340B Drug Pricing Program Database


CH09054D WEST OAKLAND HEALTH COUNCIL, THE (Active) - information as of 5/13/2025 10:51:56 PM

Main Details
WEST OAKLAND HEALTH COUNCIL, THE
COMMUNITY RECOVERY CENTER EAST
HRSA-Funded Health Center
BPS-H80-003031
CH09054D
H80CS00347


Additional Details
Active
4/4/2017
7/1/2017
4/24/2017
2/11/2025

Contacts

The West Oakland Health Council
Robert Phillips, CEO
(510) 835-9610

West Oakland Health Council
James McCabe, Director of Pharmacy
(510) 835-9610 Ext: 2076

Addresses

7501 International Blvd
OAKLAND, CA 94621-2843

West Oakland Health Council
700 Adeline St.
Oakland, CA 94607-2808


  • 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
CA100146244,1001462451598930067,1306967021,1457472177,1528540838
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailDOLPHIN HEALTH PHARMACY7400 MACARTHUR BLVD SUITE A
OAKLANDCA9460504/24/201707/01/2017  04/24/2017
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10475 2964 BROADWAY
OAKLANDCA9461104/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09147 2605 WEST MARCH LANE
STOCKTONCA9520704/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450104/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450104/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457704/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460204/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09329 1039 EL CAMINO REAL
REDWOOD CITYCA9406304/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461104/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457704/02/202107/01/2021  07/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09378 4100 REDWOOD RD
OAKLANDCA9461904/02/202107/01/2021  07/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 01536 3434 HIGH STREET
OAKLANDCA9461904/24/201707/01/2017  04/24/2017
Contract DetailWALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460504/02/202107/01/2021  07/01/2021
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH090540ActiveBPS-H80-004614WEST OAKLAND HEALTH COUNCIL, INC.WEST OAKLAND HEALTH CENTER..700 Adeline St OaklandCA
CH09054AActiveBPS-H80-004547WEST OAKLAND HEALTH COUNCIL, THEALBERT J THOMAS MEDICAL CLINIC10615 INTERNATIONAL BLVD OAKLANDCA
CH09054BActiveBPS-H80-004271WEST OAKLAND HEALTH COUNCIL, THEWILLIAM BYRON RUMFORD MED CLINIC2960 SACRAMENTO ST BERKELEYCA
CH09054CActiveBPS-H80-004182WEST OAKLAND HEALTH COUNCIL, THEEAST OAKLAND HEALTH CENTER7450 International Blvd. OaklandCA
CH09054DActiveBPS-H80-003031WEST OAKLAND HEALTH COUNCIL, THECOMMUNITY RECOVERY CENTER EAST7501 International Blvd OAKLANDCA
CH09054EActiveBPS-H80-038370The West Oakland Health CouncilJames A. Watson Wellness Center5709 Market Street OaklandCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH090540CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2021  
CH090540CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2021  
CH090540CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2021  
CH090540CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2021  
CH090540CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2021  
CH090540CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2021  
CH090540CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2021  
CH090540CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/01/2021  
CH090540CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/01/2021  
CH090540CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/01/2021  
CH090540CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/01/2023  
CH090540CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/01/2023  
CH090540CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/01/2021  
CH090540DOLPHIN HEALTH PHARMACY7400 MACARTHUR BLVD SUITE A
OAKLANDCA9460507/01/2017  
CH09054DDOLPHIN HEALTH PHARMACY7400 MACARTHUR BLVD SUITE A
OAKLANDCA9460507/01/2017  
CH090540GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 8431 7200 BANCROFT AVE.
OAKLANDCA9460501/01/2021  
CH09054BGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10475 2964 BROADWAY
OAKLANDCA9461107/01/2021  
CH09054DGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10475 2964 BROADWAY
OAKLANDCA9461107/01/2021  
CH09054CGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10475 2964 BROADWAY
