340B Drug Pricing Program Database


CHC24113-12 ELICA HEALTH CENTERS (Terminated) - information as of 4/29/2025 1:40:52 AM

Main Details
ELICA HEALTH CENTERS
Elica Health Centers - Watt Avenue Medical Center
HRSA-Funded Health Center
BPS-H80-021770
CHC24113-12
H80CS24113


Additional Details
Terminated
1/7/2019
4/1/2019
1/8/2019
2/6/2020

4/1/2021
Site closure

Contacts

Elica Health Centers
David E Hughes, COO/CFO
(916) 569-8484 Ext: 312

Elica Health Centers
Christina Osman, Project Director
(916) 569-8484 Ext: 802

Addresses

5708 Watt Avenue
North Highlands, CA 95660

Same as Street Address


  • 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
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC24113-00ActiveBPS-H80-012850Elica Health CentersElica Health Centers155 15th St West SacramentoCA
CHC24113-01ActiveBPS-H80-012849Elica Health CentersElica Health Centers - Midtown3701 J St Ste 201 SacramentoCA
CHC24113-02ActiveBPS-H80-019271ELICA HEALTH CENTERSElica Health Centers - Midtown Medical Center3701 J St Ste 100 SacramentoCA
CHC24113-03TerminatedBPS-H80-019567ELICA HEALTH CENTERSRevere Medical Center752 Revere Street, Unit B SacramentoCA
CHC24113-04ActiveBPS-H80-013843ELICA HEALTH CENTERSElica Health Centers Health on Wheels3701 J ST SacramentoCA
CHC24113-05TerminatedBPS-H80-019173ELICA HEALTH CENTERSNorth Avenue Medical Center1281 North Avenue SacramentoCA
CHC24113-06ActiveBPS-H80-019272ELICA HEALTH CENTERSElica Health Centers - Midtown Medical Center3701 J St Ste 103 SacramentoCA
CHC24113-07ActiveBPS-H80-019270ELICA HEALTH CENTERSElica Health Centers - Midtown Medical Center3701 J St Ste 104 SacramentoCA
CHC24113-08ActiveBPS-H80-019174ELICA HEALTH CENTERSElica Health Centers - V Street Medical Center923 V St SacramentoCA
CHC24113-09ActiveBPS-H80-019172ELICA HEALTH CENTERSElica Health Centers - Franklin Medical Center5385 Franklin Blvd Ste K SacramentoCA
CHC24113-10ActiveBPS-H80-014922ELICA HEALTH CENTERSElica Health Centers - Arden Arcade1750 Wright St Ste 1 SacramentoCA
CHC24113-11TerminatedBPS-H80-019604ELICA HEALTH CENTERSHarbor Medical Center804 Harbor Blvd. West SacramentoCA
CHC24113-12TerminatedBPS-H80-021770ELICA HEALTH CENTERSElica Health Centers - Watt Avenue Medical Center5708 Watt Avenue North HighlandsCA
CHC24113-13ActiveBPS-H80-021617ELICA HEALTH CENTERSElica Health Centers - Halyard Medical Center1276 Halyard Dr West SacramentoCA
CHC24113-14ActiveBPS-H80-021243ELICA HEALTH CENTERSElica Health Centers Health On Wheels 21276 Halyard Dr West SacramentoCA
CHC24113-15ActiveBPS-H80-027350ELICA HEALTH CENTERSElica Health Centers - Marysville3234 Marysville Blvd SacramentoCA
CHC24113-16ActiveBPS-H80-029856ELICA HEALTH CENTERSElica Health Centers Health On Wheels 31276 Halyard Dr West SacramentoCA
CHC24113-17ActiveBPS-H80-031038ELICA HEALTH CENTERSElica Health Centers - Cadillac Drive77 Cadillac Drive STE 200 SacramentoCA
CHC24113-18ActiveBPS-H80-030573ELICA HEALTH CENTERSElica Health Centers Health On Wheels 41276 Halyard Dr West SacramentoCA
CHC24113-19ActiveBPS-H80-031296ELICA HEALTH CENTERSElica Health Centers - Mack Road6339 Mack Rd SacramentoCA
CHC24113-20ActiveBPS-H80-031037ELICA HEALTH CENTERSElica Health Centers North Highlands4815 Watt Ave North HighlandsCA
CHC24113-21ActiveBPS-H80-035379ELICA HEALTH CENTERSElica Health Centers - Glendale2400 Glendale Ln SacramentoCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC24113-00ALABAMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03095 6891 VAUGHN ROAD
MONTGOMERYAL3611610/01/2020  
CHC24113-00ALABAMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04873 1431 11TH AVENUE SO.
