340B Drug Pricing Program Database


CH092176G Western Sierra Medical Clinic Inc (Active) - information as of 5/30/2025 8:14:26 PM

Main Details
Western Sierra Medical Clinic Inc
Western Sierra Medical Clinic - Kings Beach
HRSA-Funded Health Center
BPS-H80-019603
CH092176G
H80CS08234


Additional Details
Active
7/17/2017
10/1/2017
7/21/2017
2/13/2025

Contacts

Western Sierra Medical Clinic
Jennifer Malone, CEO
(530) 273-3819

Western Sierra Medical Clinic
Francine Novak, Chief Planning and Development Officer
(530) 273-4984 Ext: 102

Addresses

8665 Salmon Ave
Kings Beach, CA 96143

Western Sierra Medical Clinic, Inc
844 Old Tunnel Rd, Grass Valley
Grass Valley, CA 95945


  • 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
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailTHRIFTY PAYLESS, INC.RITE AID #6106 8245 NORTH LAKE BOULEVARD
PO BOX 1175 		KINGS BEACHCA9614312/06/201701/01/2018 11/01/202411/07/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH0921760ActiveBPS-H80-000052WESTERN SIERRA MEDICAL CLINIC 209 NEVADA STREET DOWNIEVILLECA
CH092176ATerminatedBPS-H80-000052WESTERN SIERRA MEDICAL CLINICMOBILE CLINIC SITE209 NEVADA STREET DOWNIEVILLECA
CH092176BActiveBPS-H80-014470WESTERN SIERRA MEDICAL CLINIC INCWestern Sierra Medical Clinic844 Old Tunnel Rd Grass ValleyCA
CH092176CTerminatedBPS-H80-013615WESTERN SIERRA MEDICAL CLINIC INCWestern Sierra Medical Clinic co-location of services at Community Recovery Resources (CoRR)180 Sierra College Drive, Suite 100 Grass ValleyCA
CH092176DTerminatedBPS-H80-018207WESTERN SIERRA MEDICAL CLINIC INCWestern Sierra Medical Clinic12183 Locksley Lane Suite #107 AuburnCA
CH092176ETerminatedBPS-H80-018726WESTERN SIERRA MEDICAL CLINIC INCWestern Sierra Medical Clinic3111 Professional Drive AuburnCA
CH092176FActiveBPS-H80-018578WESTERN SIERRA MEDICAL CLINIC INCWestern Sierra Medical Clinic10544 Spenceville Rd Penn ValleyCA
CH092176GActiveBPS-H80-019603Western Sierra Medical Clinic IncWestern Sierra Medical Clinic - Kings Beach8665 Salmon Ave Kings BeachCA
CH092176HActiveBPS-H80-037108WESTERN SIERRA MEDICAL CLINIC, INC.Western Sierra Medical Clinic - Rock Creek3257 Professional Dr, Ste C AuburnCA
CH092176JActiveBPS-H80-036865WESTERN SIERRA MEDICAL CLINIC, INC.Western Sierra Medical Clinic - Education Street11720 Education Street STE 3 AuburnCA
CH092176KActiveBPS-H80-027902WESTERN SIERRA MEDICAL CLINIC, INC.Western Sierra Medical Clinic - Ophthalmology Services400 Sierra College Dr # A1 Grass ValleyCA
CH092176LTerminatedBPS-H80-032037WESTERN SIERRA MEDICAL CLINIC, INC.Temporary Site - Mobile Site150 Glasson Way Grass ValleyCA
CH092176MTerminatedBPS-H80-032041WESTERN SIERRA MEDICAL CLINIC, INC.Temporary Site - Hospitality House1262 Sutton Way Grass ValleyCA
CHC28981-00ActiveBPS-H80-039536WESTERN SIERRA MEDICAL CLINIC INCSierra Family Medical Clinic, Oregon House8676 Marysville Rd. Oregon HouseCA
CHC28981-01ActiveBPS-H80-039539WESTERN SIERRA MEDICAL CLINIC INCSierra Family Medical Clinic Inc Tyler Foote15301 Tyler Foote Rd Nevada CityCA
CHC28981-02ActiveBPS-H80-039538WESTERN SIERRA MEDICAL CLINIC, INC.Searls Avenue590 Searls Ave Nevada CityCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH0921760ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280907/01/2024  
CH0921760AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291101/01/2020  
CH092176BAMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291101/01/2020  
CH0921760AMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700307/01/2025  
