340B Drug Pricing Program Database


RWI92653 Shanti Orange County (Active) - information as of 5/6/2025 12:03:43 AM

Main Details
Shanti Orange County
Ryan White Part A
RWI92653
H89HA00019


Additional Details
Active
1/13/2017
4/1/2017
2/14/2017
2/22/2025
3/1/2024 - 2/28/2025

Contacts

Shanti Orange County
Lindsay Ann Fitzpatrick, Executive Director
(949) 452-0888 Ext: 9494520888

Shanti Orange County
Melissa Reynoso, Program Coordinator
(949) 452-0888 Ext: 9494520888

Addresses

23461 South Pointe Drive
Suite 100
Laguna Hills, CA 92653

Same as Street Address


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

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282104/08/202204/13/2022  04/13/2022
Contract DetailAVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080804/08/202204/13/2022  04/13/2022
Contract DetailCOAST HILLS PHARMACY2610 SAN MIGUEL DR
NEWPORT BEACHCA9266001/14/201904/01/2019 01/01/202004/02/2021
Contract DetailGARDEN GROVE COMMUNITY PHARMACY12665 GARDEN GROVE BLVD STE 108
GARDEN GROVECA92843-191504/08/202204/13/2022  04/13/2022
Contract DetailLAGUNA DRUGS239 BROADWAY ST
LAGUNA BEACHCA92651-180602/14/201704/01/2017 01/01/202004/02/2021
Contract DetailLONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245304/08/202204/13/2022  04/13/2022
Contract DetailMISSION PLAZA PHARMACY26800 CROWN VALLEY PKWY STE 185
MISSION VIEJOCA92691-730404/02/202107/01/2021  07/01/2021
Contract DetailPHARMEDQUEST PHARMACY SERVICESDBA AVITA PHARMACY 1072 26800 CROWN VALLEY PKWY STE 185
MISSION VIEJOCA9269107/15/202207/20/2022  07/20/2022
Contract DetailQUALITY DRUG CLINICAL CARE4 TECHNOLOGY DR STE 100
IRVINECA9261801/14/201904/01/2019  04/01/2019
Contract DetailVIA LIDO DRUGS3445 VIA LIDO
NEWPORT BEACHCA9266301/14/201904/01/2019 01/01/202004/02/2021
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsAssistance Received From DateUpdateRecertification3/1/2023 12:00:00 AM3/1/2024 12:00:00 AM2/22/2025 9:52 PM
DetailsAssistance Received To DateUpdateRecertification2/28/2024 12:00:00 AM2/28/2025 12:00:00 AM2/22/2025 9:52 PM
DetailsLast Recertification DateUpdateRecertification2/8/2024 11:32:47 AM2/22/2025 9:52:40 PM2/22/2025 9:52 PM
DetailsAssistance Received From DateUpdateRecertification3/1/2022 12:00:00 AM3/1/2023 12:00:00 AM2/8/2024 11:32 AM
DetailsAssistance Received To DateUpdateRecertification2/28/2023 12:00:00 AM2/28/2024 12:00:00 AM2/8/2024 11:32 AM
DetailsLast Recertification DateUpdateRecertification2/4/2023 10:41:22 AM2/8/2024 11:32:47 AM2/8/2024 11:32 AM
DetailsNOFO NumberUpdate HRSA-17-036 12/16/2023 10:34 AM
DetailsAssistance Received From DateUpdateRecertification3/1/2020 12:00:00 AM3/1/2022 12:00:00 AM2/4/2023 10:41 AM
DetailsAssistance Received To DateUpdateRecertification2/28/2022 12:00:00 AM2/28/2023 12:00:00 AM2/4/2023 10:41 AM
DetailsLast Recertification DateUpdateRecertification2/4/2022 4:25:51 PM2/4/2023 10:41:22 AM2/4/2023 10:41 AM
DetailsLast Recertification DateUpdateRecertification2/23/2021 11:26:43 AM2/4/2022 4:25:51 PM2/4/2022 4:25 PM
DetailsAssistance Received From DateUpdateRecertification 3/1/2020 12:00:00 AM2/23/2021 11:26 AM
DetailsAssistance Received To DateUpdateRecertification 2/28/2022 12:00:00 AM2/23/2021 11:26 AM