BIRMINGHAMAL3520510/01/2020  
CHC24113-00BEL AIR PHARMACY #5147465 RUSH RIVER DRIVE
SACRAMENTOCA9583101/01/2021  
CHC24113-00BEL AIR PHARMACY #5283250 ARENA BLVD.
SACRAMENTOCA9583401/01/2021  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/01/2025  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/01/2025  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620301/01/2025  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522601/01/2025  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/01/2025  
CHC24113-00CAPITAL CITY PHARMACY500 UNIVERSITY AVE STE 110
SACRAMENTOCA95825-650407/01/2014 07/19/2015
CHC24113-00CAPITOL PHARMACY, INC.CAPITOL PHARMACY 1250 HARBOR BLVD STE 600
WEST SACRAMENTOCA9569104/01/2021  
CHC24113-13CAPITOL PHARMACY, INC.CAPITOL PHARMACY 1250 HARBOR BLVD STE 600
WEST SACRAMENTOCA9569101/01/2024  
CHC24113-00CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2021  
CHC24113-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2021  
CHC24113-00CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2021  
CHC24113-00CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2021  
CHC24113-00CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2021  
CHC24113-00CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2021  
CHC24113-00CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2021  
CHC24113-00CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/01/2021  
CHC24113-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2020  
CHC24113-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2021  
CHC24113-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2021  
CHC24113-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2021  
CHC24113-00CVS PHARMACY, INC.DBA: CVS/PHARMACY # 06746 1514 N ALEXANDER
BAYTOWNTX7752007/01/2020  
CHC24113-00CVS PHARMACY, INC.DBA: CVS/PHARMACY # 00357 1701 E. PARMER LN.
AUSTINTX7875410/01/2020  
CHC24113-00CVS PHARMACY, INC.DBA: CVS/PHARMACY # 01792 4201 E. PARK AVE.
PLANOTX7507401/01/2022  
CHC24113-00CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2021  
CHC24113-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2024  
CHC24113-00DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654101/01/2025  
CHC24113-00DOLPHIN HEALTH PHARMACY7400 MACARTHUR BLVD SUITE A
OAKLANDCA9460501/01/2020 05/02/2025
CHC24113-00EVERGREEN PHARMACEUTICAL OF CALIFORNIA,OMNICARE OF SACRAMENTO 3630 BUSINESS DR.
SUITE D 		SACRAMENTOCA9582010/01/2021  
CHC24113-00FAMILY DISCOUNT PHARMACYPRESCRIPTION SERVICES INC 5830 JAMESON CT
SUITE B 		CARMICHAELCA95608-089601/01/2020 01/23/2020
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582110/01/2019  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582010/01/2019  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10005 6401 MACK RD.
SACRAMENTOCA9582310/01/2019  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17342 2005 TOWN CENTER PLZ
WEST SACRAMENTOCA9569110/01/2019  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16857 8101 COSUMNES RIVER BLVD
SACRAMENTOCA9582304/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 8431 7200 BANCROFT AVE.
OAKLANDCA9460507/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10478 657 US HIGHWAY 101 N.