CH0921760AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503401/01/2020  
CH092176BAZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503401/01/2020  
CH0921760CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2024  
CH0921760CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2024  
CH0921760CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2024  
CH0921760CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2024  
CH0921760CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2024  
CH0921760CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2024  
CH0921760CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2024  
CH0921760CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/01/2024  
CH0921760CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2024  
CH0921760CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2024  
CH0921760CLINIC PHARMACIES III, INCDBA WESTERN SIERRA PHARMACY 844 OLD TUNNEL RD
GRASS VALLEYCA9594507/01/2017 01/15/2019
CH092176ACLINIC PHARMACIES III, INCDBA WESTERN SIERRA PHARMACY 844 OLD TUNNEL RD
GRASS VALLEYCA9594501/01/2016 04/01/2019
CH092176BCLINIC PHARMACIES III, INCDBA WESTERN SIERRA PHARMACY 844 OLD TUNNEL RD
GRASS VALLEYCA9594510/01/2015  
CH0921760CLINIC PHARMACIES III, LLC DBAWESTERN SIERRA PHARMACY 844 OLD TUNNEL RD, SUITE A
GRASS VALLEYCA95945-852401/16/2019  
CH0921760CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/01/2023  
CH0921760CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/01/2023  
CHC28981-02CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/01/2024  
CHC28981-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/01/2024  
CHC28981-01CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/01/2024  
CH0921760CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2024  
CH0921760DEMARTINI SPRING HILL PHCY INCDEMARTINI'S COMPOUNDING CENTER 102 CATHERINE LANE
GRASS VALLEYCA95945-959401/01/2014 05/31/2016
CH092176ADEMARTINI SPRING HILL PHCY INCDEMARTINI'S COMPOUNDING CENTER 102 CATHERINE LANE
GRASS VALLEYCA95945-959401/01/2014 05/31/2016
CH092176BDEMARTINI SPRING HILL PHCY INCDEMARTINI'S COMPOUNDING CENTER 102 CATHERINE LANE
GRASS VALLEYCA95945-959401/01/2014 05/31/2016
CHC28981-01DEMARTINI SPRING HILL PHCY INCDEMARTINI'S COMPOUNDING CENTER 102 CATHERINE LANE
GRASS VALLEYCA95945-959404/01/2016  
CHC28981-00DEMARTINI SPRING HILL PHCY INCDEMARTINI'S COMPOUNDING CENTER 102 CATHERINE LANE
GRASS VALLEYCA95945-959407/01/2016  
CH0921760DOKIMOS NEVADA CITY PHARMACY737 ZION ST
NEVADA CITYCA95959-292001/01/2016 04/01/2019
CH092176BDOKIMOS NEVADA CITY PHARMACY737 ZION ST
NEVADA CITYCA95959-292002/25/2011 01/01/2021
CHC28981-01DOKIMOS NEVADA CITY PHARMACY737 ZION ST
NEVADA CITYCA95959-292004/01/2016  
CHC28981-00DOKIMOS NEVADA CITY PHARMACY737 ZION ST
NEVADA CITYCA95959-292007/01/2016  
CH0921760DOKIMOS' EAST MAIN PHARMACY640 E MAIN ST STE 2
GRASS VALLEYCA95945-585401/01/2016 04/01/2019
CH092176BDOKIMOS' EAST MAIN PHARMACY640 E MAIN ST STE 2
GRASS VALLEYCA95945-585404/05/2010 01/01/2021
CHC28981-01DOKIMOS' EAST MAIN PHARMACY640 E MAIN ST STE 2
GRASS VALLEYCA95945-585404/01/2016  
CHC28981-00DOKIMOS' EAST MAIN PHARMACY640 E MAIN ST STE 2
GRASS VALLEYCA95945-585407/01/2016  
CHC28981-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16109 1153 BUTTE HOUSE RD
YUBA CITYCA9599110/01/2019  
CH0921760GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16080 1925 DOUGLAS BLVD
ROSEVILLECA9566110/01/2023  
CH0921760GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16473 2700 BELL RD
AUBURNCA9560310/01/2023  