OAKLANDCA9461107/01/2021  
CH09054AGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10475 2964 BROADWAY
OAKLANDCA9461107/01/2021  
CH090540GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10475 2964 BROADWAY
OAKLANDCA9461107/01/2021  
CH090540GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17624 1555 40TH STREET
EMERYVILLECA9460810/01/2022  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09553 4349 SAN PABLO AVE
EMERYVILLECA9460801/01/2021 08/30/2022
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461107/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450107/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09147 2605 WEST MARCH LANE
STOCKTONCA9520707/01/2021  
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457707/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461107/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457707/01/2021  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450107/01/2021 01/17/2023
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450107/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460207/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09147 2605 WEST MARCH LANE
STOCKTONCA9520707/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450107/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457707/01/2021  
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09329 1039 EL CAMINO REAL
REDWOOD CITYCA9406307/01/2021  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09378 4100 REDWOOD RD
OAKLANDCA9461907/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461107/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450107/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09329 1039 EL CAMINO REAL
REDWOOD CITYCA9406307/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457707/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09378 4100 REDWOOD RD
OAKLANDCA9461907/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457707/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450107/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457707/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460207/01/2021  
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09378 4100 REDWOOD RD
OAKLANDCA9461907/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09378 4100 REDWOOD RD
OAKLANDCA9461907/01/2021  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460207/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460207/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09329 1039 EL CAMINO REAL
REDWOOD CITYCA9406307/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450107/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461107/01/2021  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09130 175 41ST ST
OAKLANDCA9461107/01/2021  
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457707/01/2021  
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09147 2605 WEST MARCH LANE
STOCKTONCA9520707/01/2021  
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450107/01/2021  
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460207/01/2021  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09942 1401 WASHINGTON AVE
SAN LEANDROCA9457707/01/2021  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09329 1039 EL CAMINO REAL
REDWOOD CITYCA9406307/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457707/01/2021  
CH09054DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09378 4100 REDWOOD RD
OAKLANDCA9461907/01/2021  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09147 2605 WEST MARCH LANE
STOCKTONCA9520707/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09329 1039 EL CAMINO REAL
REDWOOD CITYCA9406307/01/2021  
CH090540LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09635 1550 EAST 14TH STREET
SAN LEANDROCA9457707/01/2021  
CH09054ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450107/01/2021  
CH09054CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09128 2314 SANTA CLARA AVE
ALAMEDACA9450107/01/2021  
CH09054BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09147 2605 WEST MARCH LANE
STOCKTONCA9520707/01/2021  
CH090540PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/01/2021  
CH090540PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/01/2021  
