Covered Entity Details

CH09152L Mountain Health & Community Services, Inc. (Terminated) - information as of 5/20/2025 12:45:49 AM

Main Details

Name

Mountain Health & Community Services, Inc.

Subdivision Name

Community Heights Family Medicine

Type

HRSA-Funded Health Center

Site ID

BPS-H80-019538

340B ID

CH09152L

Grant Number

H80CS00284

Additional Details

Current Program Status

Terminated

Registration Date

7/12/2017

Participating Start Date

10/1/2017

Participating Approval Date

7/13/2017

Last Recertification Date

2/7/2020

Termination Date
Termination Reason

7/1/2020
Other

Contacts

Authorizing Official

Mountain Health & Community Services, Inc
Amy Weisiger, CFO
(619) 478-5254 Ext: 229

Primary Contact

Mountain Health and Community Services, Inc.
Maria Ramirez, Credentialing Coordinator
(619) 478-5254 Ext: 238

Addresses

Street Address

4690 El Cajon Boulevard
San Diego, CA 92115

Billing Address

Mountain Health & Community Services, Inc.
31115 Highway 94
Campo, CA 91906

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	1487011847
		1487011847

Shipping Addresses

Same as Street Address

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
CH091520	Terminated	BPS-H80-005030	MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.	Mountain Empire Family Medicine	31115 HIGHWAY 94	Campo	CA
CH09152B	Terminated	BPS-H80-004839	MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.	ALPINE FAMILY MEDICINE	1620 ALPINE BLVD STE B119	ALPINE	CA
CH09152G	Terminated	BPS-H80-000875	MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.	25th Street Family Medicine	316 25th St	San Diego	CA
CH09152H	Terminated	BPS-H80-000995	MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.	Escondido Family Medicine	255 N Ash St STE 101	Escondido	CA
CH09152J	Terminated	BPS-H80-017649	MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.	North Inland Family Medicine	125 West Mission Avenue, Suite 105	Escondido	CA
CH09152K	Terminated	BPS-H80-017714	MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.	Santee Family Medicine	120 Town Center Parkway	Santee	CA
CH09152L	Terminated	BPS-H80-019538	Mountain Health & Community Services, Inc.	Community Heights Family Medicine	4690 El Cajon Boulevard	San Diego	CA
CH09152M	Terminated	BPS-H80-019539	Mountain Health & Community Services, Inc.	Alpine Family Medicine Suite 111	1620 Alpine Boulevard Suite 111	Alpine	CA
CH09152N	Terminated	BPS-H80-006480	Mountain Health & Community Services, Inc.	MOUNTAIN EMPIRE JR/SR HIGH SCH	3305 BUCKMAN SPRINGS RD	PINE VALLEY	CA
CH09152P	Terminated	BPS-H80-019551	Mountain Health & Community Services, Inc.	Alpine Family Medicine Suite 107-109	1620 Alpine Boulevard, Suite 107 - 109	Alpine	CA
CH09152Q	Terminated	BPS-H80-019536	Mountain Health & Community Services, Inc.	Alpine Family Medicine Suite 110	1620 Alpine Boulevard, Suite 110	Alpine	CA
CH09152R	Terminated	BPS-H80-019537	Mountain Health & Community Services, Inc.	Alpine Family Medicine Suite 116-118	1620 Alpine Boulevard, Suite 116-118	Alpine	CA
CH09152S	Terminated	BPS-H80-019535	Mountain Health & Community Services, Inc.	Alpine Family Medicine Suite 114	1620 Alpine Boulevard Suite 114	Alpine	CA
CH09152T	Terminated	BPS-H80-020979	Mountain Health & Community Services, Inc.	Mountain Health Family Medicine	1388 Buckman Springs Rd	Campo	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH091520	COMMUNITY MEDICAL PHARMACY	IN-HOUSE PHARMACIES, INC.	610 GATEWAY CENTER WAY NO. A	SAN DIEGO	CA	92102-4548	08/29/2012	07/01/2020