CH0921760GARFIELD BEACH CVS, L.L.C.CVS/PHARMACY #17882 111 W. MCKNIGHT WAY
GRASS VALLEYCA9594910/01/2023  
CH0921760GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5091 1771 PLEASANT GROVE BLVD.
SUITE 100 		ROSEVILLECA9574710/01/2023  
CH0921760GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16833 10451 FAIRWAY DR
ROSEVILLECA9567810/01/2023  
CH0921760GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16109 1153 BUTTE HOUSE RD
YUBA CITYCA9599104/01/2025  
CH0921760GREATER PLACER PHARMACY, INC.GREATER PLACER PHARMACY 3133 PROFESSIONAL DR STE 17
AUBURNCA95603-246307/01/2017  
CH0921760K MART PHARMACY #9746111 MCKNIGHT WAY
GRASS VALLEYCA9594901/01/2018 07/01/2024
CH092176BK MART PHARMACY #9746111 MCKNIGHT WAY
GRASS VALLEYCA9594901/01/2018 12/31/2023
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09155 1005 SUTTON WAY
GRASS VALLEYCA9594501/01/2016 08/01/2017
CHC28981-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03947 10045 COMBIE RD
AUBURNCA9560210/01/2019  
CHC28981-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09155 1005 SUTTON WAY
GRASS VALLEYCA9594510/01/2019  
CHC28981-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09174 11411 DEERFIELD DR
TRUCKEECA9616110/01/2019  
CHC28981-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09691 906 E ST.
MARYSVILLECA9590110/01/2019  
CHC28981-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09932 1274 STABLER LN
YUBA CITYCA9599310/01/2019  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09174 11411 DEERFIELD DR
TRUCKEECA9616110/01/2023  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09155 1005 SUTTON WAY
GRASS VALLEYCA9594510/01/2023  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03947 10045 COMBIE RD
AUBURNCA9560210/01/2023  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09535 63 LINCOLN BLVD
LINCOLNCA9564810/01/2023  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09150 388 ELM ST.
AUBURNCA9560310/01/2023  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02661 4785 GRANITE DR
ROCKLINCA9567710/01/2023  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09914 2140 GRASS VALLEY HWY
AUBURNCA9560310/01/2023  
CHC28981-02LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09155 1005 SUTTON WAY
GRASS VALLEYCA9594501/01/2024  
CHC28981-02LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03947 10045 COMBIE RD
AUBURNCA9560201/01/2024  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09691 906 E ST.
MARYSVILLECA9590104/01/2025  
CH0921760LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09932 1274 STABLER LN
YUBA CITYCA9599304/01/2025  
CH0921760LOYALTON PHARMACY60801 HIGHWAY 49 PO BOX 36
LOYALTONCA9611801/22/2009 09/30/2015
CH092176ALOYALTON PHARMACY60801 HIGHWAY 49 PO BOX 36
LOYALTONCA9611801/22/2009 09/30/2015
CH092176BM.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312601/01/2020  
CH0921760M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312601/01/2020  
CH0921760OVERLAKE PHARMACY, LLC4124 148TH AVE NE STE JA
REDMONDWA9805204/01/2020  
CH0921760PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310101/01/2020  
CH092176BPILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310101/01/2020  
CH0921760PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2024  
CH0921760PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2024  
CH0921760PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2024  
CHC28981-01RALEY'S PHARMACY #213692 FREEMAN LANE
GRASS VALLEYCA9594907/01/2016  
CHC28981-00RALEY'S PHARMACY #213692 FREEMAN LANE
GRASS VALLEYCA9594907/01/2016  