CRESCENT CITYCA9553107/01/2020 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567007/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10360 474 WINTON PKWY
LIVINGSTONCA9533407/01/2020 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5091 1771 PLEASANT GROVE BLVD.
SUITE 100 		ROSEVILLECA9574707/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16413 7505 LAGUNA BLVD
ELK GROVECA9575810/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17516 10881 OLSON DR
RANCHO CORDOVACA9567010/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 00182 8400 BRADSHAW RD.
ELK GROVECA9562410/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16107 4707 PACIFIC AVE
STOCKTONCA9520710/01/2020 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17538 6507 4TH AVE
SACRAMENTOCA9581710/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16106 1919 FULTON AVE
SACRAMENTOCA9582510/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16109 1153 BUTTE HOUSE RD
YUBA CITYCA9599101/01/2021  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09696 10048 MILLS AVE.
WHITTIERCA9060401/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08897 3361 MARKET ST.
RIVERSIDECA9250107/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16234 3527 W FLORIDA AVE
HEMETCA9254507/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17508 4601 2ND ST
DAVISCA9561810/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16489 5837 SUNRISE BLVD
CITRUS HEIGHTSCA9561010/01/2021  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16755 5740 N BLACKSTONE AVE
FRESNOCA9371010/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17200 3601 N FREEWAY BLVD
SACRAMENTOCA9583410/01/2021  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16080 1925 DOUGLAS BLVD
ROSEVILLECA9566110/01/2021  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS/PHARMACY # 11339 777 S. HARBOR BLVD., SUITE E-164
LA HABRACA9063110/01/2021 02/19/2024
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #17822 1707 J STREET
SACRAMENTOCA9581107/01/2023 02/27/2024
CHC24113-09GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582001/01/2024  
CHC24113-02GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582101/01/2024  
CHC24113-07GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17342 2005 TOWN CENTER PLZ
WEST SACRAMENTOCA9569101/01/2024  
CHC24113-17GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582107/01/2025  
CHC24113-00GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00040 1424 W BASELINE RD
TEMPEAZ8528307/01/2020 06/01/2023
CHC24113-00GERMAN DOBSON CVS, L.L.C.CVS/PHARMACY #10529 7111 EAST BELL RD.
SCOTTSDALEAZ8525401/01/2022 05/08/2025
CHC24113-00INNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089601/23/2020 10/01/2021
CHC24113-00INNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089607/01/2023 04/01/2024
CHC24113-01INNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089601/01/2024 04/01/2024
CHC24113-00INNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554207/01/2020  
CHC24113-01INNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554201/01/2021  
CHC24113-00INNOVA PHARMACY III2400 GLENDALE LN STE A
SACRAMENTOCA95825-243104/01/2020 10/01/2021
CHC24113-10INNOVA PHARMACY III2400 GLENDALE LN STE A
SACRAMENTOCA95825-243101/01/2021 10/01/2021
CHC24113-00INNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510801/01/2021  
CHC24113-20INNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510804/01/2021  
CHC24113-00INNOVA PHARMACY OF ARDEN-ARCADERETAIL PHARMACY 2400 GLENDALE LN STE A
SACRAMENTOCA9582507/01/2023  
CHC24113-21INNOVA PHARMACY OF ARDEN-ARCADERETAIL PHARMACY 2400 GLENDALE LN STE A
SACRAMENTOCA9582501/01/2024  
CHC24113-00JEFFERSON PHARMACY1029 JEFFERSON BLVD STE A
WEST SACRAMENTOCA95691-334407/01/2014 07/19/2015
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09823 1350 FLORIN ROAD
SACRAMENTOCA9582210/01/2019  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09826 5333 ELKHORN BLVD
SACRAMENTOCA9584210/01/2019  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09992 3338 ARDEN WAY
SACRAMENTOCA9582504/01/2020 01/18/2024
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09199 5420 DEWEY DR
FAIR OAKSCA9562804/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09322 2085 FAIR OAKS BLVD
SACRAMENTOCA9582504/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03945 1701 K ST
SACRAMENTOCA9581104/01/2020 04/25/2023
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583304/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03943 5039 FOLSOM BLVD
SACRAMENTOCA9581904/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01825 5040 LAGUNA BLVD
