Yes
CA | | 1194122457,1548813041,1023648623,1144969809 |
Contract Detail | A1CARE PHARMACY | PLANET HEALTH INC |
2001 E 4TH ST STE 112
| SANTA ANA | CA | 92705-3916 | 04/15/2024 | 07/01/2024 | | | 07/01/2024 |
FQHCLA347 | A1CARE PHARMACY | PLANET HEALTH INC |
2001 E 4TH ST STE 112
| SANTA ANA | CA | 92705-3916 | 01/01/2019 | | |
FQHCLA347B | A1CARE PHARMACY | PLANET HEALTH INC |
2001 E 4TH ST STE 112
| SANTA ANA | CA | 92705-3916 | 07/01/2024 | | |
FQHCLA347 | AHCS SPECIALTY CARE | 12832 VALLEY VIEW ST |
STE A & B
| GARDEN GROVE | CA | 92845 | 07/01/2020 | | 07/01/2021 |
FQHCLA347 | AHCS SPECIALTY CARE | 12832 VALLEY VIEW ST |
STE A
| GARDEN GROVE | CA | 92845 | 07/01/2021 | | 04/01/2024 |
FQHCLA347 | ALLCARE SPECIALTY PHARMACY | 1403 N. TUSTIN AVE STE 150 |
| SANTA ANA | CA | 92705 | 10/01/2020 | | |
FQHCLA347 | CURA PHARMACY | 17400 IRVINE BLVD STE P |
| TUSTIN | CA | 92780-3030 | 04/01/2023 | | |
FQHCLA347D | CURA PHARMACY | 17400 IRVINE BLVD STE P |
| TUSTIN | CA | 92780-3030 | 07/01/2024 | | |
FQHCLA347 | DIPLOMAT SPECIALTY PHARMACY | 4100 S SAGINAW ST |
STE D
| FLINT | MI | 48507-2683 | 01/01/2021 | | 10/05/2022 |
FQHCLA347 | MISSION PLAZA PHARMACY | 26800 CROWN VALLEY PKWY STE 185 |
| MISSION VIEJO | CA | 92691-7304 | 04/01/2020 | | 07/01/2021 |
FQHCLA347 | MISSION PLAZA PHARMACY 2 | 4631 TELLER AVE |
STE 110
| NEWPORT BEACH | CA | 92660 | 04/01/2021 | | 12/30/2022 |
FQHCLA347 | OPTUM INFUSION SERVICES 305, LLC | 15529 COLLEGE BLVD. |
| LENEXA | KS | 66219-1351 | 10/01/2021 | | 12/30/2022 |
FQHCLA347 | OPTUM INFUSION SERVICES 500, INC. | 4900 RIVERGRADE RD STE E120 |
| IRWINDALE | CA | 91706-1419 | 10/01/2021 | | 08/02/2022 |
FQHCLA347 | OPTUM INFUSION SERVICES 550, LLC | 1819 ASTON AVE STE 104 |
| CARLSBAD | CA | 92008 | 10/01/2022 | | 12/30/2022 |
FQHCLA347 | OPTUM PHARMACY 701, LLC | 4100 S SAGINAW ST STE D |
| FLINT | MI | 48507 | 10/05/2022 | | |
FQHCLA347 | OPTUM PHARMACY 702, LLC | 1050 PATROL RD |
| JEFFERSONVILLE | IN | 47130 | 01/01/2021 | | |
FQHCLA347 | OPTUM PHARMACY 705, LLC | 1100 LEE BRANCH LN |
| BIRMINGHAM | AL | 35242-7298 | 10/01/2021 | | |
FQHCLA347 | OPTUM PHARMACY 707, INC | 4900 RIVERGRADE RD STE E110 |
| IRWINDALE | CA | 91706-1401 | 01/01/2021 | | |
FQHCLA347 | OPTUM PHARMACY 806, INC. | 2288 AUBURN BLVD |
STE. 102
| SACRAMENTO | CA | 95821-1618 | 01/01/2021 | | 10/01/2021 |
FQHCLA347 | THERESA PHARMACY INC | DBA ACARE PHARMACY |
9860 KATELLA AVE
| ANAHEIM | CA | 92804 | 07/01/2019 | | 07/01/2019 |
FQHCLA347 | TRAN-RX, LLC | DBA: ALLCARE PHARMACY #3 |
1106 E. 17TH ST STE B
| SANTA ANA | CA | 92701 | 07/01/2020 | | 12/01/2020 |
FQHCLA347 | VEGAS PHARMACY | 8352 W WARM SPRINGS RD, STE #330 |
| LAS VEGAS | NV | 89113 | 01/01/2023 | | 02/08/2023 |
FQHCLA347 | WALGREEN CO. | DBA: WALGREENS # 03636 |
3237 E. CHAPMAN AVE.
| ORANGE | CA | 92869 | 04/01/2018 | | 04/30/2018 |
FQHCLA347 | WALGREEN CO. | DBA: WALGREENS # 06388 |
1301 E 17TH STREET
| SANTA ANA | CA | 92705 | 04/01/2018 | | 04/30/2018 |
FQHCLA347 | WALGREEN CO. | DBA: WALGREENS # 07286 |
13052 NEWPORT AVE
| TUSTIN | CA | 92780 | 04/01/2018 | | 04/30/2018 |
FQHCLA347 | WALGREEN CO. | DBA: WALGREENS #10336 |
1538 E CHAPMAN AVE
| ORANGE | CA | 92866 | 04/01/2018 | | 04/30/2018 |
Details | Last Recertification Date | Update | Recertification | 2/14/2024 7:38:53 AM | 2/21/2025 6:19:41 PM | 2/21/2025 6:19 PM |
Contacts | Primary Contact | Update | Group Change Request | Sahakian, Izabella Sahakian
Operations Director
Families Together of Orange County Community Health Center
7146659890 | Pham, Mary
Pharmacy Director
Families Together of Orange County
7146659890 | 4/12/2024 2:55 PM |
Contacts | Primary Contact | Update | Recertification | Sahakian, Izabella
Operations Director
Families Together of Orange County
7146659890 | Sahakian, Izabella Sahakian
Operations Director
Families Together of Orange County Community Health Center
7146659890 | 2/14/2024 7:38 AM |
Details | Last Recertification Date | Update | Recertification | 2/8/2023 11:24:25 AM | 2/14/2024 7:38:53 AM | 2/14/2024 7:38 AM |
Details | Last Recertification Date | Update | Recertification | 2/7/2022 2:22:49 PM | 2/8/2023 11:24:25 AM | 2/8/2023 11:24 AM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1144969809 | 1/15/2023 11:39 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | CA | 1/15/2023 11:39 PM |
