340B Drug Pricing Program Database


CH09208B ALLIANCE MEDICAL CENTER, INC. (Active) - information as of 6/26/2025 3:04:04 AM

Main Details
ALLIANCE MEDICAL CENTER, INC.
Windsor Dental Clinic
HRSA-Funded Health Center
BPS-H80-018781
CH09208B
H80CS00249


Additional Details
Active
2/28/2017
4/1/2017
3/7/2017
2/18/2025

Contacts

Alliance Medical Center
Susannah Labbe, CEO
(707) 480-3898

Alliance Medical Center
Amy G Fawcett, CFO
(949) 923-9545

Addresses

8499 Old Redwood Hwy. STE 111 & 112
Windsor, CA 95492

Alliance Medical Center, Inc
1381 University Ave.
Healdsburg, CA 95448


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites 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 DetailAMC COMMUNITY PHARMACY1381 UNIVERSITY STREET SUITE A
HEALDSBURGCA9544801/15/201804/01/2018  01/15/2018
Contract DetailRALEY'S PHARMACY #3418852 LAKEWOOD DRIVE
WINDSORCA9549201/15/201804/01/2018  01/15/2018
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #0956 1799 MARLOW ROAD
SANTA ROSACA9540101/15/201804/01/2018 07/02/201910/04/2019
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #0998 1115 VINE ST
HEALDSBURGCA9544801/15/201804/01/2018 07/02/201910/04/2019
Contract DetailTHRIFTY PAYLESS, INC.RITE AID #6021 1793 MARLOW ROAD
SANTA ROSACA9540101/15/201804/01/2018  01/15/2018
Contract DetailTHRIFTY PAYLESS, INC.RITE AID #6029 525 HEALDSBURG AVENUE
HEALDSBURGCA9544801/15/201804/01/2018  01/15/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03084 7800 OLD REDWOOD HWY
COTATICA9493101/15/201804/01/2018  01/15/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06722 4610 SONOMA HWY
SANTA ROSACA95409-413701/15/201804/01/2018  01/15/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03297 3093 MARLOW ROAD
SANTA ROSACA9540301/15/201804/01/2018  01/15/2018
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH092080ActiveBPS-H80-005352ALLIANCE MEDICAL CENTER, INC.ALLIANCE MEDICAL CENTER1381 UNIVERSITY AVENUE HEALDSBURGCA
CH09208AActiveBPS-H80-007557ALLIANCE MEDICAL CENTER, INC.Alliance Medical Center - Windsor8465 Old Redwood Hwy. STE 320 WindsorCA
CH09208BActiveBPS-H80-018781ALLIANCE MEDICAL CENTER, INC.Windsor Dental Clinic8499 Old Redwood Hwy. STE 111 & 112 WindsorCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH092080AMC COMMUNITY PHARMACY1381 UNIVERSITY STREET SUITE A
HEALDSBURGCA9544807/01/2015 01/14/2019
CH092080AMC COMMUNITY PHARMACY1381 UNIVERSITY ST SUITE A
HEALDSBURGCA9544804/01/2016 01/14/2019
CH09208AAMC COMMUNITY PHARMACY1381 UNIVERSITY STREET SUITE A
HEALDSBURGCA9544801/01/2016  
CH09208BAMC COMMUNITY PHARMACY1381 UNIVERSITY STREET SUITE A
HEALDSBURGCA9544804/01/2018  
CH092080CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2024  
CH092080CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2024  
CH092080CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2024  
CH092080CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2024  
CH092080CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2024  
CH092080CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2024  