ELK GROVECA9575804/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09972 7465 RUSH RIVER DR STE 500
SACRAMENTOCA9583104/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 04151 2050 CLUB CENTER DR
SACRAMENTOCA9583504/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09208 13763 MONO WAY
SONORACA9537004/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09814 8101 GREENBACK LANE
FAIR OAKSCA9562807/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09809 4959 MARCONI AVE
CARMICHAELCA9560807/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09958 5090 FOOTHILLS BLVD
ROSEVILLECA9574707/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03066 8351 ELK GROVE FLORIN RD
SACRAMENTOCA9582907/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09186 110 E LAUREL DR
SALINASCA9390607/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06793 3020 GREEN VALLEY RD STE B
CAMERON PARKCA9568207/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09147 2605 WEST MARCH LANE
STOCKTONCA9520707/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09917 625 ELMIRA RD
VACAVILLECA9568707/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09261 100 W LODI AVE
LODICA9524007/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09155 1005 SUTTON WAY
GRASS VALLEYCA9594510/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07128 2780 ESPLANADE
CHICOCA9597310/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09597 1750 41ST AVE
CAPITOLACA9501010/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09691 906 E ST.
MARYSVILLECA9590110/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09830 6632 PACIFIC AVENUE
STOCKTONCA9520710/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07910 1794 ASHLAN AVE
CLOVISCA9361101/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09180 7 W MAIN ST
WOODLANDCA9569501/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09909 8320 EL CAMINO REAL
ATASCADEROCA9342201/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03009 3500 PALMER DR
CAMERON PARKCA9568201/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09993 9280 SIERRA COLLEGE BLVD
ROSEVILLECA9566107/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09916 5070 WEST LN
STOCKTONCA9521007/01/2021 05/11/2022
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09243 1000 W KETTLEMAN LN
LODICA9524007/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09815 738 BANCROFT RD
WALNUT CREEKCA9459810/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09980 9479 MADISON AVE
FOLSOMCA9563010/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09490 6450 PONY EXPRESS TRL
POLLOCK PINESCA9572610/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09927 1193 ADMIRAL CALLAGHAN LANE
VALLEJOCA9459110/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09142 1550 E COVELL BLVD
DAVISCA9561610/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02124 8585 ELK GROVE BLVD
ELK GROVECA9562410/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09219 330 BON AIR SHOPPING CTR
GREENBRAECA9490410/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09132 9285 ELK GROVE BLVD
ELK GROVECA9562410/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09536 490 MARKET PL
SAN RAMONCA9458301/01/2022 04/17/2024
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03909 4330 LATROBE RD
EL DORADO HILLSCA9576201/01/2022  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09923 1005 E BIDWELL ST
FOLSOMCA9563001/01/2022 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09487 8861 GREENBACK LN
ORANGEVALECA9566201/01/2022 01/18/2023
CHC24113-14LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583301/01/2024  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09868 2455 SAN RAMON VALLEY BLVD
SAN RAMONCA9458307/01/2024 05/08/2025
CHC24113-00NEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08792 680 N. MCCARRAN BLVD.
SPARKSNV8943110/01/2020  
CHC24113-00NEVADA CVS PHARMACY, L.L.C.CVS/PHARMACY # 10861 8491 FARM RD.
LAS VEGASNV8913101/01/2021 05/08/2025
CHC24113-00NEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00157 2890 NORTHTOWNE LANE
RENONV8951207/01/2021  
CHC24113-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2020  
CHC24113-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2021  
CHC24113-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2021  
CHC24113-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681307/01/2021  
CHC24113-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255001/01/2025  
CHC24113-00RALEY'S PHARMACY #4163518 MARCONI AVENUE
SACRAMENTOCA9582101/01/2021  
CHC24113-00RALEY'S PHARMACY #4208391 FOLSOM BLVD.
