340B Drug Pricing Program Database


CHC28990-10 Riverside County Health System (Active) - information as of 6/2/2025 8:30:16 AM

Main Details
Riverside County Health System
Moreno Valley Community Health Center
HRSA-Funded Health Center
BPS-H80-022222
CHC28990-10
H80CS28990


Additional Details
Active
4/1/2019
7/1/2019
4/2/2019
2/20/2025

Contacts

RUHS
Leah Patterson, Chief Nursing Officer
(951) 486-7532

RUHS
Davalyn Tidwell, Pharmacy Director
(951) 486-4527

Addresses

23520 Cactus Ave
Moreno Valley, CA 92553-8906

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

Yes
Shipping Addresses

RUHS- Neighborhood Pharmacy
7140 Indiana Ave
Pharmacy
Riverside, CA 92504

RUHS- Behavioral Health Retail
9990 County Farm Road
Pharmacy
Riverside
Riverside, CA 92503

RUHS- MC - Retail Pharmacy
26520 Cactus Avenue
Pharmacy
Moreno Valley, CA 92555

RUHS - Corona Pharmacy
2813 South Main Street
Corona, CA 92882

RUHS- Surgical Center Pharmacy
26600 Cactus Avenue
Moreno Valley, CA 92555
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC28990-00ActiveBPS-H80-015629RIVERSIDE COUNTY HEALTH SYSTEMPerris Family Care Center308 E SAN JACINTO AVE PERRISCA
CHC28990-01ActiveBPS-H80-015623RIVERSIDE COUNTY HEALTH SYSTEMRiverside Neighborhood Health Center7140 INDIANA AVE RIVERSIDECA
CHC28990-02ActiveBPS-H80-015622RIVERSIDE COUNTY HEALTH SYSTEMRubidoux Family Care Center5256 MISSION BLVD RIVERSIDECA
CHC28990-03ActiveBPS-H80-015620RIVERSIDE COUNTY HEALTH SYSTEMHemet Family Care Center880 N STATE ST HEMETCA
CHC28990-04TerminatedBPS-H80-015614RIVERSIDE COUNTY HEALTH SYSTEMPalm Springs Family Care Center1515 N SUNRISE WAY PALM SPRINGSCA
CHC28990-05ActiveBPS-H80-015613RIVERSIDE COUNTY HEALTH SYSTEMIndio Family Care Center47923 OASIS ST INDIOCA
CHC28990-06ActiveBPS-H80-015606RIVERSIDE COUNTY HEALTH SYSTEMLake Elsinore Family Care Center2499 E LAKESHORE DR LAKE ELSINORECA
CHC28990-07ActiveBPS-H80-015611RIVERSIDE COUNTY HEALTH SYSTEMBanning Family Care Center3055 W RAMSEY ST BANNINGCA
CHC28990-08ActiveBPS-H80-021947RIVERSIDE COUNTY HEALTH SYSTEMCorona Community Health Center2813 S MAIN ST CORONACA
CHC28990-09ActiveBPS-H80-027759RIVERSIDE COUNTY HEALTH SYSTEMJurupa Valley Community Health Center8876 Mission Blvd Jurupa ValleyCA
CHC28990-10ActiveBPS-H80-022222Riverside County Health SystemMoreno Valley Community Health Center23520 Cactus Ave Moreno ValleyCA
CHC28990-11ActiveBPS-H80-027874Riverside County Health SystemPerris Valley Community Health Center450 E San Jacinto Ave PerrisCA
CHC28990-12ActiveBPS-H80-030385Riverside County Health SystemMain Campus Community Health Center26600 Cactus Ave. STE 300 Moreno ValleyCA
CHC28990-13TerminatedBPS-H80-034014Riverside, County ofBlythe Community Health Center1297 W Hobsonway Ste 100 BlytheCA
CHC28990-14ActiveBPS-H80-031028Riverside, County ofMobile Health Clinic #147923 Oasis St IndioCA
CHC28990-15ActiveBPS-H80-034506RIVERSIDE COUNTY HEALTH SYSTEMPalm Springs Community Health Center191 N Sunrise Way Palm SpringsCA
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/12/2024 3:12:07 PM2/20/2025 9:09:30 PM2/20/2025 9:09 PM
DetailsLast Recertification DateUpdateRecertification3/6/2023 7:49:49 AM2/12/2024 3:12:07 PM2/12/2024 3:12 PM
DetailsLast Recertification DateUpdateRecertification2/28/2022 10:48:52 AM3/6/2023 7:49:49 AM3/6/2023 7:49 AM
DetailsLast Recertification DateUpdateRecertification2/11/2021 12:24:11 PM2/28/2022 10:48:52 AM2/28/2022 10:48 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestPatterson, Leah Chief Nursing Officer RUHS 9514864665Patterson, Leah Chief Nursing Officer RUHS 95148675322/8/2022 4:24 PM
AddressesShipping AddressInsertRecertification RUHS- Surgical Center Pharmacy 26600 Cactus Avenue Moreno Valley, CA 925552/11/2021 12:24 PM