CH092080CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2024  
CH092080CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/01/2024  
CH092080CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/01/2024  
CH092080CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/01/2024  
CH092080CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/01/2024  
CH092080IMGRX HEALDSBURG, INC. DBAAMC COMMUNITY PHARMACY 1381 UNIVERSITY STREET, SUITE A
HEALDSBURGCA9544801/14/2019  
CH092080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09931 9030 BROOKS RD S
WINDSORCA9549201/01/2020  
CH092080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01173 455 CENTER ST
HEALDSBURGCA9544801/01/2020  
CH092080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 00345 1111 S CLOVERDALE BLVD
CLOVERDALECA9542504/01/2022  
CH092080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09872 6877 SEBASTOPOL AVENUE
SEBASTOPOLCA9547204/01/2022  
CH092080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09946 463 STONY POINT RD
SANTA ROSACA9540104/01/2022  
CH092080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09656 2771 4TH ST
SANTA ROSACA9540504/01/2022  
CH092080PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/01/2024  
CH092080PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/01/2024  
CH092080PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/01/2024  
CH092080RALEY'S PHARMACY #3418852 LAKEWOOD DRIVE
WINDSORCA9549203/29/2011  
CH09208ARALEY'S PHARMACY #3418852 LAKEWOOD DRIVE
WINDSORCA9549208/17/2010  
CH09208BRALEY'S PHARMACY #3418852 LAKEWOOD DRIVE
WINDSORCA9549204/01/2018  
CH092080SAFEWAY INCSAFEWAY PHARMACY #0956 1799 MARLOW ROAD
SANTA ROSACA9540110/08/2010 07/02/2019
CH092080SAFEWAY INCSAFEWAY PHARMACY #0998 1115 VINE ST
HEALDSBURGCA9544811/07/2009 07/02/2019
CH092080SAFEWAY INCSAFEWAY PHARMACY #0713 100 CALISTOGA RD
SANTA ROSACA9540910/08/2010 01/30/2018
CH092080SAFEWAY INCSAFEWAY PHARMACY #1576 2300 MENDOCINO AVENUE
SANTA ROSACA9540310/08/2010 01/30/2018
CH092080SAFEWAY INCSAFEWAY PHARMACY #1265 2785 YULUPA AVE
SANTA ROSACA9540510/08/2010 01/30/2018
CH092080SAFEWAY INCSAFEWAY PHARMACY #1434 9080 BROOKS RD S
WINDSORCA95492-781107/13/2010 07/02/2019
CH09208ASAFEWAY INCSAFEWAY PHARMACY #1576 2300 MENDOCINO AVENUE
SANTA ROSACA9540310/08/2010 01/30/2018
CH09208ASAFEWAY INCSAFEWAY PHARMACY #0998 1115 VINE ST
HEALDSBURGCA9544807/13/2010 07/02/2019
CH09208ASAFEWAY INCSAFEWAY PHARMACY #1265 2785 YULUPA AVE
SANTA ROSACA9540510/08/2010 01/30/2018
CH09208ASAFEWAY INCSAFEWAY PHARMACY #0713 100 CALISTOGA RD
SANTA ROSACA9540910/08/2010 01/30/2018
CH09208ASAFEWAY INCSAFEWAY PHARMACY #0956 1799 MARLOW ROAD
SANTA ROSACA9540110/08/2010 07/02/2019
CH09208ASAFEWAY INCSAFEWAY PHARMACY #1434 9080 BROOKS RD S
WINDSORCA95492-781101/01/2010 07/02/2019
CH09208BSAFEWAY INCSAFEWAY PHARMACY #0956 1799 MARLOW ROAD
SANTA ROSACA9540104/01/2018 07/02/2019
CH09208BSAFEWAY INCSAFEWAY PHARMACY #0998 1115 VINE ST
HEALDSBURGCA9544804/01/2018 07/02/2019
CH092080SAFEWAY INCSAFEWAY PHARMACY #0950 16405 HWY 116