SACRAMENTOCA9582601/01/2021  
CHC24113-00RALEY'S PHARMACY #4474650 NATOMAS BLVD.
SACRAMENTOCA9583501/01/2021  
CHC24113-00RALEY'S PHARMACY #4481601 WEST CAPITOL AVENUE
WEST SACRAMENTOCA9569101/01/2021  
CHC24113-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/01/2025  
CHC24113-00SAFEWAY INCSAFEWAY PHARMACY #2242 1025 ALHAMBRA BLVD
SACRAMENTOCA9581601/01/2021 10/18/2024
CHC24113-00SAFEWAY INCSAFEWAY PHARMACY #1530 3320 ARDEN WAY
SACRAMENTOCA9582501/01/2021 10/18/2024
CHC24113-00SAFEWAY INCSAFEWAY PHARMACY #2684 1814 19TH STREET
SACRAMENTOCA9581101/01/2021 10/18/2024
CHC24113-00SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301301/01/2025  
CHC24113-00THRIFTY PAYLESS INC.RITE AID #6070 2419 DEL PASO BOULEVARD
SACRAMENTOCA9581507/01/2014 07/19/2015
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582407/01/2014 07/19/2015
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583807/01/2014 07/19/2015
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6065 1260 WEST CAPITOL AVENUE
WEST SACRAMENTOCA9569107/01/2014 07/19/2015
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582410/01/2019 04/23/2024
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566010/01/2019  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6065 1260 WEST CAPITOL AVENUE
WEST SACRAMENTOCA9569110/01/2019  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6069 831 K STREET
SACRAMENTOCA9581410/01/2019 02/28/2022
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6071 1125 ALHAMBRA BOULEVARD
SACRAMENTOCA9581610/01/2019 05/03/2022
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583810/01/2019  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6080 1309 FULTON AVENUE
SACRAMENTOCA9582510/01/2019 10/18/2023
CHC24113-17THRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582401/01/2024 04/23/2024
CHC24113-06THRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583801/01/2024  
CHC24113-18THRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566001/01/2024  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6083 7860 GERBER ROAD
SACRAMENTOCA9582804/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6043 2805 BELL ROAD
AUBURNCA9560304/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6044 4010 MANZANITA AVENUE
CARMICHAELCA9560804/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6403 4241 MARCONI AVENUE
SACRAMENTOCA9582104/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6081 9133 KIEFER BOULEVARD
SACRAMENTOCA9582604/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6086 4300 ELVERTA ROAD
ANTELOPECA9584304/01/2025  
CHC24113-00VIBRANT CARE PHARMACY, INC.7400 MACARTHUR BLVD STE B
OAKLANDCA94605-293901/01/2020 05/02/2025
CHC24113-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2019  
CHC24113-00WAL-MART PHARMACY 10-15543223 EAST HAMMER LANE
STOCKTONCA9521201/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-16978465 ELK GROVE BLVD
ELK GROVECA9575801/01/2023  
CHC24113-00WAL-MART PHARMACY 10-17601018 RILEY STREET
FOLSOMCA9563001/01/2023  
CHC24113-00WAL-MART PHARMACY 10-17891601 S. LOWER SACRAMENTO RD.
LODICA9524201/01/2023  
CHC24113-00WAL-MART PHARMACY 10-18817901 WATT AVE
ANTELOPECA9584310/01/2019  
CHC24113-00WAL-MART PHARMACY 10-21901720 EAST MAIN STREET
WOODLANDCA9577601/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-24184300 MISSOURI FLAT RD
PLACERVILLECA9566701/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-245710655 FOLSOM BLVD.