CH090540PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681301/01/2021  
CH090540PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/01/2021  
CH090540WALGREEN CODBA: WALGREENS #10526 3250 LAKESHORE AVE STE B
OAKLANDCA94610-272001/01/2022  
CH090540WALGREEN CO.DBA: WALGREENS # 13595 1333 BROADWAY STE 145
OAKLANDCA9461201/01/2017  
CH090540WALGREEN CO.DBA: WALGREENS # 03170 3400 TELEGRAPH AVENUE
OAKLANDCA9460901/01/2017 11/08/2022
CH090540WALGREEN CO.DBA: WALGREENS # 03295 8102 INTERNATIONAL BLVD
OAKLANDCA9462101/01/2017 07/29/2021
CH090540WALGREEN CO.DBA: WALGREENS #11706 301 E. 18TH STREET
OAKLANDCA94606-181301/01/2017 02/24/2025
CH090540WALGREEN CO.DBA: WALGREENS # 01625 5055 TELEGRAPH AVE
OAKLANDCA9460901/01/2017 02/27/2025
CH090540WALGREEN CO.DBA: WALGREENS # 02609 2995 SAN PABLO AVE.
BERKELEYCA9470201/01/2017 11/17/2021
CH090540WALGREEN CO.DBA: WALGREENS # 04050 1916 WEBSTER ST.
ALAMEDACA9450101/01/2017  
CH090540WALGREEN CO.DBA: WALGREENS # 01536 3434 HIGH STREET
OAKLANDCA9461901/01/2017 01/22/2025
CH090540WALGREEN CO.DBA: WALGREENS # 01537 3232 FOOTHILL BLVD
OAKLANDCA9460101/01/2017  
CH090540WALGREEN CO.DBA: WALGREENS # 09248 2300 OTIS DRIVE
ALAMEDACA9450104/01/2017  
CH090540WALGREEN CO.DBA: WALGREENS # 02426 15500 WASHINGTON AVE
SAN LEANDROCA9457904/01/2017  
CH090540WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16477 3009 BROADWAY
OAKLANDCA9461110/01/2017  
CH09054DWALGREEN CO.DBA: WALGREENS # 01536 3434 HIGH STREET
OAKLANDCA9461907/01/2017  
CH09054CWALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460507/01/2021  
CH090540WALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460507/01/2021 01/30/2025
CH09054DWALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460507/01/2021  
CH09054BWALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460507/01/2021  
CH09054AWALGREEN CO.WALGREENS #15330 5809 FOOTHILL BLVD
OAKLANDCA9460507/01/2021  
CH090540WALGREEN CO.DBA: WALGREENS # 02506 1150 MACDONALD AVE
RICHMONDCA9480101/01/2022 01/30/2025
CH090540WALGREEN CO.DBA: WALGREENS # 07376 2901 RAILROAD AVE
PITTSBURGCA94565-522401/01/2022  
CH090540WALGREEN CO.DBA: WALGREENS # 15025 2190 SHATTUCK AVENUE
BERKELEYCA94704-130701/01/2022 08/30/2023
CH090540WALGREEN CO.DBA: WALGREENS # 02306 1138 W TENNYSON RD
HAYWARDCA9454401/01/2022  
CH090540WALGREEN CO.DBA: WALGREENS # 04614 2801 ADELINE ST
BERKELEYCA9470301/01/2022  
CH090540WALGREEN CO.DBA: WALGREENS # 02401 21463 FOOTHILL BLVD.
HAYWARDCA9454101/01/2022 04/15/2024
CH090540WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15296 2262 MARKET ST
SAN FRANCISCOCA9411401/01/2022  
CH090540WALGREEN CO.DBA: WALGREENS # 06502 23958 HESPERIAN BLVD
HAYWARDCA94541-724101/01/2022  
CH090540WALGREEN CO.DBA: WALGREENS # 07274 1456 136TH AVE
SAN LEANDROCA94578-255201/01/2022 03/27/2025
CH090540WALGREEN CO.DBA: WALGREENS # 02314 1050 GILMAN ST
BERKELEYCA9471001/01/2022  
CH090540WALGREEN CO.DBA: WALGREENS # 03770 11565 SAN PABLO AVE
EL CERRITOCA9453001/01/2022  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/30/2024 2:21:19 AM2/11/2025 2:04:37 PM2/11/2025 2:04 PM
DetailsLast Recertification DateUpdateRecertification2/3/2023 6:22:03 PM1/30/2024 2:21:19 AM1/30/2024 2:21 AM
DetailsLast Recertification DateUpdateRecertification1/31/2022 12:41:00 PM2/3/2023 6:22:03 PM2/3/2023 6:22 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestRobinson, Angela Oakland Health Chief Financial Officer The West Oakland Health Council 5108359610-2006Phillips, Robert CEO The West Oakland Health Council 51083596101/19/2023 8:10 AM
ContactsAuthorizing OfficialUpdateGroup Change RequestSimpson Akpawu, Erika CEO West Oakland Health Council 5108359610-2101Robinson, Angela Oakland Health Chief Financial Officer The West Oakland Health Council 5108359610-20068/19/2022 6:24 AM
DetailsLast Recertification DateUpdateRecertification2/2/2021 7:14:55 PM1/31/2022 12:41:00 PM1/31/2022 12:41 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestDuFauchard, Preston Chief Executive Officer The West Oakland Health Council 5108359610Simpson Akpawu, Erika CEO West Oakland Health Council 5108359610-210111/30/2021 6:10 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/2/2021 7:14 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1001462442/2/2021 7:14 PM
