Covered Entity Details

FQHCLA397 Health Service Alliance (Active) - information as of 6/8/2025 12:56:41 AM

Main Details

Name

Health Service Alliance

Subdivision Name

Chino Valley Community Health Center

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-028006

340B ID

FQHCLA397

Grant Number

LALCS33333

Additional Details

Current Program Status

Active

Registration Date

9/9/2019

Participating Start Date

10/1/2019

Participating Approval Date

9/10/2019

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Health Service Alliance
Jeff Cox, Chief Executive Officer
(909) 784-6117

Primary Contact

Health Service Alliance
Christen Grelling, Chief Operations Officer
(909) 464-9675 Ext: 104

Addresses

Street Address

13193 Central Ave STE 100
Chino, CA 91710

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	921185	1801307368

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ABC PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786-3782	10/14/2020	01/01/2021		01/01/2021
Contract Detail	ABC PHARMACY	7974 HAVEN AVE STE 120	NDCBU #166	RANCHO CUCAMONGA	CA	91730	10/04/2021	10/04/2021		10/04/2021
Contract Detail	ABC PHARMACY	3907 CHICAGO AVE STE A		RIVERSIDE	CA	92507	10/04/2021	10/04/2021		10/04/2021
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/15/2024	07/01/2024		07/01/2024
Contract Detail	APPLE PHARMACY INC	DBA ABC PHARMACY	5050 SAN BERNARDINO ST STE 110	MONTCLAIR	CA	91763	09/17/2019	10/01/2019		10/01/2019
Contract Detail	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	04/09/2025	07/01/2025		04/09/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	04/09/2025	07/01/2025		04/09/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/09/2025	07/01/2025		04/09/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/09/2025	07/01/2025		04/09/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	04/09/2025	07/01/2025		04/09/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	04/09/2025	07/01/2025		04/09/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	04/09/2025	07/01/2025		04/09/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	04/09/2025	07/01/2025		04/09/2025
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/15/2024	07/01/2024		07/01/2024
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/15/2024	07/01/2024		07/01/2024
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	04/09/2025	07/01/2025		04/09/2025
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09778	12101 CENTRAL AVE.	CHINO	CA	91710	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09816	3290 CHINO HILLS PARKWAY	CHINO HILLS	CA	91709	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09792	690 EAST FOOTHILL BLVD.	UPLAND	CA	91786	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09698	100 W. FOOTHILL BLVD.	UPLAND	CA	91786	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16338	3944 GRAND AVE	CHINO	CA	91710	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09727	2456 S GROVE AVE	ONTARIO	CA	91761	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09745	4535 HOLT BLVD	MONTCLAIR	CA	91763	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09729	2238 S. EUCLID AVE., SUITE A	ONTARIO	CA	91762	07/15/2022	10/01/2022		10/01/2022
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09723	11428 KENYON WAY	RANCHO CUCAMONGA	CA	91701	04/15/2024	07/01/2024		07/01/2024
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10914	8956 FOOTHILL BLVD	RANCHO CUCAMONGA	CA	91730	07/16/2024	10/01/2024		10/01/2024
Contract Detail	GENOA HEALTHCARE LLC	2008 N GAREY AVE, SUITE 1A AND 1B		POMONA	CA	91767	10/12/2023	01/01/2024		01/01/2024
Contract Detail	GENOA HEALTHCARE LLC	17782 COWAN ST STE G		IRVINE	CA	92614	10/12/2023	01/01/2024		01/01/2024
Contract Detail	HENDRICKS PHARMACY	HENDRICKS PHARMACY	137 N HARVARD AVE	CLAREMONT	CA	91711	09/17/2019	10/01/2019	05/01/2021	07/16/2021
Contract Detail	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09837	311 S MOUNTAIN AVE	UPLAND	CA	91786	07/15/2022	10/01/2022		10/01/2022
Contract Detail	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09190	1299 E ONTARIO AVE	CORONA	CA	92881	04/09/2025	07/01/2025		04/09/2025
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 120		LAS VEGAS	NV	89118	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM FRONTIER THERAPIES, LLC	325 W ATHERTON RD	SUITE 1	FLINT	MI	48507-2601	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/12/2023	01/01/2024		01/01/2024
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/15/2024	07/01/2024		07/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/15/2024	07/01/2024		07/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/15/2024	07/01/2024		07/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2919	126 EIGHTH AVE.	NEW YORK	NY	10011	04/15/2024	07/01/2024		07/01/2024
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/09/2025	07/01/2025		04/09/2025
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/09/2025	07/01/2025		04/09/2025
Contract Detail	ROYALTY PHARMACY	ROYALTY PHARMACY	1902 ROYALTY DR. STE 110	POMONA	CA	91767-3036	09/17/2019	10/01/2019	05/01/2021	07/16/2021
Contract Detail	SANTA BARBARA SPECIALTY PHARMACY	SANTA BARBARA SPECIALTY PHARMACY LLC DBA	4690 CARPINTERIA AVE STE B	CARPINTERIA	CA	93013-1875	04/09/2025	07/01/2025		04/09/2025