DetailsLast Recertification DateUpdateRecertification1/28/2020 5:32:14 PM2/23/2021 11:26:43 AM2/23/2021 11:26 AM
DetailsNOFO NumberUpdateRecertification HRSA-17-0362/23/2021 11:26 AM
DetailsLast Recertification DateUpdateRecertification1/30/2019 2:34:39 PM1/28/2020 5:32:14 PM1/28/2020 5:32 PM
DetailsLast Recertification DateUpdateRecertification2/9/2018 11:44:27 AM1/30/2019 2:34:39 PM1/30/2019 2:34 PM
ContactsPrimary ContactUpdateChange RequestKasman, Sarah Executive Director Shanti Orange County 9494520888Reynoso, Melissa Program Coordinator Shanti Orange County 9494520888-94945208881/14/2019 3:41 PM
ContactsAuthorizing OfficialUpdateChange RequestFitzpatrick, Lindsay Ann Executive Director Shanti Orange County 9494520888Fitzpatrick, Lindsay Ann Executive Director Shanti Orange County 9494520888-94945208881/14/2019 3:41 PM
ContactsPrimary ContactUpdateRecertificationKasman, Sarah Executive Director 9494520888Kasman, Sarah Executive Director Shanti Orange County 94945208882/9/2018 11:44 AM
ContactsSigned ByUpdateRecertificationKasman, Sarah Executive Director 9494520888Kasman, Sarah Executive Director Shanti Orange County 94945208882/9/2018 11:44 AM
DetailsLast Recertification DateUpdateRecertification 2/9/2018 11:44:27 AM2/9/2018 11:44 AM
ContactsAuthorizing OfficialUpdateAO Change RequestKasman, Sarah Executive Director 9494520888Fitzpatrick, Lindsay Ann Executive Director Shanti Orange County 94945208882/8/2018 10:07 AM
AddressesMain AddressInsert   23461 South Pointe Drive Suite 100 Laguna Hills, CA 926532/14/2017 2:54 PM
ContactsAuthorizing OfficialInsert  Kasman, Sarah Executive Director 94945208882/14/2017 2:54 PM
ContactsPrimary ContactInsert  Kasman, Sarah Executive Director 94945208882/14/2017 2:54 PM
ContactsSigned ByInsert  Kasman, Sarah Executive Director 94945208882/14/2017 2:54 PM
DatesParticipating Approval DateUpdate  2/14/2017 12:00:00 AM2/14/2017 2:53 PM
DetailsStateUpdate PendingActive2/14/2017 2:53 PM
DatesStart DateUpdate  4/1/2017 12:00:00 AM2/14/2017 2:53 PM
Details340B IDUpdate ONLINE_REG_74876RWI92653 1/23/2017 8:43 AM
DetailsGrant NumberUpdate  H89HA000191/19/2017 1:48 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_748761/13/2017 2:31 PM
DetailsLast Recertification DateInsert   1/13/2017 2:31 PM
DetailsGrant NumberInsert   1/13/2017 2:31 PM
Details340B IDInsert  ONLINE_REG1/13/2017 2:31 PM
DetailsIs Authorizing Official EHB DataInsert   1/13/2017 2:31 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/13/2017 2:31 PM
DetailsMedicare Provider NumberInsert   1/13/2017 2:31 PM
DetailsEntity NameInsert  Shanti Orange County1/13/2017 2:31 PM
DetailsProgram CodeInsert  RWI1/13/2017 2:31 PM
DetailsEntity SubnameInsert   1/13/2017 2:31 PM
DatesParticipating Approval DateInsert   1/13/2017 2:31 PM
DetailsStateInsert  Pending1/13/2017 2:31 PM
DatesRegistration DateInsert  1/13/2017 12:00:00 AM1/13/2017 2:31 PM
DatesSigned By DateInsert  1/13/2017 12:00:00 AM1/13/2017 2:31 PM
DatesStart DateInsert   1/13/2017 2:31 PM
TerminationsTermination CommentsInsert   1/13/2017 2:31 PM
TerminationsTermination DateInsert   1/13/2017 2:31 PM
TerminationsTermination Effective DateInsert   1/13/2017 2:31 PM
TerminationsTermination ReasonInsert   1/13/2017 2:31 PM