Covered Entity Details

CH092134L Eisner Health at Van Nuys (Active) - information as of 4/25/2025 8:34:50 PM

Main Details

Name

Eisner Health at Van Nuys

Subdivision Name

Eisner Health at Van Nuys

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017398

340B ID

CH092134L

Grant Number

H80CS04223

Additional Details

Current Program Status

Active

Registration Date

7/14/2016

Participating Start Date

10/1/2016

Participating Approval Date

7/27/2016

Last Recertification Date

2/18/2025

Contacts

Authorizing Official

Eisner Health
Monica Gutierrez-McCarthy, CEO
(213) 342-3325

Primary Contact

Eisner Health
Nicole Marie Tavares-Kuhn, Director, Pharmacy Services
(213) 588-0467

Addresses

Street Address

6618 Van Nuys Blvd
Van Nuys, CA 91405

Billing Address

Eisner Health
1530 S Olive St
Los Angeles, CA 90015

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	1982075107,1326370073	1326370073,1982075107

Shipping Addresses

Shipping Address 1

Eisner Health at Van Nuys
6618 Van Nuys Blvd
Van Nuys, CA 91405

Shipping Address 2

Eisner Health
1500 S Olive St RM#101
Los Angeles, CA 90015

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	City	State
CH0921340	Active	BPS-H80-004005	Eisner Health	Eisner Health	1530 S Olive St	Los Angeles	CA
CH092134A	Active	BPS-H80-009069	Eisner Health Family Planning Clinic at Los Angeles High School	Eisner Health Family Planning Clinic at Los Angeles High School	4650 W Olympic Blvd Rm 40	Los Angeles	CA
CH092134B	Terminated	BPS-H80-006593	PEDIATRIC & FAMILY MEDICAL CENTER	Metropolitan High School	727 Wilson St.	Los Angeles	CA
CH092134D	Active	BPS-H80-009415	Eisner Health - Student and Family Wellness Center at Santee	Eisner Health - Student and Family Wellness Center at Santee	1921 Maple Ave.	Los Angeles	CA
CH092134F	Active	BPS-H80-010592	Eisner Health Family Medicine Center at California Hospital	Eisner Health Family Medicine Center at California Hospital	1400 S. Grand Ave. STE 101	Los Angeles	CA
CH092134G	Active	BPS-H80-014876	Eisner Health at Lynwood	Eisner Health at Lynwood	3680 E Imperial Hwy	Lynwood	CA
CH092134H	Active	BPS-H80-014796	Eisner Health - Women's Health Center	Eisner Pediatric & Family Medical Center Women's Health Center	1513 S. Grand Avenue	Los Angeles	CA
CH092134J	Terminated	BPS-H80-017444	Eisner Health at Panorama City OB	Eisner Health at Panorama City OB	15251 Roscoe Blvd	Panorama City	CA
CH092134K	Terminated	BPS-H80-017443	Eisner Health at Panorama City - Pediatrics	Eisner Health at Panorama City - Pediatrics	15253 Roscoe Blvd	Panorama City	CA
CH092134L	Active	BPS-H80-017398	Eisner Health at Van Nuys	Eisner Health at Van Nuys	6618 Van Nuys Blvd	Van Nuys	CA
CH092134M	Active	BPS-H80-019073	Eisner Health Intergenerational Health Center	Eisner Health Intergenerational Health Center	15477 Ventura Blvd	Sherman Oaks	CA
CH092134N	Active	BPS-H80-038097	PEDIATRIC AND FAMILY MEDICAL FOUNDATION	Eisner Health Mid-Valley	15211 Vanowen St, Ste 315	Van Nuys	CA
CH092134P	Active	BPS-H80-033722	PEDIATRIC AND FAMILY MEDICAL FOUNDATION	Eisner Health Intergenerational Health Center - Panorama City	8640 Van Nuys Blvd	Panorama City	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
CH092134G	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	01/01/2021
CH092134F	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	01/01/2021
CH0921340	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	10/01/2020
CH0921340	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/01/2020
CH092134G	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	01/01/2021
CH092134F	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	01/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/26/2024 2:44:18 PM	2/18/2025 5:26:10 PM	2/18/2025 5:26 PM
Contacts	Authorizing Official	Update	Group Change Request	Brodine, Warren J Chief Executive Officer Eisner Health 2137461037-3305	Gutierrez-McCarthy, Monica CEO Eisner Health 2133423325	4/15/2024 10:09 AM