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #6468	7339 MILLIKEN AVE SUITE 110	RANCHO CUCAMONGA	CA	91730	04/15/2024	07/01/2024		07/01/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5602	1841 EAST 4TH STREET	ONTARIO	CA	91764	04/15/2024	07/01/2024		07/01/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5587	8760 19TH STREET	RANCHO CUCAMONGA	CA	91701	04/15/2024	07/01/2024		07/01/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #6338	2059 SOUTH GAREY AVENUE	POMONA	CA	91766	04/15/2024	07/01/2024		07/01/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5694	1133 N.MOUNT VERNON AVE.	COLTON	CA	92324	04/15/2024	07/01/2024		07/01/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5600	1050 NORTH MOUNTAIN AVENUE	ONTARIO	CA	91762	04/15/2024	07/01/2024		07/01/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #6492	15890 SOQUEL CANYON PARKWAY	CHINO HILLS	CA	91709	04/15/2025	07/01/2025		04/15/2025
Contract Detail	UPLAND PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786	10/15/2024	01/01/2025		01/01/2025
Contract Detail	VIP PHARMACY INC	DBA VIP PHARMACY	13193 CENTRAL AVE STE 120	CHINO	CA	91710	09/17/2019	10/01/2019		10/01/2019
Contract Detail	WAL-MART PHARMACY 10-1941	1950 AUTO CENTER DR		GLENDORA	CA	91740	10/15/2024	01/01/2025		01/01/2025
Contract Detail	WAL-MART PHARMACY 10-2292	1275 NORTH AZUSA AVENUE		COVINA	CA	91722	10/15/2024	01/01/2025		01/01/2025
Contract Detail	WAL-MART PHARMACY 10-3464	3943 GRAND AVENUE		CHINO	CA	91710	10/15/2024	01/01/2025		01/01/2025
Contract Detail	WAL-MART PHARMACY 10-3796	1333 NORTH MOUNTAIN AVENUE		ONTARIO	CA	91762-1105	10/15/2024	01/01/2025		01/01/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
FQHCLA397	Active	BPS-LAL-028006	Health Service Alliance	Chino Valley Community Health Center	13193 Central Ave STE 100	Chino	CA
FQHCLA397A	Active	BPS-LAL-028007	Health Service Alliance	Montclair Community Health Center	5050 San Bernardino St	Montclair	CA
FQHCLA397B	Active	BPS-LAL-032465	Health Service Alliance	Health Service Alliance	9804 Foothill Blvd	Rancho Cucamonga	CA
FQHCLA397C	Active	BPS-LAL-036867	Health Service Alliance	Rancho Cucamonga Community Health Center	10837 Laurel St, Ste 204	Rancho Cucamonga	CA
FQHCLA397D	Active	BPS-LAL-035964	Health Service Alliance	Alta Loma Community Health Center	9089 Baseline Road STE 200	Rancho Cucamonga	CA
FQHCLA397E	Active	BPS-LAL-035246	Health Service Alliance	Palm Desert Community Health Center	41990 Cook St STE F-2002	Palm Desert	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA397	ABC PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786-3782	01/01/2021
FQHCLA397A	ABC PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786-3782	01/01/2021
FQHCLA397A	ABC PHARMACY	7974 HAVEN AVE STE 120	NDCBU #166	RANCHO CUCAMONGA	CA	91730	10/01/2021
FQHCLA397A	ABC PHARMACY	3907 CHICAGO AVE STE A		RIVERSIDE	CA	92507	10/01/2021
FQHCLA397B	ABC PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786-3782	01/01/2022
FQHCLA397B	ABC PHARMACY	3907 CHICAGO AVE STE A		RIVERSIDE	CA	92507	01/01/2022
FQHCLA397	ABC PHARMACY	7974 HAVEN AVE STE 120	NDCBU #166	RANCHO CUCAMONGA	CA	91730	10/04/2021
FQHCLA397	ABC PHARMACY	3907 CHICAGO AVE STE A		RIVERSIDE	CA	92507	10/04/2021
FQHCLA397B	ABC PHARMACY	7974 HAVEN AVE STE 120	NDCBU #166	RANCHO CUCAMONGA	CA	91730	01/01/2022
FQHCLA397C	ABC PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786-3782	07/01/2025
FQHCLA397C	ABC PHARMACY	3907 CHICAGO AVE STE A		RIVERSIDE	CA	92507	07/01/2025
FQHCLA397C	ABC PHARMACY	7974 HAVEN AVE STE 120	NDCBU #166	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397D	ABC PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786-3782	07/01/2025
FQHCLA397D	ABC PHARMACY	7974 HAVEN AVE STE 120	NDCBU #166	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397D	ABC PHARMACY	3907 CHICAGO AVE STE A		RIVERSIDE	CA	92507	07/01/2025
FQHCLA397E	ABC PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786-3782	07/01/2025
FQHCLA397E	ABC PHARMACY	7974 HAVEN AVE STE 120	NDCBU #166	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397E	ABC PHARMACY	3907 CHICAGO AVE STE A		RIVERSIDE	CA	92507	07/01/2025
FQHCLA397	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2024
FQHCLA397C	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2025
FQHCLA397D	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2025
FQHCLA397E	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2025
FQHCLA397A	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2025
FQHCLA397B	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2025
FQHCLA397	APPLE PHARMACY INC	DBA ABC PHARMACY	5050 SAN BERNARDINO ST STE 110	MONTCLAIR	CA	91763	10/01/2019
FQHCLA397A	APPLE PHARMACY INC	DBA ABC PHARMACY	5050 SAN BERNARDINO ST STE 110	MONTCLAIR	CA	91763	10/01/2019
FQHCLA397B	APPLE PHARMACY INC	DBA ABC PHARMACY	5050 SAN BERNARDINO ST STE 110	MONTCLAIR	CA	91763	01/01/2022
FQHCLA397C	APPLE PHARMACY INC	DBA ABC PHARMACY	5050 SAN BERNARDINO ST STE 110	MONTCLAIR	CA	91763	07/01/2025
FQHCLA397D	APPLE PHARMACY INC	DBA ABC PHARMACY	5050 SAN BERNARDINO ST STE 110	MONTCLAIR	CA	91763	07/01/2025
FQHCLA397E	APPLE PHARMACY INC	DBA ABC PHARMACY	5050 SAN BERNARDINO ST STE 110	MONTCLAIR	CA	91763	07/01/2025
FQHCLA397	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2025
FQHCLA397C	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2025
FQHCLA397D	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2025
FQHCLA397E	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2025