RANCHO CORDOVACA9567001/01/2023  
CHC24113-00WAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583310/01/2019  
CHC24113-19WAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583301/01/2024  
CHC24113-00WAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582310/01/2019  
CHC24113-04WAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582301/01/2024  
CHC24113-00WAL-MART PHARMACY 10-30905609 PACIFIC ST
ROCKLINCA9567701/01/2023  
CHC24113-00WAL-MART PHARMACY 10-35875454 CROSSING DR.
ROCKLINCA9567701/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-3652755 RIVER POINT CT
WEST SACRAMENTOCA9569110/01/2019  
CHC24113-10WAL-MART PHARMACY 10-3652755 RIVER POINT CT
WEST SACRAMENTOCA9569101/01/2024  
CHC24113-00WAL-MART PHARMACY 10-37127010 AUBURN BLVD
CITRUS HEIGHTSCA9562101/01/2023  
CHC24113-00WAL-MART PHARMACY 10-43098961 GREENBACK LANE
ORANGEVALECA9566201/01/2023  
CHC24113-00WAL-MART PHARMACY 10-51361131 N BEALE RD
MARYSVILLECA9590101/01/2022  
CHC24113-00WAL-MART PHARMACY 10-51925821 ANTELOPE ROAD
SACRAMENTOCA9584210/01/2019  
CHC24113-08WAL-MART PHARMACY 10-51925821 ANTELOPE ROAD
SACRAMENTOCA9584201/01/2024  
CHC24113-00WAL-MART PHARMACY 10-56061250 E GIBSON ROAD
WOODLANDCA9577601/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-56838455 ELK GROVE BLVD
ELK GROVECA9575801/01/2023  
CHC24113-00WAL-MART PHARMACY 10-584810075 BRUCEVILLE RD
ELK GROVECA9575701/01/2023  
CHC24113-00WAL-MART PHARMACY 10-5979255 LINCOLN BLVD.
LINCOLNCA9564801/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-59804080 DOUGLAS BLVD.
GRANITE BAYCA9574601/01/2023 04/12/2024
CHC24113-00WAL-MART PHARMACY 10-59816005 MADISON AVE
CARMICHAELCA9560801/01/2022  
CHC24113-00WAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582110/01/2019  
CHC24113-16WAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582101/01/2024  
CHC24113-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2019  
CHC24113-00WALGREEN CODBA: WALGREENS #10693 6819 WATT AVE
NORTH HIGHLANDSCA95660-320301/01/2021 02/22/2024
CHC24113-00WALGREEN CODBA: WALGREENS #07191 6199 SUNRISE BOULEVARD
CITRUS HEIGHTSCA9561001/01/2022 02/20/2024
CHC24113-00WALGREEN CODBA: WALGREENS #10114 3521 DEL PASO ROAD
SACRAMENTOCA9583504/01/2023  
CHC24113-00WALGREEN CODBA: WALGREENS #10716 250 FLORIN RD
SACRAMENTOCA9583104/01/2023  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06706 7155 24TH STREET
SACRAMENTOCA9582201/01/2021 01/29/2025
CHC24113-00WALGREEN CO.DBA: WALGREENS #11262 840 EL CAMINO AVE
SACRAMENTOCA95815-251301/01/2021 11/08/2023
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05036 4495 MACK RD
SACRAMENTOCA9582301/01/2021  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05374 2900 STOCKTON BLVD
SACRAMENTOCA9581701/01/2021  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06193 2201 ARDEN WAY
SACRAMENTOCA9582501/01/2021 04/09/2024
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06613 1401 BROADWAY
SACRAMENTOCA9581801/01/2021 01/23/2025
CHC24113-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15987 1020 29TH ST STE 140
SACRAMENTOCA9581601/01/2021 06/09/2021
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05500 4331 ANTELOPE ROAD
SACRAMENTOCA9584301/01/2021  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 04198 1351 W CAPITOL AVE
WEST SACRAMENTOCA9569101/01/2021  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06419 9180 FRANKLIN BLVD
ELK GROVECA9575801/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS #09532 4050 SUNRISE BLVD
RANCHO CORDOVACA9574201/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05501 3999 FOOTHILLS BLVD
ROSEVILLECA9574701/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05499 7299 LAGUNA BLVD
ELK GROVECA9575801/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 04107 10 WEST MAIN ST.