Details	Last Recertification Date	Update	Recertification	2/9/2023 1:35:18 PM	2/26/2024 2:44:18 PM	2/26/2024 2:44 PM
Details	Last Recertification Date	Update	Recertification	2/24/2022 5:48:15 PM	2/9/2023 1:35:18 PM	2/9/2023 1:35 PM
Addresses	Shipping Address	Delete	Recertification	Eisner Health 1500 S Olive St Los Angeles, CA 90015		2/24/2022 5:48 PM
Addresses	Shipping Address	Insert	Recertification		Eisner Health 1500 S Olive St RM#101 Los Angeles, CA 90015	2/24/2022 5:48 PM
Contacts	Primary Contact	Update	Recertification	Alton, Nicole Director, Pharmacy Services Eisner Health 2133423333	Tavares-Kuhn, Nicole Marie Director, Pharmacy Services Eisner Health 2135880467	2/24/2022 5:48 PM
Details	Last Recertification Date	Update	Recertification	2/22/2021 2:14:12 PM	2/24/2022 5:48:15 PM	2/24/2022 5:48 PM
Addresses	Shipping Address	Delete	Change Request	Eisner Pediatric & Family Medical Center at Vn Nuys 6618 Van Nuys Bl. Van Nuys, CA 91405-4617		4/20/2021 11:29 AM
Addresses	Shipping Address	Delete	Change Request	Eisner Pediatric & Family Medical Center Pharmacy 1500 S Olive St Los Angeles, CA 90015-3023		4/20/2021 11:29 AM
Addresses	Shipping Address	Insert	Change Request		Eisner Health 1500 S Olive St Los Angeles, CA 90015	4/20/2021 11:29 AM
Addresses	Shipping Address	Insert	Change Request		Eisner Health at Van Nuys 6618 Van Nuys Blvd Van Nuys, CA 91405	4/20/2021 11:29 AM
Addresses	Main Address	Update	Change Request	6618 Van Nuys Bl. Van Nuys, CA 91405-4617	6618 Van Nuys Blvd Van Nuys, CA 91405	4/20/2021 11:29 AM
Addresses	Billing Address	Update	Change Request	Pediatric & Family Medical Center 1530 S Olive St Los Angeles, CA 90015-3023	Eisner Health 1530 S Olive St Los Angeles, CA 90015	4/20/2021 11:29 AM
Details	Entity Name	Update	Change Request	PEDIATRIC & FAMILY MEDICAL CENTER	Eisner Health at Van Nuys	4/20/2021 11:29 AM
Details	Entity Subname	Update	Change Request	Eisner Pediatric & Family Medical Center at Van Nuys	Eisner Health at Van Nuys	4/20/2021 11:29 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1720468804 (CA)		2/22/2021 2:14 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1982075115 (CA)		2/22/2021 2:14 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1720468804 ( )		2/22/2021 2:14 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1982075107 ( )		2/22/2021 2:14 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1982075115 ( )		2/22/2021 2:14 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1326370073 ( )		2/22/2021 2:14 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326370073	2/22/2021 2:14 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	2/22/2021 2:14 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1982075107	2/22/2021 2:14 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	2/22/2021 2:14 PM
Details	Last Recertification Date	Update	Recertification	1/31/2020 10:33:00 AM	2/22/2021 2:14:12 PM	2/22/2021 2:14 PM
Details	Last Recertification Date	Update	Recertification	2/15/2019 6:22:37 PM	1/31/2020 10:33:00 AM	1/31/2020 10:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/10/2020 6:20 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1720468804	1/10/2020 6:20 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	1/10/2020 6:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/10/2020 6:20 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1982075107	1/10/2020 6:20 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	1/10/2020 6:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1720468804	1/10/2020 6:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1982075107	1/10/2020 6:20 PM
Details	Last Recertification Date	Update	Recertification	2/13/2018 8:25:50 PM	2/15/2019 6:22:37 PM	2/15/2019 6:22 PM