CH091520	DMK PHARMACY	1730 ALPINE BLVD STE 109		ALPINE	CA	91901-3877	07/01/2016	07/01/2020
CH091520	DRUG CO PHARMACY	307 N ASH ST		ESCONDIDO	CA	92027	01/01/2014	07/01/2020
CH091520	EXPRESS PHARMACY	1111 E WASHINGTON AVE STE C		ESCONDIDO	CA	92025-2226	07/01/2019	07/01/2020
CH091520	GALLOWAY'S MEDICAL CENTER PHARMACY	2995 NATIONAL AVENUE		SAN DIEGO	CA	92113	10/10/2012	07/01/2020
CH091520	MEDICINE CARE PHARMACY II	1685 E MAIN ST	SUITE 101	EL CAJON	CA	92021	01/01/2014	07/01/2020
CH091520	MEDPILOT PHARMACY INCORPORATED	9323 CHESAPEAKE DR STE C1		SAN DIEGO	CA	92123-1034	01/01/2019	07/01/2020
CH091520	THE VONS COMPANIES INC	VONS PHARMACY #2156	2345 EAST VALLEY PARKWAY	ESCONDIDO	CA	92027	04/13/2012	07/01/2020
CH091520	THRIFTY PAYLESS, INC.	RITE AID #6225	1665 ALPINE BOULEVARD	ALPINE	CA	91901	10/01/2013	07/01/2020
CH091520	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017	07/01/2020
CH091520	WAL-MART PHARMACY 10-2253	13487 CAMINO CANADA		EL CAJON (EAST)	CA	92021	09/21/2012	07/01/2020
CH091520	WAL-MART PHARMACY 10-2479	3412 COLLEGE AVENUE		SAN DIEGO (E)	CA	92115	09/21/2012	07/01/2020
CH091520	WAL-MART PHARMACY 10-3494	732 CENTER DR		SAN MARCOS	CA	92069	09/21/2012	04/28/2018
CH091520	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017	07/01/2020
CH091520	WALGREEN CO.	DBA: WALGREENS # 05700	1574 E VALLEY PKWY	ESCONDIDO	CA	92027	09/05/2012	07/01/2020
CH091520	WALGREEN CO.	DBA: WALGREENS # 05844	215 NORTH 2ND STREET	EL CAJON	CA	92021	09/05/2012	07/01/2020
CH091520	WALGREEN CO.	DBA: WALGREENS # 06656	3222 UNIVERSITY AVENUE	SAN DIEGO	CA	92104-2010	09/05/2012	07/01/2020
CH091520	WALGREEN CO.	DBA: WALGREENS # 07869	885 EUCLID AVE	NATIONAL CITY	CA	91950	09/05/2012	07/01/2020
CH091520	WALGREEN CO.	DBA: WALGREENS # 05455	111 W WASHINGTON AVE	ESCONDIDO	CA	92025	04/01/2015	07/01/2020
CH091520	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13434	640 UNIVERSITY AVE	SAN DIEGO	CA	92103	01/01/2018	07/01/2020
CH091520	WALGREEN CO.	DBA: WALGREENS #09817	9305 MISSION GORGE RD	SANTEE	CA	92071-3815	07/01/2018	07/01/2020
CH091520	WALGREEN CO.	DBA: WALGREENS #11990	9728 WINTER GARDENS BLVD	LAKESIDE	CA	92040	10/01/2018	07/01/2018
CH091520	WALGREEN CO.	DBA: WALGREENS #11990	9728 WINTER GARDENS BLVD	LAKESIDE	CA	92040	01/01/2019	07/01/2020
CH091520	WESTERN PHARMACY GROUP LLC	DBA GALLOWAY'S MEDICAL CENTER PHARMACY	2995 NATIONAL AVE	SAN DIEGO	CA	92113-2419	10/01/2018	07/01/2020
CH091520	WESTERN PHARMACY GROUP LLC	DBA COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY SUITES A--E	SAN DIEGO	CA	92102	10/01/2018	07/01/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		3/31/2020 12:00:00 AM	5/27/2020 11:33 AM
Details	State	Update	Termination Request	Active	To Be Terminated	5/27/2020 11:33 AM
Terminations	Termination Comments	Update	Termination Request		Mountain Health Merged with another FQHC on April 1, 2020	5/27/2020 11:33 AM
Terminations	Termination Date	Update	Termination Request		7/1/2020 12:00:00 AM	5/27/2020 11:33 AM
Terminations	Termination Effective Date	Update	Termination Request		4/1/2020 12:00:00 AM	5/27/2020 11:33 AM
Terminations	Termination Reason	Update	Termination Request		Other	5/27/2020 11:33 AM
Details	Last Recertification Date	Update	Recertification	2/20/2019 5:44:29 PM	2/7/2020 6:59:03 PM	2/7/2020 6:59 PM
