01/2022  
CH0911100WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/01/2022  
CH0911100WESTERN PHARMACY GROUP LLCDBA MEDICAL CENTER PHARMACY 3904 PARK BLVD
SAN DIEGOCA92103-350207/01/2018  
CH0911100WESTERN PHARMACY GROUP LLCDBA MEDICAL CENTER PHARMACY 4074 FAIRMOUNT AVE
SAN DIEGOCA92105-160807/01/2018 10/28/2021
CH0911100WESTERN PHARMACY GROUP LLCDBA GALLOWAY'S MEDICAL CENTER PHARMACY 2995 NATIONAL AVE
SAN DIEGOCA92113-241907/01/2018  
CH0911100WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E 		SAN DIEGOCA9210207/01/2018  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/14/2024 6:18:15 PM2/14/2025 4:46:26 PM2/14/2025 4:46 PM
DetailsLast Recertification DateUpdateRecertification2/15/2023 2:11:38 PM2/14/2024 6:18:15 PM2/14/2024 6:18 PM
DetailsLast Recertification DateUpdateRecertification2/24/2022 2:04:54 PM2/15/2023 2:11:38 PM2/15/2023 2:11 PM
DetailsLast Recertification DateUpdateRecertification2/3/2021 6:12:19 PM2/24/2022 2:04:54 PM2/24/2022 2:04 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:12 PM
Medicaid BillingMedicaid: NumberInsertRecertification 14577248582/3/2021 6:12 PM
Medicaid BillingMedicaid: StateInsertRecertification CA2/3/2021 6:12 PM
Medicaid BillingNPI: NumberDeleteRecertification1457724858 ( ) 2/3/2021 6:12 PM
Medicaid BillingNPI: NumberInsertRecertification 14577248582/3/2021 6:12 PM
Medicaid BillingNPI: StateInsertRecertification CA2/3/2021 6:12 PM
DetailsLast Recertification DateUpdateRecertification2/10/2020 6:25:37 PM2/3/2021 6:12:19 PM2/3/2021 6:12 PM
Medicaid BillingNPI: NumberInsertRecertification 14577248582/10/2020 6:25 PM
DetailsLast Recertification DateUpdateRecertification2/20/2019 4:24:13 PM2/10/2020 6:25:37 PM2/10/2020 6:25 PM
DetailsLast Recertification DateUpdateRecertification2/15/2018 4:30:04 PM2/20/2019 4:24:13 PM2/20/2019 4:24 PM
ContactsPrimary ContactUpdateRecertificationFEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER San Diego Family Care 8582799676Quintanar, Manuel Horacio Chief Financial Officer San Diego Family Care 85851429582/15/2018 4:30 PM
DetailsLast Recertification DateUpdateRecertification1/27/2017 12:00:00 AM2/15/2018 4:30:04 PM2/15/2018 4:30 PM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 2/15/2018 4:30 PM
ContactsAuthorizing OfficialUpdate FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER 8582799676FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER San Diego Family Care 858279967610/16/2017 4:03 PM
ContactsPrimary ContactUpdate FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER 8582799676FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER San Diego Family Care 858279967610/16/2017 4:03 PM
ContactsSigned ByUpdate FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER 8582799676FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER San Diego Family Care 858279967610/16/2017 4:03 PM
AddressesMain AddressInsert   7011 Linda Vista Road San Diego, CA 92111-63071/27/2017 12:59 PM
ContactsAuthorizing OfficialInsert  FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER 85827996761/27/2017 12:59 PM
ContactsPrimary ContactInsert  FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER 85827996761/27/2017 12:59 PM
ContactsSigned ByInsert  FEINBERG, ROBERTA L. CHIEF EXECUTIVE OFFICER 85827996761/27/2017 12:59 PM
DetailsLast Recertification DateUpdate  1/27/2017 12:00:00 AM1/27/2017 12:59 PM
DatesParticipating Approval DateUpdate  7/5/2016 12:00:00 AM7/5/2016 6:22 PM
DetailsStateUpdate PendingActive7/5/2016 6:22 PM
DatesStart DateUpdate  10/1/2016 12:00:00 AM7/5/2016 6:22 PM
Details340B IDUpdate ONLINE_REG_70920CH091110C7/5/2016 2:58 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_709207/5/2016 1:51 PM
DetailsLast Recertification DateInsert   7/5/2016 1:51 PM
DetailsGrant NumberInsert  H80CS023197/5/2016 1:51 PM
Details340B IDInsert  ONLINE_REG7/5/2016 1:51 PM
DetailsIs Authorizing Official EHB DataInsert  False7/5/2016 1:51 PM
DatesLast Date That 340B Drugs PurchasedInsert   7/5/2016 1:51 PM
DetailsMedicare Provider NumberInsert   7/5/2016 1:51 PM
DetailsEntity NameInsert  SAN DIEGO FAMILY CARE7/5/2016 1:51 PM
DetailsProgram CodeInsert  CH7/5/2016 1:51 PM
DetailsEntity SubnameInsert  San Diego Family Care7/5/2016 1:51 PM
DatesParticipating Approval DateInsert   7/5/2016 1:51 PM
DetailsStateInsert  Pending7/5/2016 1:51 PM
DatesRegistration DateInsert  7/5/2016 12:00:00 AM7/5/2016 1:51 PM
DatesSigned By DateInsert  7/5/2016 12:00:00 AM7/5/2016 1:51 PM
DatesStart DateInsert   7/5/2016 1:51 PM
TerminationsTermination CommentsInsert   7/5/2016 1:51 PM
TerminationsTermination DateInsert   7/5/2016 1:51 PM
TerminationsTermination Effective DateInsert   7/5/2016 1:51 PM
TerminationsTermination ReasonInsert   7/5/2016 1:51 PM