Covered Entity Details

RWII93401B Access Support Network (Active) - information as of 6/6/2025 12:36:59 PM

Main Details

Name

Access Support Network

Subdivision Name

Monterey

Type

Ryan White Part B

340B ID

RWII93401B

Grant Number

X07HA10954

Additional Details

Current Program Status

Active

Registration Date

4/17/2023

Participating Start Date

5/8/2023

Participating Approval Date

4/19/2023

Last Recertification Date

2/12/2025

Time Period the Assistance was Received

4/1/2024 - 3/31/2026

Contacts

Authorizing Official

Access Support Network
David Kilburn, Executive Director
(805) 781-3660 Ext: 212

Primary Contact

Access Support Network
Elena Salais, Program Compliance Manager
(805) 703-3316

Addresses

Street Address

Montage Medical Group Ryan Ranch Campus
2 Upper Ragsdale Dr. Building A
Monterey, CA 93940

Billing Address

Access Support Network
P.O. Box 12158
San Luis Obispo, CA 93406

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
Participating from effective date: (04/1/2020) until terminated effective date: (04/1/2023), reinstatement effective date: (07/1/2023)	04/19/2023

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	ICARE RX LLC	14447 COUNTRY WALK DR		MIAMI	FL	33186	02/20/2020	04/01/2020	04/01/2023	04/01/2023
Contract Detail	ICARE RX LLC	14447 COUNTRY WALK DR		MIAMI	FL	33186	05/04/2023	07/01/2023		07/01/2023
Contract Detail	PHYSICIAN'S RX PHARMACY, LLC	PHYSICIANS RX PHARMACY, LLC	9701 APOLLO DRIVE #400	LARGO	MD	20774	02/20/2020	04/01/2020	04/01/2023	04/01/2023
Contract Detail	PHYSICIAN'S RX PHARMACY, LLC	PHYSICIANS RX PHARMACY, LLC	9701 APOLLO DRIVE #400	LARGO	MD	20774	05/04/2023	07/01/2023		07/01/2023
Contract Detail	PRXP OF CA LLC	PRXP OF CA LLC	4345 E LOWELL ST STE C & D	ONTARIO	CA	91761	02/20/2020	04/01/2020	04/01/2023	04/01/2023
Contract Detail	PRXP OF CA LLC	PRXP OF CA LLC	4345 E LOWELL ST STE C & D	ONTARIO	CA	91761	05/04/2023	05/08/2023		05/08/2023
Contract Detail	PRXP OF KS LLC	PRXP OF KS LLC	300-340 SOUTHWEST BLVD SUITE 103	KANSAS CITY	KS	66103	02/20/2020	04/01/2020	04/01/2023	04/01/2023
Contract Detail	PRXP OF KS LLC	PRXP OF KS LLC	300-340 SOUTHWEST BLVD SUITE 103	KANSAS CITY	KS	66103	05/04/2023	07/01/2023		07/01/2023
Contract Detail	PRXP OF NEW YORK LLC	DBA BROADWAY FAMILY PHARMACY	601 AMSTERDAM AVE	NEW YORK	NY	10024	02/20/2020	04/01/2020	04/01/2023	04/01/2023
Contract Detail	PRXP OF NEW YORK LLC	DBA BROADWAY FAMILY PHARMACY	601 AMSTERDAM AVE	NEW YORK	NY	10024	05/04/2023	05/08/2023		05/08/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Assistance Received From Date	Update	Recertification	4/1/2023 12:00:00 AM	4/1/2024 12:00:00 AM	2/12/2025 11:23 AM
Details	Assistance Received To Date	Update	Recertification	3/31/2024 12:00:00 AM	3/31/2026 12:00:00 AM	2/12/2025 11:23 AM
Details	Last Recertification Date	Update	Recertification	1/31/2024 2:58:16 AM	2/12/2025 11:23:18 AM	2/12/2025 11:23 AM
Details	Grant Number	Update	Recertification	X07HA12778	X07HA10954	2/12/2025 11:23 AM
Details	Last Recertification Date	Update	Recertification		1/31/2024 2:58:16 AM	1/31/2024 2:58 AM
Details	NOFO Number	Update		HRSA-17-036		12/16/2023 10:34 AM
Details	State	Update	OPA Edit	Approved	Active	5/8/2023 10:05 PM
Dates	Start Date	Update	OPA Edit	7/1/2023 12:00:00 AM	5/8/2023 12:00:00 AM	5/8/2023 10:05 PM
Addresses	Main Address	Insert	Reinstatement		Montage Medical Group Ryan Ranch Campus 2 Upper Ragsdale Dr. Building A Monterey, CA 93940	4/19/2023 9:51 AM
Addresses	Billing Address	Insert	Reinstatement		Access Support Network P.O. Box 12158 San Luis Obispo, CA 93406	4/19/2023 9:51 AM
Details	Assistance Received From Date	Update	Reinstatement	4/1/2020 12:00:00 AM	4/1/2023 12:00:00 AM	4/19/2023 9:51 AM
Details	Assistance Received To Date	Update	Reinstatement	3/31/2021 12:00:00 AM	3/31/2024 12:00:00 AM	4/19/2023 9:51 AM
Details	Last Recertification Date	Update	Reinstatement	2/8/2022 11:08:12 AM		4/19/2023 9:51 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	3/31/2023 12:00:00 AM		4/19/2023 9:51 AM
Dates	Participating Approval Date	Update	Reinstatement	2/20/2020 9:58:23 AM	4/19/2023 9:51:48 AM	4/19/2023 9:51 AM
Details	State	Update	Reinstatement	Terminated	Approved	4/19/2023 9:51 AM
Dates	Registration Date	Update	Reinstatement	1/17/2020 10:18:56 PM	4/17/2023 3:34:12 PM	4/19/2023 9:51 AM
Dates	Signed By Date	Update	Reinstatement	1/17/2020 10:18:58 PM	4/17/2023 3:34:16 PM	4/19/2023 9:51 AM
Dates	Start Date	Update	Reinstatement	4/1/2020 12:00:00 AM	7/1/2023 12:00:00 AM	4/19/2023 9:51 AM