WOODLANDCA9569501/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06658 6325 FAIR OAKS BLVD
CARMICHAELCA9560801/01/2022 04/30/2025
CHC24113-00WALGREEN CO.DBA: WALGREENS #12525 700 TWELVE BRIDGES DR
LINCOLNCA9564801/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06142 9200 ELK GROVE FLORIN RD
ELK GROVECA9562401/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06915 2177 SUNSET BLVD
ROCKLINCA95765-474301/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06612 8400 ELK GROVE FLORIN ROAD
ELK GROVECA95624-945001/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05774 7787 SUNRISE BLVD
CITRUS HEIGHTSCA9561001/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS #16058 1492 BLUE OAKS BLVD
ROSEVILLECA9574701/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06036 4051 DOUGLAS BLVD
GRANITE BAYCA95746-590101/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05152 6144 DEWEY DRIVE
CITRUS HEIGHTSCA9562101/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 04170 4200 ARDEN WAY
SACRAMENTOCA9586404/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 04136 1919 FRUITRIDGE RD.
SACRAMENTOCA9582204/01/2022  
CHC24113-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15987 1020 29TH ST STE 140
SACRAMENTOCA9581610/01/2024  
CHC24113-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2024  
CHC24113-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2024  
CHC24113-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2024  
CHC24113-00WALMART PHARMACY #10-24648270 DELTA SHORES CIR
SACRAMENTOCA95832-910101/01/2023  
CHC24113-00WALMART PHARMACY 10-30818915 GERBER ROAD
SACRAMENTOCA9582901/01/2023  
CHC24113-00WALMART PHARMACY 10-4127215 CALIFORNIA ST.
WOODLANDCA9569501/01/2023 05/08/2025
CHC24113-00WALMART PHARMACY 10-42021400 LEAD HILL BLVD
ROSEVILLECA9566101/01/2023  
CHC24113-00WALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566010/01/2019  
CHC24113-15WALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566001/01/2024  
CHC24113-00WALMART PHARMACY 10-47596197 SUNRISE BLVD
CITRUS HEIGHTSCA9561001/01/2023  
CHC24113-00WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/01/2023  
CHC24113-00WALMART PHARMACY 10-523110470 TWIN CITIES ROAD
GALTCA9563201/01/2023  
CHC24113-00WALMART PHARMACY 10-65304420 FLORIN RD
SACRAMENTOCA9582310/01/2019 12/09/2019
CHC24113-00Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CHC24113-00WASHINGTON CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10285 10712 SE CARR ROAD
RENTONWA9805501/01/2022 05/08/2025
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateProfile Change RequestOsman, Christina Senior Project Manager Elica Health Centers 9165698484-802Osman, Christina Project Director Elica Health Centers 9165698484-80210/18/2022 3:34 PM
DetailsStateUpdate To Be TerminatedTerminated4/1/2021 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 11/23/2020 12:00:00 AM1/14/2021 5:13 PM
DetailsStateUpdateTermination RequestActiveTo Be Terminated1/14/2021 5:13 PM
TerminationsTermination DateUpdateTermination Request 4/1/2021 12:00:00 AM1/14/2021 5:13 PM
TerminationsTermination Effective DateUpdateTermination Request 12/31/2020 12:00:00 AM1/14/2021 5:13 PM
TerminationsTermination ReasonUpdateTermination Request Site closure1/14/2021 5:13 PM