Details | Last Recertification Date | Update | Recertification | 2/2/2021 8:19:25 PM | 2/7/2022 2:22:49 PM | 2/7/2022 2:22 PM |
Contacts | Primary Contact | Update | Profile Change Request | Sahakian, Izabella
Clinic Manager
Families Together of Orange County
7146659890 | Sahakian, Izabella
Operations Director
Families Together of Orange County
7146659890 | 2/7/2022 2:16 PM |
Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/2/2021 8:19 PM |
Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/2/2021 8:19 PM |
Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/2/2021 8:19 PM |
Details | Last Recertification Date | Update | Recertification | 2/10/2020 11:04:02 AM | 2/2/2021 8:19:25 PM | 2/2/2021 8:19 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1194122457 | 7/13/2020 1:16 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1548813041 | 7/13/2020 1:16 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1023648623 | 7/13/2020 1:16 PM |
Medicaid Billing | NPI: Number | Delete | Recertification | 1194122457 ( ) | | 2/10/2020 11:04 AM |
Contacts | Primary Contact | Update | Recertification | Cabrera, Manuel
Office Manager
Families Together of Orange County
7149138631 | Sahakian, Izabella
Clinic Manager
Families Together of Orange County
7146659890 | 2/10/2020 11:04 AM |
Details | Last Recertification Date | Update | Recertification | | 2/10/2020 11:04:02 AM | 2/10/2020 11:04 AM |
Details | State | Update | | Approved | Active | 10/1/2019 12:04 AM |
Contacts | Signed By | Insert | New Registration | | Rossel, Alexander
CEO
Families Together of Orange County
7146659890 | 8/5/2019 11:26 AM |
Details | 340B ID | Update | New Registration | | FQHCLA347B | 8/5/2019 11:26 AM |
Dates | Participating Approval Date | Update | New Registration | | 8/5/2019 11:26:30 AM | 8/5/2019 11:26 AM |
Details | State | Update | New Registration | Pending | Approved | 8/5/2019 11:26 AM |
Dates | Signed By Date | Update | New Registration | | 7/12/2019 6:32:42 PM | 8/5/2019 11:26 AM |
Dates | Start Date | Update | New Registration | | 10/1/2019 12:00:00 AM | 8/5/2019 11:26 AM |
Addresses | Main Address | Insert | New Registration | |
9918 Katella Ave. STE A
Garden Grove, CA 92804-6419 | 7/12/2019 6:32 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1194122457 | 7/12/2019 6:32 PM |
Contacts | Primary Contact | Insert | New Registration | | Cabrera, Manuel
Office Manager
Families Together of Orange County
7149138631 | 7/12/2019 6:32 PM |
Contacts | Authorizing Official | Insert | New Registration | | Rossel, Alexander
CEO
Families Together of Orange County
7146659890 | 7/12/2019 6:32 PM |
Details | Last Recertification Date | Insert | New Registration | | | 7/12/2019 6:32 PM |
Details | Grant Number | Insert | New Registration | | LALCS00186 | 7/12/2019 6:32 PM |
Details | 340B ID | Insert | New Registration | | | 7/12/2019 6:32 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 7/12/2019 6:32 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 7/12/2019 6:32 PM |
Details | Medicare Provider Number | Insert | New Registration | | | 7/12/2019 6:32 PM |
Details | Entity Name | Insert | New Registration | | Families Together Of Orange County | 7/12/2019 6:32 PM |
Details | Program Code | Insert | New Registration | | FQHCLA | 7/12/2019 6:32 PM |
Details | Entity Subname | Insert | New Registration | | Families Together of Orange County - Garden Grove | 7/12/2019 6:32 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 7/12/2019 6:32 PM |
Details | State | Insert | New Registration | | Pending | 7/12/2019 6:32 PM |
Dates | Registration Date | Insert | New Registration | | 7/12/2019 6:32:40 PM | 7/12/2019 6:32 PM |
Dates | Signed By Date | Insert | New Registration | | | 7/12/2019 6:32 PM |
Dates | Start Date | Insert | New Registration | | | 7/12/2019 6:32 PM |
Terminations | Termination Comments | Insert | New Registration | | | 7/12/2019 6:32 PM |
Terminations | Termination Date | Insert | New Registration | | | 7/12/2019 6:32 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 7/12/2019 6:32 PM |
Terminations | Termination Reason | Insert | New Registration | | | 7/12/2019 6:32 PM |