FQHCLA397B	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2025
FQHCLA397A	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2025
FQHCLA397	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/01/2025
FQHCLA397C	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/01/2025
FQHCLA397D	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/01/2025
FQHCLA397E	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/01/2025
FQHCLA397B	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/01/2025
FQHCLA397A	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/01/2025
FQHCLA397	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2025
FQHCLA397	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2025
FQHCLA397	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2025
FQHCLA397	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2025
FQHCLA397	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2025
FQHCLA397C	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2025
FQHCLA397C	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2025
FQHCLA397C	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2025
FQHCLA397C	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2025
FQHCLA397C	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2025
FQHCLA397D	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2025
FQHCLA397D	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2025
FQHCLA397D	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2025
FQHCLA397D	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2025
FQHCLA397D	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2025
FQHCLA397E	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2025
FQHCLA397E	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2025
FQHCLA397E	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2025
FQHCLA397E	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2025
FQHCLA397E	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2025
FQHCLA397A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2025
FQHCLA397B	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2025
FQHCLA397B	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2025
FQHCLA397B	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2025
FQHCLA397B	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2025
FQHCLA397B	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2025
FQHCLA397A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2025
FQHCLA397A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2025
FQHCLA397A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2025
FQHCLA397A	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2025
FQHCLA397	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/01/2025
FQHCLA397C	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/01/2025
FQHCLA397D	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/01/2025
FQHCLA397E	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/01/2025
FQHCLA397B	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/01/2025
FQHCLA397A	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/01/2025
FQHCLA397	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2024
FQHCLA397C	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2025
FQHCLA397D	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2025
FQHCLA397E	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2025
FQHCLA397A	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2025
FQHCLA397B	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2025
FQHCLA397	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2024
FQHCLA397C	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2025
FQHCLA397D	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2025
FQHCLA397E	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2025
FQHCLA397A	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2025
FQHCLA397B	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2025
FQHCLA397	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2024
FQHCLA397C	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2025
FQHCLA397D	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2025
FQHCLA397E	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2025
FQHCLA397A	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2025
FQHCLA397B	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2025
FQHCLA397	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2024
FQHCLA397C	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2025
FQHCLA397D	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2025
FQHCLA397E	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2025
FQHCLA397A	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2025
FQHCLA397B	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2025
FQHCLA397	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2024
FQHCLA397C	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2025
FQHCLA397D	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2025
FQHCLA397E	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2025
FQHCLA397A	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2025
FQHCLA397B	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2025
FQHCLA397	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2024
FQHCLA397C	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
FQHCLA397D	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