GUERNEVILLECA9544610/01/2023  
CH092080SAFEWAY INCSAFEWAY PHARMACY #0998 1115 VINE ST
HEALDSBURGCA9544810/01/2023  
CH09208ASAFEWAY INCSAFEWAY PHARMACY #0998 1115 VINE ST
HEALDSBURGCA9544810/01/2023  
CH092080THRIFTY PAYLESS, INC.RITE AID #6029 525 HEALDSBURG AVENUE
HEALDSBURGCA9544810/01/2012  
CH092080THRIFTY PAYLESS, INC.RITE AID #6021 1793 MARLOW ROAD
SANTA ROSACA9540110/01/2012  
CH09208BTHRIFTY PAYLESS, INC.RITE AID #6021 1793 MARLOW ROAD
SANTA ROSACA9540104/01/2018  
CH09208BTHRIFTY PAYLESS, INC.RITE AID #6029 525 HEALDSBURG AVENUE
HEALDSBURGCA9544804/01/2018  
CH092080WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2018  
CH092080WAL-MART PHARMACY 10-25536650 HEMBREE LANE
WINDSORCA9549210/01/2018  
CH092080WAL-MART PHARMACY 10-25536650 HEMBREE LANE
WINDSORCA9549210/01/2018 10/01/2018
CH092080WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2018  
CH09208AWALGREEN CO.DBA: WALGREENS # 03297 3093 MARLOW ROAD
SANTA ROSACA9540304/01/2018  
CH092080WALGREEN CO.DBA: WALGREENS # 03297 3093 MARLOW ROAD
SANTA ROSACA9540304/01/2018  
CH09208AWALGREEN CO.DBA: WALGREENS # 03084 7800 OLD REDWOOD HWY
COTATICA9493104/01/2018  
CH092080WALGREEN CO.DBA: WALGREENS # 06722 4610 SONOMA HWY
SANTA ROSACA95409-413704/01/2018  
CH092080WALGREEN CO.DBA: WALGREENS # 03084 7800 OLD REDWOOD HWY
COTATICA9493104/01/2018  
CH09208AWALGREEN CO.DBA: WALGREENS # 06722 4610 SONOMA HWY
SANTA ROSACA95409-413704/01/2018  
CH09208BWALGREEN CO.DBA: WALGREENS # 03084 7800 OLD REDWOOD HWY
COTATICA9493104/01/2018  
CH09208BWALGREEN CO.DBA: WALGREENS # 06722 4610 SONOMA HWY
SANTA ROSACA95409-413704/01/2018  
CH09208BWALGREEN CO.DBA: WALGREENS # 03297 3093 MARLOW ROAD
SANTA ROSACA9540304/01/2018  
CH092080WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/01/2024  
CH092080Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/3/2024 3:07:09 PM2/18/2025 5:21:01 PM2/18/2025 5:21 PM
DetailsLast Recertification DateUpdateRecertification2/8/2023 4:16:24 PM2/3/2024 3:07:09 PM2/3/2024 3:07 PM
ContactsPrimary ContactUpdateGroup Change RequestWaterman, Judith P CFO Alliance Medical Center 7074631463Fawcett, Amy G CFO Alliance Medical Center 949923954510/18/2023 4:56 PM
DetailsLast Recertification DateUpdateRecertification2/21/2022 2:12:14 PM2/8/2023 4:16:24 PM2/8/2023 4:16 PM
ContactsAuthorizing OfficialUpdateAO Change RequestArmstrong, Alex CEO Alliance Medical Center 7073852306Labbe, Susannah CEO Alliance Medical Center 70748038989/15/2022 8:42 AM
ContactsAuthorizing OfficialUpdateAO Change RequestChurchill, Joan Chief Executive Officer Alliance Medical Center 7075436292Armstrong, Alex CEO Alliance Medical Center 70738523066/15/2022 12:46 PM
DetailsLast Recertification DateUpdateRecertification2/24/2021 7:38:03 PM2/21/2022 2:12:14 PM2/21/2022 2:12 PM
Medicaid BillingNPI: NumberDeleteRecertification1750399796 ( ) 2/24/2021 7:38 PM
ContactsPrimary ContactUpdateRecertificationWaterman, Judy CFO Alliance Medical Center 7074631463Waterman, Judith P CFO Alliance Medical Center 70746314632/24/2021 7:38 PM