Details	Last Recertification Date	Update	Recertification	2/23/2018 2:21:24 PM	2/20/2019 5:44:29 PM	2/20/2019 5:44 PM
Details	Last Recertification Date	Update	Recertification		2/23/2018 2:21:24 PM	2/23/2018 2:21 PM
Contacts	Primary Contact	Update	Change Request	Weisiger, Amy CFO Mountain Health & Community Services, Inc 6194785254-229	Ramirez, Maria Credentialing Coordinator Mountain Health and Community Services, Inc. 6194785254-238	2/5/2018 12:58 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		2/5/2018 12:58 PM
Contacts	Authorizing Official	Update		Weisiger, Amy CFO 6194785254-229	Weisiger, Amy CFO Mountain Health & Community Services, Inc 6194785254-229	9/26/2017 1:17 PM
Contacts	Primary Contact	Update		Weisiger, Amy CFO 6194785254-229	Weisiger, Amy CFO Mountain Health & Community Services, Inc 6194785254-229	9/26/2017 1:17 PM
Contacts	Signed By	Update		Weisiger, Amy CFO 6194785254-229	Weisiger, Amy CFO Mountain Health & Community Services, Inc 6194785254-229	9/26/2017 1:17 PM
Contacts	Authorizing Official	Insert			Weisiger, Amy CFO 6194785254-229	7/13/2017 4:43 PM
Contacts	Primary Contact	Insert			Weisiger, Amy CFO 6194785254-229	7/13/2017 4:43 PM
Contacts	Signed By	Insert			Weisiger, Amy CFO 6194785254-229	7/13/2017 4:43 PM
Addresses	Main Address	Insert			4690 El Cajon Boulevard San Diego, CA 92115	7/13/2017 2:03 PM
Addresses	Billing Address	Insert			Mountain Health & Community Services, Inc. 31115 Highway 94 Campo, CA 91906	7/13/2017 2:03 PM
Details	State	Update		Approved	Active	7/13/2017 2:03 PM
Dates	Participating Approval Date	Update			7/13/2017 12:00:00 AM	7/13/2017 2:02 PM
Details	State	Update		Pending	Approved	7/13/2017 2:02 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/13/2017 2:02 PM
Details	340B ID	Update		ONLINE_REG_78387	CH09152L	7/13/2017 12:38 PM
Medicaid Billing	NPI: Number	Insert			1487011847	7/12/2017 6:48 PM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_78387	7/12/2017 6:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/12/2017 6:48 PM
Medicaid Billing	Medicaid: Number	Insert			1487011847	7/12/2017 6:48 PM
Medicaid Billing	Medicaid: State	Insert			CA	7/12/2017 6:48 PM
Details	Last Recertification Date	Insert				7/12/2017 6:48 PM
Details	Grant Number	Insert			H80CS00284	7/12/2017 6:48 PM
Details	340B ID	Insert			ONLINE_REG	7/12/2017 6:48 PM
Details	Is Authorizing Official EHB Data	Insert			False	7/12/2017 6:48 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/12/2017 6:48 PM
Details	Medicare Provider Number	Insert				7/12/2017 6:48 PM
Details	Entity Name	Insert			Mountain Health & Community Services, Inc.	7/12/2017 6:48 PM
Details	Program Code	Insert			CH	7/12/2017 6:48 PM
Details	Entity Subname	Insert			Community Heights Family Medicine	7/12/2017 6:48 PM
Dates	Participating Approval Date	Insert				7/12/2017 6:48 PM
Details	State	Insert			Pending	7/12/2017 6:48 PM
Dates	Registration Date	Insert			7/12/2017 12:00:00 AM	7/12/2017 6:48 PM
Dates	Signed By Date	Insert			7/12/2017 12:00:00 AM	7/12/2017 6:48 PM
Dates	Start Date	Insert				7/12/2017 6:48 PM
Terminations	Termination Comments	Insert				7/12/2017 6:48 PM
Terminations	Termination Date	Insert				7/12/2017 6:48 PM
Terminations	Termination Effective Date	Insert				7/12/2017 6:48 PM
Terminations	Termination Reason	Insert				7/12/2017 6:48 PM

340B Drug Pricing Program Database