CH0921760RALEY'S PHARMACY #213692 FREEMAN LANE
GRASS VALLEYCA9594904/01/2024  
CH0921760SAVE MART PHARMACY #608  12054 NEVADA CITY HWY
GRASS VALLEYCA9594501/01/2016 07/01/2024
CH092176ASAVE MART PHARMACY #608  12054 NEVADA CITY HWY
GRASS VALLEYCA9594501/01/2014 04/01/2019
CH092176BSAVE MART PHARMACY #608  12054 NEVADA CITY HWY
GRASS VALLEYCA9594501/01/2014 07/01/2024
CHC28981-01SAVE MART PHARMACY #608  12054 NEVADA CITY HWY
GRASS VALLEYCA9594507/01/2016  
CHC28981-00SAVE MART PHARMACY #608  12054 NEVADA CITY HWY
GRASS VALLEYCA9594507/01/2016  
CH0921760THRIFTY PAYLESS, INC.RITE AID #6089 720 SUTTON WAY
GRASS VALLEYCA9594509/19/2012  
CH0921760THRIFTY PAYLESS, INC.RITE AID #6043 2805 BELL ROAD
AUBURNCA9560307/01/2017  
CHC28981-01THRIFTY PAYLESS, INC.RITE AID #6089 720 SUTTON WAY
GRASS VALLEYCA9594507/01/2016  
CHC28981-00THRIFTY PAYLESS, INC.RITE AID #6089 720 SUTTON WAY
GRASS VALLEYCA9594507/01/2016  
CH092176GTHRIFTY PAYLESS, INC.RITE AID #6106 8245 NORTH LAKE BOULEVARD
PO BOX 1175 		KINGS BEACHCA9614301/01/2018 11/01/2024
CH0921760THRIFTY PAYLESS, INC.RITE AID #6106 8245 NORTH LAKE BOULEVARD
PO BOX 1175 		KINGS BEACHCA9614301/01/2018 11/01/2024
CH092176BTHRIFTY PAYLESS, INC.RITE AID #6106 8245 NORTH LAKE BOULEVARD
PO BOX 1175 		KINGS BEACHCA9614301/01/2018 11/01/2024
CH0921760TRUEPILL3121 DIABLO AVE
HAYWARDCA9454504/01/2020  
CH0921760WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2024  
CH0921760WAL-MART PHARMACY 10-30905609 PACIFIC ST
ROCKLINCA9567704/01/2024  
CH0921760WAL-MART PHARMACY 10-35875454 CROSSING DR.
ROCKLINCA9567704/01/2024  
CH0921760WAL-MART PHARMACY 10-43098961 GREENBACK LANE
ORANGEVALECA9566204/01/2024  
CH0921760WAL-MART PHARMACY 10-51361131 N BEALE RD
MARYSVILLECA9590104/01/2024  
CH0921760WAL-MART PHARMACY 10-5979255 LINCOLN BLVD.
LINCOLNCA9564804/01/2024  
CH0921760WAL-MART PHARMACY 10-59804080 DOUGLAS BLVD.
GRANITE BAYCA9574604/01/2024 07/01/2024
CH0921760WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2024  
CH0921760WAL-MART PHARMACY WHSE #452250 NORTH 8TH STREET SUITE 102-A
ROGERSAR7275604/01/2024  
CH0921760WALGREEN CO.DBA: WALGREENS #10881 880 SUTTON WAY
GRASS VALLEYCA9594507/01/2015  
CHC28981-01WALGREEN CO.DBA: WALGREENS #10881 880 SUTTON WAY
GRASS VALLEYCA9594511/03/2022  
CHC28981-01WALGREEN CO.DBA: WALGREENS # 02277 602 10TH STREET
MARYSVILLECA9590111/03/2022  
CHC28981-00WALGREEN CO.DBA: WALGREENS #10881 880 SUTTON WAY
GRASS VALLEYCA9594511/03/2022  
CHC28981-00WALGREEN CO.DBA: WALGREENS # 02277 602 10TH STREET
MARYSVILLECA9590111/03/2022  
CHC28981-02WALGREEN CO.DBA: WALGREENS # 02277 602 10TH STREET
MARYSVILLECA9590101/01/2024  
CHC28981-02WALGREEN CO.DBA: WALGREENS #10881 880 SUTTON WAY
GRASS VALLEYCA9594501/01/2024  
CH0921760Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616807/01/2024  
CH0921760WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E 		SAN DIEGOCA9210210/01/2019 10/31/2019
CH092176BWESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E 		SAN DIEGOCA9210210/01/2019 10/31/2019
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/1/2024 2:25:05 PM2/13/2025 3:51:24 PM2/13/2025 3:51 PM
Medicaid BillingNPI: NumberInsertChange Request 18515134697/1/2024 12:10 PM
Medicaid BillingNPI: StateInsertChange Request CA7/1/2024 12:10 PM
DetailsLast Recertification DateUpdateRecertification2/6/2023 2:53:04 PM2/1/2024 2:25:05 PM2/1/2024 2:25 PM
AddressesBilling AddressInsertRecertification Western Sierra Medical Clinic, Inc 844 Old Tunnel Rd, Grass Valley Grass Valley, CA 959452/6/2023 2:53 PM