DetailsLast Recertification DateUpdateRecertification1/27/2020 11:57:39 AM2/24/2021 7:38:03 PM2/24/2021 7:38 PM
ContactsAuthorizing OfficialUpdateAO Change RequestArmstrong, Alex CEO Alliance Medical Center 7073852306Churchill, Joan Chief Executive Officer Alliance Medical Center 707543629211/30/2020 6:21 AM
DetailsLast Recertification DateUpdateRecertification2/7/2019 3:13:32 PM1/27/2020 11:57:39 AM1/27/2020 11:57 AM
Medicaid BillingNPI: NumberUpdateRecertification151841886217503997962/7/2019 3:13 PM
DetailsLast Recertification DateUpdateRecertification2/12/2018 2:50:50 PM2/7/2019 3:13:32 PM2/7/2019 3:13 PM
DetailsLast Recertification DateUpdateRecertification 2/12/2018 2:50:50 PM2/12/2018 2:50 PM
ContactsPrimary ContactUpdateChange RequestWaterman, Judy CFO 7074631463Waterman, Judy CFO Alliance Medical Center 707463146312/1/2017 12:47 PM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 12/1/2017 12:47 PM
ContactsAuthorizing OfficialUpdate Armstrong, Alex CEO 7073852306Armstrong, Alex CEO Alliance Medical Center 70738523069/22/2017 2:09 PM
ContactsSigned ByUpdate Armstrong, Alex CEO 7073852306Armstrong, Alex CEO Alliance Medical Center 70738523069/22/2017 2:09 PM
AddressesMain AddressInsert   8499 Old Redwood Hwy. STE 111 & 112 Windsor, CA 954923/16/2017 11:35 AM
ContactsAuthorizing OfficialInsert  Armstrong, Alex CEO 70738523063/16/2017 11:35 AM
ContactsSigned ByInsert  Armstrong, Alex CEO 70738523063/16/2017 11:35 AM
ContactsPrimary ContactInsert  Waterman, Judy CFO 70746314633/16/2017 11:35 AM
AddressesBilling AddressInsert  Alliance Medical Center, Inc 1381 University Ave. Healdsburg, CA 954483/7/2017 5:52 PM
DatesParticipating Approval DateUpdate  3/7/2017 12:00:00 AM3/7/2017 5:51 PM
DetailsStateUpdate PendingActive3/7/2017 5:51 PM
DatesStart DateUpdate  4/1/2017 12:00:00 AM3/7/2017 5:51 PM
Details340B IDUpdate ONLINE_REG_75669CH09208B3/7/2017 2:41 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_756692/28/2017 5:52 PM
Medicaid BillingNPI: NumberInsert  15184188622/28/2017 5:52 PM
DetailsLast Recertification DateInsert   2/28/2017 5:52 PM
DetailsGrant NumberInsert  H80CS002492/28/2017 5:52 PM
Details340B IDInsert  ONLINE_REG2/28/2017 5:52 PM
DetailsIs Authorizing Official EHB DataInsert  False2/28/2017 5:52 PM
DatesLast Date That 340B Drugs PurchasedInsert   2/28/2017 5:52 PM
DetailsMedicare Provider NumberInsert   2/28/2017 5:52 PM
DetailsEntity NameInsert  ALLIANCE MEDICAL CENTER, INC.2/28/2017 5:52 PM
DetailsProgram CodeInsert  CH2/28/2017 5:52 PM
DetailsEntity SubnameInsert  Windsor Dental Clinic2/28/2017 5:52 PM
DatesParticipating Approval DateInsert   2/28/2017 5:52 PM
DetailsStateInsert  Pending2/28/2017 5:52 PM
DatesRegistration DateInsert  2/28/2017 12:00:00 AM2/28/2017 5:52 PM
DatesSigned By DateInsert  2/28/2017 12:00:00 AM2/28/2017 5:52 PM
DatesStart DateInsert   2/28/2017 5:52 PM
TerminationsTermination CommentsInsert   2/28/2017 5:52 PM
TerminationsTermination DateInsert   2/28/2017 5:52 PM
TerminationsTermination Effective DateInsert   2/28/2017 5:52 PM
TerminationsTermination ReasonInsert   2/28/2017 5:52 PM