Covered Entity Details

RWI90010 Special Service for Groups INC (Terminated) - information as of 4/24/2025 10:16:14 PM

Main Details

Name

Special Service for Groups INC

Subdivision Name

APAIT

Type

Ryan White Part A

340B ID

RWI90010

Grant Number

H89HA00016

Additional Details

Current Program Status

Terminated

Registration Date

1/14/2020

Participating Start Date

4/1/2020

Participating Approval Date

3/5/2020

Last Recertification Date

Time Period the Assistance was Received

Termination Date
Termination Reason

4/1/2021
Failure to recertify

Contacts

Authorizing Official

Special Service for Groups, Inc.
Abigail Radaza Proff, Senior Program Manager
(213) 553-1899

Primary Contact

Special Service for Groups, Inc.
Jury Candelario, jcandelario@apaitonline.org
(213) 553-1832

Addresses

Street Address

3055 Wilshire Blvd.
300
Los Angeles, CA 90010

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
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?
No

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	AVITA PHARMACY 1025	PHARMEDQUEST PHARMACY SERVICES DBA AVITA	3020 SATURN ST STE 100	BREA	CA	92821	03/05/2020	04/01/2020	04/09/2020	04/09/2020
Contract Detail	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	03/05/2020	04/01/2020	04/09/2020	04/09/2020
Contract Detail	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	03/05/2020	04/01/2020	04/09/2020	04/09/2020
Contract Detail	PHARMEDQUEST PHARMACY	PHARMEDQUEST PHARMACY SERVICES	451 W. LAMBERT RD STE 209	BREA	CA	92821-9282	03/05/2020	04/01/2020	04/09/2020	04/09/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		3/31/2021 12:00:00 AM	3/9/2021 2:45 PM
Details	State	Update	Recertification	Active	To Be Terminated	3/9/2021 2:45 PM
Terminations	Termination Date	Update	Recertification		4/1/2021 12:00:00 AM	3/9/2021 2:45 PM
Terminations	Termination Effective Date	Update	Recertification		3/31/2021 12:00:00 AM	3/9/2021 2:45 PM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	3/9/2021 2:45 PM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Addresses	Main Address	Insert	New Registration		3055 Wilshire Blvd. 300 Los Angeles, CA 90010	3/5/2020 2:15 PM
Contacts	Signed By	Insert	New Registration		Proff, Abigail Radaza Senior Program Manager Special Service for Groups, Inc. 2135531899	3/5/2020 2:15 PM
Details	Grant Number	Update	New Registration	PH003363	H89HA00016	3/5/2020 2:15 PM
Details	340B ID	Update	New Registration		RWI90010	3/5/2020 2:15 PM
Dates	Participating Approval Date	Update	New Registration		3/5/2020 2:15:52 PM	3/5/2020 2:15 PM
Details	State	Update	New Registration	Pending	Approved	3/5/2020 2:15 PM
Dates	Signed By Date	Update	New Registration		1/28/2020 4:37:25 PM	3/5/2020 2:15 PM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	3/5/2020 2:15 PM
Addresses	Main Address	Insert	New Registration		3055 Wilshire Blvd. 300 Los Angeles, CA 90010	1/14/2020 7:32 PM
Contacts	Authorizing Official	Insert	New Registration		Proff, Abigail Radaza Senior Program Manager Special Service for Groups, Inc. 2135531899	1/14/2020 7:32 PM
Contacts	Primary Contact	Insert	New Registration		Candelario, Jury jcandelario@apaitonline.org Special Service for Groups, Inc. 2135531832	1/14/2020 7:32 PM
Details	Last Recertification Date	Insert	New Registration			1/14/2020 7:32 PM
Details	Grant Number	Insert	New Registration		PH003363	1/14/2020 7:32 PM
Details	340B ID	Insert	New Registration			1/14/2020 7:32 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2020 7:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2020 7:32 PM
Details	Medicare Provider Number	Insert	New Registration			1/14/2020 7:32 PM
Details	Entity Name	Insert	New Registration		Special Service for Groups INC	1/14/2020 7:32 PM
Details	Program Code	Insert	New Registration		RWI	1/14/2020 7:32 PM
Details	Entity Subname	Insert	New Registration		APAIT	1/14/2020 7:32 PM
Dates	Participating Approval Date	Insert	New Registration			1/14/2020 7:32 PM
Details	State	Insert	New Registration		Pending	1/14/2020 7:32 PM
Dates	Registration Date	Insert	New Registration		1/14/2020 7:32:44 PM	1/14/2020 7:32 PM
Dates	Signed By Date	Insert	New Registration			1/14/2020 7:32 PM
Dates	Start Date	Insert	New Registration			1/14/2020 7:32 PM
Terminations	Termination Comments	Insert	New Registration			1/14/2020 7:32 PM
Terminations	Termination Date	Insert	New Registration			1/14/2020 7:32 PM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2020 7:32 PM
Terminations	Termination Reason	Insert	New Registration			1/14/2020 7:32 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History