Terminations	Termination Date	Update	Reinstatement	4/1/2023 12:00:00 AM		4/19/2023 9:51 AM
Terminations	Termination Effective Date	Update	Reinstatement	4/1/2023 12:00:00 AM		4/19/2023 9:51 AM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		4/19/2023 9:51 AM
Details	Comments Public	Insert	Reinstatement		Participating from effective date: (04/1/2020) until terminated effective date: (04/1/2023), reinstatement effective date: (07/1/2023)	4/19/2023 9:47 AM
Details	State	Update		To Be Terminated	Terminated	4/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		3/31/2023 12:00:00 AM	3/6/2023 2:16 PM
Details	State	Update	Recertification	Active	To Be Terminated	3/6/2023 2:16 PM
Terminations	Termination Date	Update	Recertification		4/1/2023 12:00:00 AM	3/6/2023 2:16 PM
Terminations	Termination Effective Date	Update	Recertification		4/1/2023 12:00:00 AM	3/6/2023 2:16 PM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	3/6/2023 2:16 PM
Contacts	Primary Contact	Update	Recertification	Gottlieb, Kris Development Director Access Support Network 8057813660-210	Salais, Elena Program Compliance Manager Access Support Network 8057033316	2/8/2022 11:08 AM
Details	Last Recertification Date	Update	Recertification	2/8/2021 7:56:38 AM	2/8/2022 11:08:12 AM	2/8/2022 11:08 AM
Details	Assistance Received From Date	Update	Recertification		4/1/2020 12:00:00 AM	2/8/2021 7:56 AM
Details	Assistance Received To Date	Update	Recertification		3/31/2021 12:00:00 AM	2/8/2021 7:56 AM
Details	Last Recertification Date	Update	Recertification		2/8/2021 7:56:38 AM	2/8/2021 7:56 AM
Details	Grant Number	Update	Recertification	X08HA10851	X07HA12778	2/8/2021 7:56 AM
Details	NOFO Number	Update	Recertification		HRSA-17-036	2/8/2021 7:56 AM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Kilburn, David Executive Director Access Support Network 8057813660-212	2/20/2020 9:58 AM
Details	340B ID	Update	New Registration		RWII93401B	2/20/2020 9:58 AM
Dates	Participating Approval Date	Update	New Registration		2/20/2020 9:58:23 AM	2/20/2020 9:58 AM
Details	State	Update	New Registration	Pending	Approved	2/20/2020 9:58 AM
Dates	Signed By Date	Update	New Registration		1/17/2020 10:18:58 PM	2/20/2020 9:58 AM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/20/2020 9:58 AM
Contacts	Primary Contact	Update	Profile Change Request	Gottlieb, Kris Finance Director Access Support Network 8057813660-210	Gottlieb, Kris Development Director Access Support Network 8057813660-210	1/30/2020 6:54 PM
Addresses	Main Address	Insert	New Registration		Montage Medical Group Ryan Ranch Campus 2 Upper Ragsdale Dr. Building A Monterey, CA 93940	1/17/2020 10:18 PM
Addresses	Billing Address	Insert	New Registration		Access Support Network P.O. Box 12158 San Luis Obispo, CA 93406	1/17/2020 10:18 PM
Contacts	Authorizing Official	Insert	New Registration		Kilburn, David Executive Director Access Support Network 8057813660-212	1/17/2020 10:18 PM
Contacts	Primary Contact	Insert	New Registration		Gottlieb, Kris Finance Director Access Support Network 8057813660-210	1/17/2020 10:18 PM
Details	Last Recertification Date	Insert	New Registration			1/17/2020 10:18 PM
Details	Grant Number	Insert	New Registration		X08HA10851	1/17/2020 10:18 PM
Details	340B ID	Insert	New Registration			1/17/2020 10:18 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/17/2020 10:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/17/2020 10:18 PM
Details	Medicare Provider Number	Insert	New Registration			1/17/2020 10:18 PM
Details	Entity Name	Insert	New Registration		Access Support Network	1/17/2020 10:18 PM
Details	Program Code	Insert	New Registration		RWII	1/17/2020 10:18 PM
Details	Entity Subname	Insert	New Registration		Monterey	1/17/2020 10:18 PM
Dates	Participating Approval Date	Insert	New Registration			1/17/2020 10:18 PM
Details	State	Insert	New Registration		Pending	1/17/2020 10:18 PM
Dates	Registration Date	Insert	New Registration		1/17/2020 10:18:56 PM	1/17/2020 10:18 PM
Dates	Signed By Date	Insert	New Registration			1/17/2020 10:18 PM
Dates	Start Date	Insert	New Registration			1/17/2020 10:18 PM
Terminations	Termination Comments	Insert	New Registration			1/17/2020 10:18 PM
Terminations	Termination Date	Insert	New Registration			1/17/2020 10:18 PM
Terminations	Termination Effective Date	Insert	New Registration			1/17/2020 10:18 PM
Terminations	Termination Reason	Insert	New Registration			1/17/2020 10:18 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History