FQHCLA397E	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
FQHCLA397A	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
FQHCLA397B	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2025
FQHCLA397	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2024
FQHCLA397D	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2025
FQHCLA397E	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2025
FQHCLA397A	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2025
FQHCLA397B	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2025
FQHCLA397C	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2025
FQHCLA397	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2024
FQHCLA397A	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2025
FQHCLA397B	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2025
FQHCLA397D	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2025
FQHCLA397E	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2025
FQHCLA397	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2024
FQHCLA397A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2025
FQHCLA397B	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2025
FQHCLA397C	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2025
FQHCLA397	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2024
FQHCLA397A	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2025
FQHCLA397B	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2025
FQHCLA397C	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2025
FQHCLA397	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2024
FQHCLA397D	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2025
FQHCLA397A	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2025
FQHCLA397B	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2025
FQHCLA397	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2024
FQHCLA397A	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2025
FQHCLA397B	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2025
FQHCLA397D	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2025
FQHCLA397	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2024
FQHCLA397A	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2025
FQHCLA397B	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2025
FQHCLA397	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2025
FQHCLA397A	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2025
FQHCLA397B	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2025
FQHCLA397E	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2025
FQHCLA397D	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2025
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09778	12101 CENTRAL AVE.	CHINO	CA	91710	10/01/2022
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09816	3290 CHINO HILLS PARKWAY	CHINO HILLS	CA	91709	10/01/2022
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09792	690 EAST FOOTHILL BLVD.	UPLAND	CA	91786	10/01/2022
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09698	100 W. FOOTHILL BLVD.	UPLAND	CA	91786	10/01/2022
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16338	3944 GRAND AVE	CHINO	CA	91710	10/01/2022
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09727	2456 S GROVE AVE	ONTARIO	CA	91761	10/01/2022
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09745	4535 HOLT BLVD	MONTCLAIR	CA	91763	10/01/2022
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09729	2238 S. EUCLID AVE., SUITE A	ONTARIO	CA	91762	10/01/2022
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09816	3290 CHINO HILLS PARKWAY	CHINO HILLS	CA	91709	01/01/2024
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09778	12101 CENTRAL AVE.	CHINO	CA	91710	01/01/2024
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09727	2456 S GROVE AVE	ONTARIO	CA	91761	01/01/2024
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09729	2238 S. EUCLID AVE., SUITE A	ONTARIO	CA	91762	01/01/2024
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09745	4535 HOLT BLVD	MONTCLAIR	CA	91763	01/01/2024
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09698	100 W. FOOTHILL BLVD.	UPLAND	CA	91786	01/01/2024
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09792	690 EAST FOOTHILL BLVD.	UPLAND	CA	91786	01/01/2024
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16338	3944 GRAND AVE	CHINO	CA	91710	01/01/2024
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09816	3290 CHINO HILLS PARKWAY	CHINO HILLS	CA	91709	01/01/2024
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09778	12101 CENTRAL AVE.	CHINO	CA	91710	01/01/2024
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09727	2456 S GROVE AVE	ONTARIO	CA	91761	01/01/2024
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09729	2238 S. EUCLID AVE., SUITE A	ONTARIO	CA	91762	01/01/2024
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09745	4535 HOLT BLVD	MONTCLAIR	CA	91763	01/01/2024
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09698	100 W. FOOTHILL BLVD.	UPLAND	CA	91786	01/01/2024
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09792	690 EAST FOOTHILL BLVD.	UPLAND	CA	91786	01/01/2024
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16338	3944 GRAND AVE	CHINO	CA	91710	01/01/2024
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09723	11428 KENYON WAY	RANCHO CUCAMONGA	CA	91701	07/01/2024
FQHCLA397	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10914	8956 FOOTHILL BLVD	RANCHO CUCAMONGA	CA	91730	10/01/2024