ContactsPrimary ContactUpdateProfile Change RequestOsman, Christina Senior Project Manager Elica Health Centers 8553542242-802Osman, Christina Senior Project Manager Elica Health Centers 9165698484-8021/8/2021 3:54 PM
ContactsPrimary ContactUpdateProfile Change RequestOsman, Christina Operations Analyst Elica Health Centers 8553542242-802Osman, Christina Senior Project Manager Elica Health Centers 8553542242-8028/21/2020 2:05 PM
DetailsLast Recertification DateUpdateRecertification 2/6/2020 3:44:06 PM2/6/2020 3:44 PM
ContactsPrimary ContactUpdateChange RequestDemerin, Ron Special Projects Elica Health Centers 9165698484-510Osman, Christina Operations Analyst Elica Health Centers 8553542242-8022/3/2020 5:05 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestHughes, David E COO/CFO Elica Health Centers 8553542242-312Hughes, David E COO/CFO Elica Health Centers 9165698484-31212/12/2019 4:38 PM
ContactsSigned ByUpdateProfile Change RequestHughes, David E COO/CFO Elica Health Centers 8553542242-312Hughes, David E COO/CFO Elica Health Centers 9165698484-31212/12/2019 4:38 PM
DetailsStateUpdate ApprovedActive4/1/2019 12:05 AM
ContactsSigned ByInsertNew Registration Hughes, David E COO/CFO Elica Health Centers 8553542242-3121/8/2019 8:09 AM
Details340B IDUpdateNew Registration CHC24113-121/8/2019 8:09 AM
DatesParticipating Approval DateUpdateNew Registration 1/8/2019 8:09:03 AM1/8/2019 8:09 AM
DetailsStateUpdateNew RegistrationPendingApproved1/8/2019 8:09 AM
DatesSigned By DateUpdateNew Registration 1/7/2019 3:20:40 PM1/8/2019 8:09 AM
DatesStart DateUpdateNew Registration 4/1/2019 12:00:00 AM1/8/2019 8:09 AM
AddressesMain AddressInsertNew Registration  5708 Watt Avenue North Highlands, CA 956601/7/2019 2:06 PM
ContactsPrimary ContactInsertNew Registration Demerin, Ron Special Projects Elica Health Centers 9165698484-5101/7/2019 2:06 PM
ContactsAuthorizing OfficialInsertNew Registration Hughes, David E COO/CFO Elica Health Centers 8553542242-3121/7/2019 2:06 PM
DetailsLast Recertification DateInsertNew Registration  1/7/2019 2:06 PM
DetailsGrant NumberInsertNew Registration H80CS241131/7/2019 2:06 PM
Details340B IDInsertNew Registration  1/7/2019 2:06 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/7/2019 2:06 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/7/2019 2:06 PM
DetailsMedicare Provider NumberInsertNew Registration  1/7/2019 2:06 PM
DetailsEntity NameInsertNew Registration ELICA HEALTH CENTERS1/7/2019 2:06 PM
DetailsProgram CodeInsertNew Registration CH1/7/2019 2:06 PM
DetailsEntity SubnameInsertNew Registration Elica Health Centers - Watt Avenue Medical Center1/7/2019 2:06 PM
DatesParticipating Approval DateInsertNew Registration  1/7/2019 2:06 PM
DetailsStateInsertNew Registration Pending1/7/2019 2:06 PM
DatesRegistration DateInsertNew Registration 1/7/2019 2:06:34 PM1/7/2019 2:06 PM
DatesSigned By DateInsertNew Registration  1/7/2019 2:06 PM
DatesStart DateInsertNew Registration  1/7/2019 2:06 PM
TerminationsTermination CommentsInsertNew Registration  1/7/2019 2:06 PM
TerminationsTermination DateInsertNew Registration  1/7/2019 2:06 PM
TerminationsTermination Effective DateInsertNew Registration  1/7/2019 2:06 PM
TerminationsTermination ReasonInsertNew Registration  1/7/2019 2:06 PM