Details	Last Recertification Date	Update	Recertification	2/14/2017 12:00:00 AM	2/13/2018 8:25:50 PM	2/13/2018 8:25 PM
Contacts	Authorizing Official	Update	Change Request	de Leon, Chona Chief Operating Officer 2137475542-3326	Brodine, Warren J Chief Executive Officer Eisner Health 2137461037-3305	1/24/2018 3:15 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		1/24/2018 3:15 PM
Contacts	Primary Contact	Update		Alton, Nicole Director, Pharmacy Services 2133423333	Alton, Nicole Director, Pharmacy Services Eisner Health 2133423333	1/12/2018 11:15 AM
Contacts	Signed By	Insert			Schultz, Herb K. President/CEO 2137475542-3331	4/6/2017 7:37 AM
Contacts	Primary Contact	Update		ALTON, NICOLE DIRECTOR OF PHARMACY SERVICES 2137461037-3333	Alton, Nicole Director, Pharmacy Services 2133423333	4/6/2017 7:37 AM
Contacts	Authorizing Official	Update		de Leon, Chona Chief Operating Officer 2137461037-3326	de Leon, Chona Chief Operating Officer 2137475542-3326	4/6/2017 7:37 AM
Addresses	Main Address	Insert			6618 Van Nuys Bl. Van Nuys, CA 91405-4617	2/14/2017 7:21 AM
Details	Last Recertification Date	Update			2/14/2017 12:00:00 AM	2/14/2017 7:20 AM
Contacts	Primary Contact	Insert			ALTON, NICOLE DIRECTOR OF PHARMACY SERVICES 2137461037-3333	10/13/2016 1:09 PM
Contacts	Authorizing Official	Insert			de Leon, Chona Chief Operating Officer 2137461037-3326	10/13/2016 1:09 PM
Addresses	Billing Address	Insert			Pediatric & Family Medical Center 1530 S Olive St Los Angeles, CA 90015-3023	10/13/2016 1:08 PM
Addresses	Shipping Address	Insert			Eisner Pediatric & Family Medical Center Pharmacy 1500 S Olive St Los Angeles, CA 90015-3023	10/13/2016 1:08 PM
Addresses	Shipping Address	Insert			Eisner Pediatric & Family Medical Center at Vn Nuys 6618 Van Nuys Bl. Van Nuys, CA 91405-4617	10/13/2016 1:08 PM
Dates	Participating Approval Date	Update			7/27/2016 12:00:00 AM	7/27/2016 1:52 PM
Details	State	Update		Pending	Active	7/27/2016 1:52 PM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	7/27/2016 1:52 PM
Details	340B ID	Update		ONLINE_REG_71671	CH092134L	7/20/2016 10:07 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_71671	7/14/2016 9:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/14/2016 9:54 AM
Medicaid Billing	Medicaid: Number	Insert			1982075115	7/14/2016 9:54 AM
Medicaid Billing	Medicaid: State	Insert			CA	7/14/2016 9:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/14/2016 9:54 AM
Medicaid Billing	Medicaid: Number	Insert			1326370073	7/14/2016 9:54 AM
Medicaid Billing	Medicaid: State	Insert			CA	7/14/2016 9:54 AM
Medicaid Billing	NPI: Number	Insert			1982075115	7/14/2016 9:54 AM
Medicaid Billing	NPI: Number	Insert			1326370073	7/14/2016 9:54 AM
Details	Last Recertification Date	Insert				7/14/2016 9:54 AM
Details	Grant Number	Insert			H80CS04223	7/14/2016 9:54 AM
Details	340B ID	Insert			ONLINE_REG	7/14/2016 9:54 AM
Details	Is Authorizing Official EHB Data	Insert			False	7/14/2016 9:54 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/14/2016 9:54 AM
Details	Medicare Provider Number	Insert				7/14/2016 9:54 AM
Details	Entity Name	Insert			PEDIATRIC & FAMILY MEDICAL CENTER	7/14/2016 9:54 AM
Details	Program Code	Insert			CH	7/14/2016 9:54 AM
Details	Entity Subname	Insert			Eisner Pediatric & Family Medical Center at Van Nuys	7/14/2016 9:54 AM
Dates	Participating Approval Date	Insert				7/14/2016 9:54 AM
Details	State	Insert			Pending	7/14/2016 9:54 AM
Dates	Registration Date	Insert			7/14/2016 12:00:00 AM	7/14/2016 9:54 AM
Dates	Signed By Date	Insert			7/14/2016 12:00:00 AM	7/14/2016 9:54 AM
Dates	Start Date	Insert				7/14/2016 9:54 AM
Terminations	Termination Comments	Insert				7/14/2016 9:54 AM
Terminations	Termination Date	Insert				7/14/2016 9:54 AM
Terminations	Termination Effective Date	Insert				7/14/2016 9:54 AM
Terminations	Termination Reason	Insert				7/14/2016 9:54 AM

340B Drug Pricing Program Database