AddressesMain AddressUpdateRecertification 8665 Salmon Avenue Kings Beach, CA 96143 8665 Salmon Ave Kings Beach, CA 961432/6/2023 2:53 PM
DetailsLast Recertification DateUpdateRecertification2/7/2022 1:38:50 PM2/6/2023 2:53:04 PM2/6/2023 2:53 PM
DetailsLast Recertification DateUpdateRecertification2/8/2021 12:36:10 PM2/7/2022 1:38:50 PM2/7/2022 1:38 PM
DetailsLast Recertification DateUpdateRecertification1/31/2020 8:41:25 AM2/8/2021 12:36:10 PM2/8/2021 12:36 PM
ContactsAuthorizing OfficialUpdateChange RequestMcFarland, Scott Chief Executive Officer Western Sierra Medical Clinic 5302734984-115Malone, Jennifer CEO Western Sierra Medical Clinic 53027338198/25/2020 9:47 AM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 8/25/2020 9:47 AM
DetailsLast Recertification DateUpdateRecertification2/7/2019 12:20:40 PM1/31/2020 8:41:25 AM1/31/2020 8:41 AM
DetailsLast Recertification DateUpdateRecertification3/6/2018 2:52:27 PM2/7/2019 12:20:40 PM2/7/2019 12:20 PM
DetailsLast Recertification DateUpdateRecertification 3/6/2018 2:52:27 PM3/6/2018 2:52 PM
ContactsAuthorizing OfficialUpdate McFarland, Scott Chief Executive Officer 5302734984-115McFarland, Scott Chief Executive Officer Western Sierra Medical Clinic 5302734984-11510/17/2017 3:30 PM
ContactsSigned ByUpdate McFarland, Scott Chief Executive Officer 5302734984-115McFarland, Scott Chief Executive Officer Western Sierra Medical Clinic 5302734984-11510/17/2017 3:30 PM
ContactsPrimary ContactUpdate Novak, Francine Chief Planning and Development Officer 5302734984-102Novak, Francine Chief Planning and Development Officer Western Sierra Medical Clinic 5302734984-10210/11/2017 12:33 PM
AddressesMain AddressInsert   8665 Salmon Avenue Kings Beach, CA 961437/21/2017 12:24 PM
ContactsPrimary ContactInsert  Novak, Francine Chief Planning and Development Officer 5302734984-1027/21/2017 12:24 PM
ContactsAuthorizing OfficialInsert  McFarland, Scott Chief Executive Officer 5302734984-1157/21/2017 12:24 PM
ContactsSigned ByInsert  McFarland, Scott Chief Executive Officer 5302734984-1157/21/2017 12:24 PM
DetailsStateUpdate ApprovedActive7/21/2017 12:24 PM
DatesParticipating Approval DateUpdate  7/21/2017 12:00:00 AM7/21/2017 12:24 PM
DetailsStateUpdate PendingApproved7/21/2017 12:24 PM
DatesStart DateUpdate  10/1/2017 12:00:00 AM7/21/2017 12:24 PM
Details340B IDUpdate ONLINE_REG_78974CH092176G7/21/2017 9:14 AM
Details340B IDUpdate ONLINE_REGONLINE_REG_789747/17/2017 11:57 AM
DetailsLast Recertification DateInsert   7/17/2017 11:57 AM
DetailsGrant NumberInsert  H80CS082347/17/2017 11:57 AM
Details340B IDInsert  ONLINE_REG7/17/2017 11:57 AM
DetailsIs Authorizing Official EHB DataInsert  False7/17/2017 11:57 AM
DatesLast Date That 340B Drugs PurchasedInsert   7/17/2017 11:57 AM
DetailsMedicare Provider NumberInsert   7/17/2017 11:57 AM
DetailsEntity NameInsert  Western Sierra Medical Clinic Inc7/17/2017 11:57 AM
DetailsProgram CodeInsert  CH7/17/2017 11:57 AM
DetailsEntity SubnameInsert  Western Sierra Medical Clinic - Kings Beach7/17/2017 11:57 AM
DatesParticipating Approval DateInsert   7/17/2017 11:57 AM
DetailsStateInsert  Pending7/17/2017 11:57 AM
DatesRegistration DateInsert  7/17/2017 12:00:00 AM7/17/2017 11:57 AM
DatesSigned By DateInsert  7/17/2017 12:00:00 AM7/17/2017 11:57 AM
DatesStart DateInsert   7/17/2017 11:57 AM
TerminationsTermination CommentsInsert   7/17/2017 11:57 AM
TerminationsTermination DateInsert   7/17/2017 11:57 AM
TerminationsTermination Effective DateInsert   7/17/2017 11:57 AM
TerminationsTermination ReasonInsert   7/17/2017 11:57 AM