Medicaid BillingMedicaid: StateInsertRecertification CA2/2/2021 7:14 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/2/2021 7:14 PM
Medicaid BillingMedicaid: NumberInsertRecertification 1001462452/2/2021 7:14 PM
Medicaid BillingMedicaid: StateInsertRecertification CA2/2/2021 7:14 PM
Medicaid BillingNPI: NumberInsertRecertification 13069670212/2/2021 7:14 PM
Medicaid BillingNPI: StateInsertRecertification CA2/2/2021 7:14 PM
Medicaid BillingNPI: NumberInsertRecertification 14574721772/2/2021 7:14 PM
Medicaid BillingNPI: StateInsertRecertification CA2/2/2021 7:14 PM
Medicaid BillingNPI: NumberInsertRecertification 15285408382/2/2021 7:14 PM
Medicaid BillingNPI: StateInsertRecertification CA2/2/2021 7:14 PM
Medicaid BillingNPI: StateUpdateRecertification CA2/2/2021 7:14 PM
DetailsLast Recertification DateUpdateRecertification1/28/2020 10:55:06 AM2/2/2021 7:14:55 PM2/2/2021 7:14 PM
DetailsLast Recertification DateUpdateRecertification1/29/2019 4:42:47 PM1/28/2020 10:55:06 AM1/28/2020 10:55 AM
DetailsLast Recertification DateUpdateRecertification2/8/2018 2:43:12 PM1/29/2019 4:42:47 PM1/29/2019 4:42 PM
ContactsAuthorizing OfficialUpdateChange RequestPettus, Benjamin F. CEO West Oakland Health Council 5108359610-2100DuFauchard, Preston Chief Executive Officer The West Oakland Health Council 510835961012/10/2018 8:03 AM
Medicaid BillingNPI: NumberInsertChange Request 15989300672/26/2018 1:53 PM
DetailsLast Recertification DateUpdateRecertification 2/8/2018 2:43:12 PM2/8/2018 2:43 PM
ContactsPrimary ContactUpdateChange RequestTaylor, Gale Lu Chief Operating Officer West Oakland Health Council 5108359610-2101McCabe, James Director of Pharmacy West Oakland Health Council 5108359610-20761/8/2018 12:14 PM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 1/8/2018 12:14 PM
ContactsAuthorizing OfficialUpdate Pettus, Benjamin F. CEO 5108359610-2100Pettus, Benjamin F. CEO West Oakland Health Council 5108359610-21001/8/2018 12:00 PM
ContactsSigned ByUpdate Pettus, Benjamin F. CEO 5108359610-2100Pettus, Benjamin F. CEO West Oakland Health Council 5108359610-21001/8/2018 12:00 PM
ContactsPrimary ContactUpdate Taylor, Gale Chief Operating Officer 5108359610-2101Taylor, Gale Lu Chief Operating Officer West Oakland Health Council 5108359610-21019/29/2017 11:10 AM
ContactsAuthorizing OfficialInsert  Pettus, Benjamin F. CEO 5108359610-21007/28/2017 3:51 PM
ContactsSigned ByInsert  Pettus, Benjamin F. CEO 5108359610-21007/28/2017 3:51 PM
AddressesMain AddressInsert   7501 International Blvd OAKLAND, CA 94621-28435/1/2017 5:48 PM
ContactsPrimary ContactInsert  Taylor, Gale Chief Operating Officer 5108359610-21015/1/2017 5:48 PM
AddressesBilling AddressInsert  West Oakland Health Council 700 Adeline St. Oakland, CA 94607-28084/24/2017 2:53 PM
DatesParticipating Approval DateUpdate  4/24/2017 12:00:00 AM4/24/2017 2:53 PM
DetailsStateUpdate PendingActive4/24/2017 2:53 PM
DatesStart DateUpdate  7/1/2017 12:00:00 AM4/24/2017 2:53 PM
Details340B IDUpdate CH090540DCH09054D4/20/2017 7:32 AM
Details340B IDUpdate CHC00347-03CH090540D4/7/2017 6:51 AM
Details340B IDUpdate ONLINE_REG_75902CHC00347-034/5/2017 8:04 AM
Details340B IDUpdate ONLINE_REGONLINE_REG_759024/4/2017 2:43 PM
DetailsLast Recertification DateInsert   4/4/2017 2:43 PM
DetailsGrant NumberInsert  H80CS003474/4/2017 2:43 PM
Details340B IDInsert  ONLINE_REG4/4/2017 2:43 PM
DetailsIs Authorizing Official EHB DataInsert  False4/4/2017 2:43 PM
DatesLast Date That 340B Drugs PurchasedInsert   4/4/2017 2:43 PM
DetailsMedicare Provider NumberInsert   4/4/2017 2:43 PM
DetailsEntity NameInsert  WEST OAKLAND HEALTH COUNCIL, THE4/4/2017 2:43 PM
DetailsProgram CodeInsert  CH4/4/2017 2:43 PM
DetailsEntity SubnameInsert  COMMUNITY RECOVERY CENTER EAST4/4/2017 2:43 PM
DatesParticipating Approval DateInsert   4/4/2017 2:43 PM
DetailsStateInsert  Pending4/4/2017 2:43 PM
DatesRegistration DateInsert  4/4/2017 12:00:00 AM4/4/2017 2:43 PM
DatesSigned By DateInsert  4/4/2017 12:00:00 AM4/4/2017 2:43 PM
DatesStart DateInsert   4/4/2017 2:43 PM
TerminationsTermination CommentsInsert   4/4/2017 2:43 PM
TerminationsTermination DateInsert   4/4/2017 2:43 PM
TerminationsTermination Effective DateInsert   4/4/2017 2:43 PM
TerminationsTermination ReasonInsert   4/4/2017 2:43 PM