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09723	11428 KENYON WAY	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397A	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10914	8956 FOOTHILL BLVD	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10914	8956 FOOTHILL BLVD	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397B	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09723	11428 KENYON WAY	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09698	100 W. FOOTHILL BLVD.	UPLAND	CA	91786	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10914	8956 FOOTHILL BLVD	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09745	4535 HOLT BLVD	MONTCLAIR	CA	91763	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09778	12101 CENTRAL AVE.	CHINO	CA	91710	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09729	2238 S. EUCLID AVE., SUITE A	ONTARIO	CA	91762	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09792	690 EAST FOOTHILL BLVD.	UPLAND	CA	91786	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09816	3290 CHINO HILLS PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09723	11428 KENYON WAY	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09727	2456 S GROVE AVE	ONTARIO	CA	91761	07/01/2025
FQHCLA397C	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16338	3944 GRAND AVE	CHINO	CA	91710	07/01/2025
FQHCLA397E	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09698	100 W. FOOTHILL BLVD.	UPLAND	CA	91786	07/01/2025
FQHCLA397E	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09729	2238 S. EUCLID AVE., SUITE A	ONTARIO	CA	91762	07/01/2025
FQHCLA397D	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09778	12101 CENTRAL AVE.	CHINO	CA	91710	07/01/2025
FQHCLA397E	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16338	3944 GRAND AVE	CHINO	CA	91710	07/01/2025
FQHCLA397D	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09727	2456 S GROVE AVE	ONTARIO	CA	91761	07/01/2025
FQHCLA397D	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09698	100 W. FOOTHILL BLVD.	UPLAND	CA	91786	07/01/2025
FQHCLA397D	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09816	3290 CHINO HILLS PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397E	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09723	11428 KENYON WAY	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397E	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09792	690 EAST FOOTHILL BLVD.	UPLAND	CA	91786	07/01/2025
FQHCLA397E	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09816	3290 CHINO HILLS PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397E	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09745	4535 HOLT BLVD	MONTCLAIR	CA	91763	07/01/2025
FQHCLA397D	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10914	8956 FOOTHILL BLVD	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397	GENOA HEALTHCARE LLC	2008 N GAREY AVE, SUITE 1A AND 1B		POMONA	CA	91767	01/01/2024
FQHCLA397	GENOA HEALTHCARE LLC	17782 COWAN ST STE G		IRVINE	CA	92614	01/01/2024
FQHCLA397A	GENOA HEALTHCARE LLC	17782 COWAN ST STE G		IRVINE	CA	92614	01/01/2024
FQHCLA397A	GENOA HEALTHCARE LLC	2008 N GAREY AVE, SUITE 1A AND 1B		POMONA	CA	91767	01/01/2024
FQHCLA397B	GENOA HEALTHCARE LLC	17782 COWAN ST STE G		IRVINE	CA	92614	01/01/2024
FQHCLA397B	GENOA HEALTHCARE LLC	2008 N GAREY AVE, SUITE 1A AND 1B		POMONA	CA	91767	01/01/2024
FQHCLA397E	GENOA HEALTHCARE LLC	17782 COWAN ST STE G		IRVINE	CA	92614	07/01/2025
FQHCLA397E	GENOA HEALTHCARE LLC	2008 N GAREY AVE, SUITE 1A AND 1B		POMONA	CA	91767	07/01/2025
FQHCLA397D	GENOA HEALTHCARE LLC	2008 N GAREY AVE, SUITE 1A AND 1B		POMONA	CA	91767	07/01/2025
FQHCLA397	HENDRICKS PHARMACY	HENDRICKS PHARMACY	137 N HARVARD AVE	CLAREMONT	CA	91711	10/01/2019	05/01/2021
FQHCLA397A	HENDRICKS PHARMACY	HENDRICKS PHARMACY	137 N HARVARD AVE	CLAREMONT	CA	91711	10/01/2019
FQHCLA397	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09837	311 S MOUNTAIN AVE	UPLAND	CA	91786	10/01/2022
FQHCLA397A	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09837	311 S MOUNTAIN AVE	UPLAND	CA	91786	01/01/2024
FQHCLA397B	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09837	311 S MOUNTAIN AVE	UPLAND	CA	91786	01/01/2024
FQHCLA397	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09190	1299 E ONTARIO AVE	CORONA	CA	92881	07/01/2025
FQHCLA397A	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09190	1299 E ONTARIO AVE	CORONA	CA	92881	07/01/2025
FQHCLA397B	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09190	1299 E ONTARIO AVE	CORONA	CA	92881	07/01/2025
FQHCLA397C	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09837	311 S MOUNTAIN AVE	UPLAND	CA	91786	07/01/2025
FQHCLA397C	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09190	1299 E ONTARIO AVE	CORONA	CA	92881	07/01/2025
FQHCLA397E	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09190	1299 E ONTARIO AVE	CORONA	CA	92881	07/01/2025
FQHCLA397	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	01/01/2024
FQHCLA397	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 120		LAS VEGAS	NV	89118	01/01/2024
FQHCLA397A	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	01/01/2024
FQHCLA397A	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 120		LAS VEGAS	NV	89118	01/01/2024
FQHCLA397B	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	01/01/2024
