Covered Entity Details

FQHCLA373A HEALTH ACCESS FOR ALL INC. (Terminated) - information as of 6/24/2025 3:07:22 AM

Main Details

Name

HEALTH ACCESS FOR ALL INC.

Subdivision Name

Angeles Community Health Center - Huntington Park

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-022003

340B ID

FQHCLA373A

Grant Number

LALCS31681

Additional Details

Current Program Status

Terminated

Registration Date

7/10/2018

Participating Start Date

10/1/2018

Participating Approval Date

8/1/2018

Last Recertification Date

2/4/2019

Termination Date
Termination Reason

4/1/2020
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

Angeles Community Health Center
Peyman Banooni, CEO
(213) 228-3808

Primary Contact

Angeles Community Health Center
Mariana Canela, Administrator
(213) 413-2222 Ext: 2120

Addresses

Street Address

6208 Seville Ave
Huntington Park, CA 90255-2913

Billing Address
Same as Street Address

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	1295288348
		1295288348

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
Contract Detail	CCRX INC	DBA CCRX	1919 W 7TH ST UNIT M	LOS ANGELES	CA	90057-4103	01/15/2019	04/01/2019		04/01/2020	04/01/2020

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
FQHCLA373	Terminated	BPS-LAL-022002	HEALTH ACCESS FOR ALL INC.	Angeles Community Health Center - 7th Street	1919 W 7th Street, 2nd Floor	Los Angeles	CA
FQHCLA373A	Terminated	BPS-LAL-022003	HEALTH ACCESS FOR ALL INC.	Angeles Community Health Center - Huntington Park	6208 Seville Ave	Huntington Park	CA
FQHCLA373B	Terminated	BPS-LAL-027195	HEALTH ACCESS FOR ALL INC.	Angeles Community Health Center - Gardena	1030 W Gardena Blvd	Gardena	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Carve-In Effective Date	Termination Date
FQHCLA373	CCRX INC	DBA CCRX	1919 W 7TH ST UNIT M	LOS ANGELES	CA	90057-4103	04/01/2019		07/01/2020
FQHCLA373A	CCRX INC	DBA CCRX	1919 W 7TH ST UNIT M	LOS ANGELES	CA	90057-4103	04/01/2019		04/01/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	New Registration	Canela, Mariana Administrator Angeles Community Health Center 2134132222	Canela, Mariana Administrator Angeles Community Health Center 2134132222-2120	10/15/2022 5:37 PM
Contacts	Authorizing Official	Update	Profile Change Request	Banooni, Peyman CEO Angeles Community Health Center 2134132222	Banooni, Peyman CEO Angeles Community Health Center 2132283808	10/15/2022 5:32 PM
Contacts	Signed By	Update	Profile Change Request	Banooni, Peyman CEO Angeles Community Health Center 2134132222	Banooni, Peyman CEO Angeles Community Health Center 2132283808	10/15/2022 5:32 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/1/2019 12:00:00 AM	2/4/2020 9:35 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/4/2020 9:35 AM
Terminations	Termination Comments	Update	Recertification		Changed from a FQHC look-alike to a H80 grantee	2/4/2020 9:35 AM
Terminations	Termination Date	Update	Recertification		4/1/2020 12:00:00 AM	2/4/2020 9:35 AM
Terminations	Termination Effective Date	Update	Recertification		9/1/2019 12:00:00 AM	2/4/2020 9:35 AM
Terminations	Termination Reason	Update	Recertification		Change of covered entity type (non-hospital)	2/4/2020 9:35 AM
Details	Grant Number	Update	OPA Edit	LAL031681	LALCS31681	5/3/2019 2:44 PM
Details	Last Recertification Date	Update	Recertification		2/4/2019 1:23:01 PM	2/4/2019 1:23 PM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Banooni, Peyman CEO Angeles Community Health Center 2134132222	8/1/2018 1:15 PM
Details	Grant Number	Update	New Registration	LALCS31681	LAL031681	8/1/2018 1:15 PM
Details	340B ID	Update	New Registration		FQHCLA373A	8/1/2018 1:15 PM
Dates	Participating Approval Date	Update	New Registration		8/1/2018 1:15:10 PM	8/1/2018 1:15 PM
Details	State	Update	New Registration	Pending	Approved	8/1/2018 1:15 PM
Dates	Signed By Date	Update	New Registration		7/10/2018 10:32:20 PM	8/1/2018 1:15 PM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	8/1/2018 1:15 PM
Details	Grant Number	Update	New Registration	LAL031681	LALCS31681	7/10/2018 10:32 PM
Addresses	Main Address	Insert	New Registration		6208 Seville Ave Huntington Park, CA 90255-2913	7/10/2018 10:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/10/2018 10:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1295288348	7/10/2018 10:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	7/10/2018 10:32 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1295288348	7/10/2018 10:32 PM
Contacts	Authorizing Official	Insert	New Registration		Banooni, Peyman CEO Angeles Community Health Center 2134132222	7/10/2018 10:32 PM
Contacts	Primary Contact	Insert	New Registration		Canela, Mariana Administrator Angeles Community Health Center 2134132222	7/10/2018 10:32 PM
Details	Last Recertification Date	Insert	New Registration			7/10/2018 10:32 PM
Details	Grant Number	Insert	New Registration		LAL031681	7/10/2018 10:32 PM
Details	340B ID	Insert	New Registration			7/10/2018 10:32 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/10/2018 10:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/10/2018 10:32 PM
Details	Medicare Provider Number	Insert	New Registration			7/10/2018 10:32 PM
Details	Entity Name	Insert	New Registration		HEALTH ACCESS FOR ALL INC.	7/10/2018 10:32 PM
Details	Program Code	Insert	New Registration		FQHCLA	7/10/2018 10:32 PM
Details	Entity Subname	Insert	New Registration		Angeles Community Health Center - Huntington Park	7/10/2018 10:32 PM
Dates	Participating Approval Date	Insert	New Registration			7/10/2018 10:32 PM
Details	State	Insert	New Registration		Pending	7/10/2018 10:32 PM
Dates	Registration Date	Insert	New Registration		7/10/2018 10:32:18 PM	7/10/2018 10:32 PM
Dates	Signed By Date	Insert	New Registration			7/10/2018 10:32 PM
Dates	Start Date	Insert	New Registration			7/10/2018 10:32 PM
Terminations	Termination Comments	Insert	New Registration			7/10/2018 10:32 PM
Terminations	Termination Date	Insert	New Registration			7/10/2018 10:32 PM
Terminations	Termination Effective Date	Insert	New Registration			7/10/2018 10:32 PM
Terminations	Termination Reason	Insert	New Registration			7/10/2018 10:32 PM

340B Drug Pricing Program Database