DetailsLast Recertification DateUpdateRecertification2/24/2020 11:15:43 AM2/11/2021 12:24:11 PM2/11/2021 12:24 PM
ContactsAuthorizing OfficialUpdateChange RequestBoatman, Ronnie Chief Operating Officer RUHS 9514864135Patterson, Leah Chief Nursing Officer RUHS 95148646651/6/2021 10:18 AM
Medicaid BillingNPI: StateUpdateChange Request CA10/6/2020 2:46 PM
ContactsAuthorizing OfficialUpdateChange RequestProuty, Greg Executive Director Clinical and Ancillary Services RUHS 9514864450Boatman, Ronnie Chief Operating Officer RUHS 951486413510/6/2020 2:46 PM
DetailsLast Recertification DateUpdateRecertification 2/24/2020 11:15:43 AM2/24/2020 11:15 AM
DetailsStateUpdate ApprovedActive7/1/2019 12:05 AM
AddressesShipping AddressDeleteChange RequestRiverside County Rubidoux Pharmacy 5256 Mission Blvd Jurupa Valley, CA 92509 4/12/2019 4:39 PM
ContactsSigned ByInsertNew Registration Prouty, Greg Executive Director Clinical and Ancillary Services RUHS 95148644504/2/2019 7:53 AM
Details340B IDUpdateNew Registration CHC28990-104/2/2019 7:53 AM
DatesParticipating Approval DateUpdateNew Registration 4/2/2019 7:53:21 AM4/2/2019 7:53 AM
DetailsStateUpdateNew RegistrationPendingApproved4/2/2019 7:53 AM
DatesSigned By DateUpdateNew Registration 4/1/2019 4:45:04 PM4/2/2019 7:53 AM
DatesStart DateUpdateNew Registration 7/1/2019 12:00:00 AM4/2/2019 7:53 AM
AddressesMain AddressInsertNew Registration  23520 Cactus Ave Moreno Valley, CA 92553-89064/1/2019 2:27 PM
AddressesShipping AddressInsertNew Registration RUHS- Neighborhood Pharmacy 7140 Indiana Ave Pharmacy Riverside, CA 925044/1/2019 2:27 PM
AddressesShipping AddressInsertNew Registration RUHS- Behavioral Health Retail 9990 County Farm Road Pharmacy Riverside Riverside, CA 925034/1/2019 2:27 PM
AddressesShipping AddressInsertNew Registration RUHS- MC - Retail Pharmacy 26520 Cactus Avenue Pharmacy Moreno Valley, CA 925554/1/2019 2:27 PM
AddressesShipping AddressInsertNew Registration Riverside County Rubidoux Pharmacy 5256 Mission Blvd Jurupa Valley, CA 925094/1/2019 2:27 PM
AddressesShipping AddressInsertNew Registration RUHS - Corona Pharmacy 2813 South Main Street Corona, CA 928824/1/2019 2:27 PM
Medicaid BillingNPI: NumberInsertNew Registration 14376423454/1/2019 2:27 PM
ContactsAuthorizing OfficialInsertNew Registration Prouty, Greg Executive Director Clinical and Ancillary Services RUHS 95148644504/1/2019 2:27 PM
ContactsPrimary ContactInsertNew Registration Tidwell, Davalyn Pharmacy Director RUHS 95148645274/1/2019 2:27 PM
DetailsLast Recertification DateInsertNew Registration  4/1/2019 2:27 PM
DetailsGrant NumberInsertNew Registration H80CS289904/1/2019 2:27 PM
Details340B IDInsertNew Registration  4/1/2019 2:27 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/1/2019 2:27 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/1/2019 2:27 PM
DetailsMedicare Provider NumberInsertNew Registration  4/1/2019 2:27 PM
DetailsEntity NameInsertNew Registration Riverside County Health System4/1/2019 2:27 PM
DetailsProgram CodeInsertNew Registration CH4/1/2019 2:27 PM
DetailsEntity SubnameInsertNew Registration Moreno Valley Community Health Center4/1/2019 2:27 PM
DatesParticipating Approval DateInsertNew Registration  4/1/2019 2:27 PM
DetailsStateInsertNew Registration Pending4/1/2019 2:27 PM
DatesRegistration DateInsertNew Registration 4/1/2019 2:27:32 PM4/1/2019 2:27 PM
DatesSigned By DateInsertNew Registration  4/1/2019 2:27 PM
DatesStart DateInsertNew Registration  4/1/2019 2:27 PM
TerminationsTermination CommentsInsertNew Registration  4/1/2019 2:27 PM
TerminationsTermination DateInsertNew Registration  4/1/2019 2:27 PM
TerminationsTermination Effective DateInsertNew Registration  4/1/2019 2:27 PM
TerminationsTermination ReasonInsertNew Registration  4/1/2019 2:27 PM