FQHCLA397B	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 120		LAS VEGAS	NV	89118	01/01/2024
FQHCLA397E	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	07/01/2025
FQHCLA397C	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 120		LAS VEGAS	NV	89118	07/01/2025
FQHCLA397D	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	07/01/2025
FQHCLA397	OPTUM FRONTIER THERAPIES, LLC	325 W ATHERTON RD	SUITE 1	FLINT	MI	48507-2601	01/01/2024
FQHCLA397A	OPTUM FRONTIER THERAPIES, LLC	325 W ATHERTON RD	SUITE 1	FLINT	MI	48507-2601	01/01/2024
FQHCLA397B	OPTUM FRONTIER THERAPIES, LLC	325 W ATHERTON RD	SUITE 1	FLINT	MI	48507-2601	01/01/2024
FQHCLA397C	OPTUM FRONTIER THERAPIES, LLC	325 W ATHERTON RD	SUITE 1	FLINT	MI	48507-2601	07/01/2025
FQHCLA397	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	01/01/2024
FQHCLA397	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/01/2024
FQHCLA397	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
FQHCLA397A	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	01/01/2024
FQHCLA397A	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/01/2024
FQHCLA397A	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
FQHCLA397B	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	01/01/2024
FQHCLA397B	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/01/2024
FQHCLA397B	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
FQHCLA397C	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	07/01/2025
FQHCLA397C	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	07/01/2025
FQHCLA397D	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	07/01/2025
FQHCLA397D	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/01/2025
FQHCLA397	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
FQHCLA397A	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
FQHCLA397B	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2024
FQHCLA397C	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2025
FQHCLA397	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	01/01/2024
FQHCLA397A	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	01/01/2024
FQHCLA397B	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	01/01/2024
FQHCLA397C	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	07/01/2025
FQHCLA397	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/01/2024
FQHCLA397A	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/01/2024
FQHCLA397B	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/01/2024
FQHCLA397C	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/01/2025
FQHCLA397E	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/01/2025
FQHCLA397	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
FQHCLA397A	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
FQHCLA397B	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2024
FQHCLA397C	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/01/2025
FQHCLA397E	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/01/2025
FQHCLA397	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
FQHCLA397A	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
FQHCLA397B	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/01/2024
FQHCLA397	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
FQHCLA397A	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
FQHCLA397B	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
FQHCLA397C	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2025
FQHCLA397	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2024
FQHCLA397A	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2025
FQHCLA397B	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2025
FQHCLA397C	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2025
FQHCLA397E	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2025
FQHCLA397	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2024
FQHCLA397	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2024
FQHCLA397	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2919	126 EIGHTH AVE.	NEW YORK	NY	10011	07/01/2024
FQHCLA397A	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2919	126 EIGHTH AVE.	NEW YORK	NY	10011	07/01/2025
FQHCLA397A	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2025
FQHCLA397A	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2025
FQHCLA397B	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2025
FQHCLA397B	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2025
FQHCLA397B	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2919	126 EIGHTH AVE.	NEW YORK	NY	10011	07/01/2025
FQHCLA397C	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2919	126 EIGHTH AVE.	NEW YORK	NY	10011	07/01/2025
FQHCLA397C	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2025
FQHCLA397C	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2025
FQHCLA397	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2025
FQHCLA397A	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2025
FQHCLA397B	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2025
FQHCLA397D	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2025
FQHCLA397	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2025
FQHCLA397A	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2025
FQHCLA397B	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2025
FQHCLA397C	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2025
FQHCLA397D	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2025
FQHCLA397E	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2025
FQHCLA397	ROYALTY PHARMACY	ROYALTY PHARMACY	1902 ROYALTY DR. STE 110	POMONA	CA	91767-3036	10/01/2019	05/01/2021
FQHCLA397A	ROYALTY PHARMACY	ROYALTY PHARMACY	1902 ROYALTY DR. STE 110	POMONA	CA	91767-3036	10/01/2019
FQHCLA397	SANTA BARBARA SPECIALTY PHARMACY	SANTA BARBARA SPECIALTY PHARMACY LLC DBA	4690 CARPINTERIA AVE STE B	CARPINTERIA	CA	93013-1875	07/01/2025
FQHCLA397A	SANTA BARBARA SPECIALTY PHARMACY	SANTA BARBARA SPECIALTY PHARMACY LLC DBA	4690 CARPINTERIA AVE STE B	CARPINTERIA	CA	93013-1875	07/01/2025
FQHCLA397B	SANTA BARBARA SPECIALTY PHARMACY	SANTA BARBARA SPECIALTY PHARMACY LLC DBA	4690 CARPINTERIA AVE STE B	CARPINTERIA	CA	93013-1875	07/01/2025
FQHCLA397D	SANTA BARBARA SPECIALTY PHARMACY	SANTA BARBARA SPECIALTY PHARMACY LLC DBA	4690 CARPINTERIA AVE STE B	CARPINTERIA	CA	93013-1875	07/01/2025
FQHCLA397C	SANTA BARBARA SPECIALTY PHARMACY	SANTA BARBARA SPECIALTY PHARMACY LLC DBA	4690 CARPINTERIA AVE STE B	CARPINTERIA	CA	93013-1875	07/01/2025
FQHCLA397	THRIFTY PAYLESS, INC.	RITE AID #6468	7339 MILLIKEN AVE SUITE 110	RANCHO CUCAMONGA	CA	91730	07/01/2024
FQHCLA397	THRIFTY PAYLESS, INC.	RITE AID #5602	1841 EAST 4TH STREET	ONTARIO	CA	91764	07/01/2024
FQHCLA397	THRIFTY PAYLESS, INC.	RITE AID #5587	8760 19TH STREET	RANCHO CUCAMONGA	CA	91701	07/01/2024
FQHCLA397	THRIFTY PAYLESS, INC.	RITE AID #6338	2059 SOUTH GAREY AVENUE	POMONA	CA	91766	07/01/2024
FQHCLA397	THRIFTY PAYLESS, INC.	RITE AID #5694	1133 N.MOUNT VERNON AVE.	COLTON	CA	92324	07/01/2024
FQHCLA397	THRIFTY PAYLESS, INC.	RITE AID #5600	1050 NORTH MOUNTAIN AVENUE	ONTARIO	CA	91762	07/01/2024
FQHCLA397	THRIFTY PAYLESS, INC.	RITE AID #6492	15890 SOQUEL CANYON PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397A	THRIFTY PAYLESS, INC.	RITE AID #5694	1133 N.MOUNT VERNON AVE.	COLTON	CA	92324	07/01/2025
FQHCLA397A	THRIFTY PAYLESS, INC.	RITE AID #6338	2059 SOUTH GAREY AVENUE	POMONA	CA	91766	07/01/2025
FQHCLA397A	THRIFTY PAYLESS, INC.	RITE AID #5602	1841 EAST 4TH STREET	ONTARIO	CA	91764	07/01/2025
FQHCLA397A	THRIFTY PAYLESS, INC.	RITE AID #5600	1050 NORTH MOUNTAIN AVENUE	ONTARIO	CA	91762	07/01/2025
FQHCLA397A	THRIFTY PAYLESS, INC.	RITE AID #6468	7339 MILLIKEN AVE SUITE 110	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397A	THRIFTY PAYLESS, INC.	RITE AID #6492	15890 SOQUEL CANYON PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397A	THRIFTY PAYLESS, INC.	RITE AID #5587	8760 19TH STREET	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397B	THRIFTY PAYLESS, INC.	RITE AID #5694	1133 N.MOUNT VERNON AVE.	COLTON	CA	92324	07/01/2025
FQHCLA397B	THRIFTY PAYLESS, INC.	RITE AID #6338	2059 SOUTH GAREY AVENUE	POMONA	CA	91766	07/01/2025
FQHCLA397B	THRIFTY PAYLESS, INC.	RITE AID #5602	1841 EAST 4TH STREET	ONTARIO	CA	91764	07/01/2025
FQHCLA397B	THRIFTY PAYLESS, INC.	RITE AID #5600	1050 NORTH MOUNTAIN AVENUE	ONTARIO	CA	91762	07/01/2025
FQHCLA397B	THRIFTY PAYLESS, INC.	RITE AID #6468	7339 MILLIKEN AVE SUITE 110	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397B	THRIFTY PAYLESS, INC.	RITE AID #6492	15890 SOQUEL CANYON PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397B	THRIFTY PAYLESS, INC.	RITE AID #5587	8760 19TH STREET	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397C	THRIFTY PAYLESS, INC.	RITE AID #5694	1133 N.MOUNT VERNON AVE.	COLTON	CA	92324	07/01/2025
FQHCLA397C	THRIFTY PAYLESS, INC.	RITE AID #5602	1841 EAST 4TH STREET	ONTARIO	CA	91764	07/01/2025
FQHCLA397C	THRIFTY PAYLESS, INC.	RITE AID #6468	7339 MILLIKEN AVE SUITE 110	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397C	THRIFTY PAYLESS, INC.	RITE AID #5600	1050 NORTH MOUNTAIN AVENUE	ONTARIO	CA	91762	07/01/2025
FQHCLA397D	THRIFTY PAYLESS, INC.	RITE AID #6492	15890 SOQUEL CANYON PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397C	THRIFTY PAYLESS, INC.	RITE AID #6338	2059 SOUTH GAREY AVENUE	POMONA	CA	91766	07/01/2025
FQHCLA397C	THRIFTY PAYLESS, INC.	RITE AID #6492	15890 SOQUEL CANYON PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397C	THRIFTY PAYLESS, INC.	RITE AID #5587	8760 19TH STREET	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397D	THRIFTY PAYLESS, INC.	RITE AID #5600	1050 NORTH MOUNTAIN AVENUE	ONTARIO	CA	91762	07/01/2025
FQHCLA397D	THRIFTY PAYLESS, INC.	RITE AID #5587	8760 19TH STREET	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397D	THRIFTY PAYLESS, INC.	RITE AID #6468	7339 MILLIKEN AVE SUITE 110	RANCHO CUCAMONGA	CA	91730	07/01/2025
FQHCLA397E	THRIFTY PAYLESS, INC.	RITE AID #6338	2059 SOUTH GAREY AVENUE	POMONA	CA	91766	07/01/2025
FQHCLA397E	THRIFTY PAYLESS, INC.	RITE AID #6492	15890 SOQUEL CANYON PARKWAY	CHINO HILLS	CA	91709	07/01/2025
FQHCLA397E	THRIFTY PAYLESS, INC.	RITE AID #5587	8760 19TH STREET	RANCHO CUCAMONGA	CA	91701	07/01/2025
FQHCLA397	UPLAND PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786	01/01/2025
FQHCLA397A	UPLAND PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786	07/01/2025
FQHCLA397B	UPLAND PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786	07/01/2025
FQHCLA397C	UPLAND PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786	07/01/2025
FQHCLA397D	UPLAND PHARMACY	954 W FOOTHILL BLVD STE 6D		UPLAND	CA	91786	07/01/2025
FQHCLA397	VIP PHARMACY INC	DBA VIP PHARMACY	13193 CENTRAL AVE STE 120	CHINO	CA	91710	10/01/2019
FQHCLA397A	VIP PHARMACY INC	DBA VIP PHARMACY	13193 CENTRAL AVE STE 120	CHINO	CA	91710	10/01/2019
FQHCLA397B	VIP PHARMACY INC	DBA VIP PHARMACY	13193 CENTRAL AVE STE 120	CHINO	CA	91710	01/01/2022
FQHCLA397C	VIP PHARMACY INC	DBA VIP PHARMACY	13193 CENTRAL AVE STE 120	CHINO	CA	91710	07/01/2025
FQHCLA397E	VIP PHARMACY INC	DBA VIP PHARMACY	13193 CENTRAL AVE STE 120	CHINO	CA	91710	07/01/2025
FQHCLA397	WAL-MART PHARMACY 10-1941	1950 AUTO CENTER DR		GLENDORA	CA	91740	01/01/2025
FQHCLA397A	WAL-MART PHARMACY 10-1941	1950 AUTO CENTER DR		GLENDORA	CA	91740	07/01/2025
FQHCLA397B	WAL-MART PHARMACY 10-1941	1950 AUTO CENTER DR		GLENDORA	CA	91740	07/01/2025
FQHCLA397C	WAL-MART PHARMACY 10-1941	1950 AUTO CENTER DR		GLENDORA	CA	91740	07/01/2025
FQHCLA397	WAL-MART PHARMACY 10-2292	1275 NORTH AZUSA AVENUE		COVINA	CA	91722	01/01/2025
FQHCLA397A	WAL-MART PHARMACY 10-2292	1275 NORTH AZUSA AVENUE		COVINA	CA	91722	07/01/2025
FQHCLA397B	WAL-MART PHARMACY 10-2292	1275 NORTH AZUSA AVENUE		COVINA	CA	91722	07/01/2025
FQHCLA397C	WAL-MART PHARMACY 10-2292	1275 NORTH AZUSA AVENUE		COVINA	CA	91722	07/01/2025
FQHCLA397E	WAL-MART PHARMACY 10-2292	1275 NORTH AZUSA AVENUE		COVINA	CA	91722	07/01/2025
FQHCLA397	WAL-MART PHARMACY 10-3464	3943 GRAND AVENUE		CHINO	CA	91710	01/01/2025
FQHCLA397A	WAL-MART PHARMACY 10-3464	3943 GRAND AVENUE		CHINO	CA	91710	07/01/2025
FQHCLA397B	WAL-MART PHARMACY 10-3464	3943 GRAND AVENUE		CHINO	CA	91710	07/01/2025
FQHCLA397C	WAL-MART PHARMACY 10-3464	3943 GRAND AVENUE		CHINO	CA	91710	07/01/2025
FQHCLA397	WAL-MART PHARMACY 10-3796	1333 NORTH MOUNTAIN AVENUE		ONTARIO	CA	91762-1105	01/01/2025
FQHCLA397B	WAL-MART PHARMACY 10-3796	1333 NORTH MOUNTAIN AVENUE		ONTARIO	CA	91762-1105	07/01/2025
FQHCLA397A	WAL-MART PHARMACY 10-3796	1333 NORTH MOUNTAIN AVENUE		ONTARIO	CA	91762-1105	07/01/2025
FQHCLA397C	WAL-MART PHARMACY 10-3796	1333 NORTH MOUNTAIN AVENUE		ONTARIO	CA	91762-1105	07/01/2025
FQHCLA397E	WAL-MART PHARMACY 10-3796	1333 NORTH MOUNTAIN AVENUE		ONTARIO	CA	91762-1105	07/01/2025
FQHCLA397D	WAL-MART PHARMACY 10-3796	1333 NORTH MOUNTAIN AVENUE		ONTARIO	CA	91762-1105	07/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 1:16:34 PM	2/11/2025 1:21:36 AM	2/11/2025 1:21 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 9:11:20 PM	2/1/2024 1:16:34 PM	2/1/2024 1:16 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 10:35:16 AM	1/31/2023 9:11:20 PM	1/31/2023 9:11 PM
Details	Last Recertification Date	Update	Recertification	2/6/2021 3:11:14 PM	2/1/2022 10:35:16 AM	2/1/2022 10:35 AM
Contacts	Authorizing Official	Update	Change Request	Chase, Terry Chief Executive Officer Health Service Alliance 9094657193	Cox, Jeff Chief Executive Officer Health Service Alliance 9097846117	7/23/2021 10:09 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/6/2021 3:11 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		921185	2/6/2021 3:11 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	2/6/2021 3:11 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/6/2021 3:11 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 5:54:54 PM	2/6/2021 3:11:14 PM	2/6/2021 3:11 PM
Details	Last Recertification Date	Update	Recertification		1/27/2020 5:54:54 PM	1/27/2020 5:54 PM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		Chase, Terry Chief Executive Officer Health Service Alliance 9094657193	9/10/2019 9:49 AM
Details	340B ID	Update	New Registration		FQHCLA397	9/10/2019 9:49 AM
Dates	Participating Approval Date	Update	New Registration		9/10/2019 9:49:50 AM	9/10/2019 9:49 AM
Details	State	Update	New Registration	Pending	Approved	9/10/2019 9:49 AM
Dates	Signed By Date	Update	New Registration		9/9/2019 4:44:13 PM	9/10/2019 9:49 AM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	9/10/2019 9:49 AM
Addresses	Main Address	Insert	New Registration		13193 Central Ave STE 100 Chino, CA 91710	9/9/2019 4:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1801307368	9/9/2019 4:29 PM
Contacts	Authorizing Official	Insert	New Registration		Chase, Terry Chief Executive Officer Health Service Alliance 9094657193	9/9/2019 4:29 PM
Details	Last Recertification Date	Insert	New Registration			9/9/2019 4:29 PM
Details	Grant Number	Insert	New Registration		LALCS33333	9/9/2019 4:29 PM
Details	340B ID	Insert	New Registration			9/9/2019 4:29 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			9/9/2019 4:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			9/9/2019 4:29 PM
Details	Medicare Provider Number	Insert	New Registration			9/9/2019 4:29 PM
Details	Entity Name	Insert	New Registration		Health Service Alliance	9/9/2019 4:29 PM
Details	Program Code	Insert	New Registration		FQHCLA	9/9/2019 4:29 PM
Details	Entity Subname	Insert	New Registration		Chino Valley Community Health Center	9/9/2019 4:29 PM
Dates	Participating Approval Date	Insert	New Registration			9/9/2019 4:29 PM
Details	State	Insert	New Registration		Pending	9/9/2019 4:29 PM
Dates	Registration Date	Insert	New Registration		9/9/2019 4:29:15 PM	9/9/2019 4:29 PM
Dates	Signed By Date	Insert	New Registration			9/9/2019 4:29 PM
Dates	Start Date	Insert	New Registration			9/9/2019 4:29 PM
Terminations	Termination Comments	Insert	New Registration			9/9/2019 4:29 PM
Terminations	Termination Date	Insert	New Registration			9/9/2019 4:29 PM
Terminations	Termination Effective Date	Insert	New Registration			9/9/2019 4:29 PM
Terminations	Termination Reason	Insert	New Registration			9/9/2019 4:29 PM

340B Drug Pricing Program Database