Covered Entity Details

CHC30722-02 UNIVERSAL COMMUNITY HEALTH CENTER (Active) - information as of 5/26/2025 12:56:06 AM

Main Details

Name

UNIVERSAL COMMUNITY HEALTH CENTER

Subdivision Name

Universal Community Health Center- Central

Type

HRSA-Funded Health Center

Site ID

BPS-H80-029632

340B ID

CHC30722-02

Grant Number

H80CS30722

Additional Details

Current Program Status

Active

Registration Date

4/1/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/21/2020

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Universal Community Health Center
Edgar Alexander Chavez, CEO
(323) 485-0467

Primary Contact

Universal Community Health Center
Vanessa Luna Jones, Director of Compliance/Risk
(323) 533-0612

Addresses

Street Address

2098 S Central Ave
Los Angeles, CA 90011-1235

Billing Address

Universal Community Health Center
2801 S. San Pedro St.
Los Angeles, CA 90011

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	1932757820	1932757820

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	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	10/04/2021	01/01/2022	02/29/2024	03/11/2024
Contract Detail	OLIVE BRANCH PHARMACY	2811 S. SAN PEDRO ST		LOS ANGELES	CA	90011	04/14/2022	07/01/2022		07/01/2022
Contract Detail	OLIVE BRANCH PHARMACY	OLIVE BRANCH PHARMACY	2070 S CENTRAL AVE	LOS ANGELES	CA	90011	04/14/2022	07/01/2022		07/01/2022
Contract Detail	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	10/04/2021	01/01/2022	02/29/2024	03/11/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC30722-00	Active	BPS-H80-019161	UNIVERSAL COMMUNITY HEALTH CENTER	Universal Community Health Center- Washington	1005 E. Washington Blvd.		Los Angeles	CA
CHC30722-01	Active	BPS-H80-019162	UNIVERSAL COMMUNITY HEALTH CENTER	Universal Community Health Center - San Pedro	2801 S. San Pedro St.		Los Angeles	CA
CHC30722-02	Active	BPS-H80-029632	UNIVERSAL COMMUNITY HEALTH CENTER	Universal Community Health Center- Central	2098 S Central Ave		Los Angeles	CA
CHC30722-03	Active	BPS-H80-032562	Universal Community Health Center	Universal Community Health Center - Almaguer	4527 E Cesar E Chavez Ave		Los Angeles	CA
CHC30722-04	Active	BPS-H80-034115	Universal Community Health Center	Universal Community Health Center - MLK	1021 W Martin Luther King Jr Blvd		Los Angeles	CA
CHC30722-05	Active	BPS-H80-035706	Universal Community Health Center	Universal Community Health Center - O'Neill	1919 S San Pedro St		Los Angeles	CA
CHC30722-06	Active	BPS-H80-033590	UNIVERSAL COMMUNITY HEALTH CENTER	Universal Community Health Center - Quincy	900 E 33rd St		Los Angeles	CA
FQHCLA308	Terminated	BPS-LAL-011293	Universal Community Health Center		1005 E. Washington Blvd.	Suite A	Los Angeles	CA
FQHCLA308A	Terminated	BPS-LAL-017783	Universal Community Health Center	Universal Community Health Center - San Pedro St.	2801 S. San Pedro St.		Los Angeles	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA308A	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	10/01/2016	07/01/2019
CHC30722-00	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10915	1025 E. ADAMS BLVD., 1ST FLOOR	LOS ANGELES	CA	90011	01/01/2024
CHC30722-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08892	5822 SOUTH VERMONT AVENUE	LOS ANGELES	CA	90044	01/01/2024
CHC30722-00	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #4019	5837 S. CENTRAL AVE.	LOS ANGELES	CA	90001	01/01/2024
FQHCLA308	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	07/01/2015	07/01/2019
CHC30722-00	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	07/01/2019	02/29/2024
CHC30722-01	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	07/01/2019	02/29/2024
CHC30722-02	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	01/01/2022	02/29/2024
FQHCLA308	OLIVE BRANCH PHARMACY	OLIVE BRANCH PHARMACY	2070 S CENTRAL AVE	LOS ANGELES	CA	90011	10/01/2013	01/01/2017
FQHCLA308A	OLIVE BRANCH PHARMACY	2811 S. SAN PEDRO ST		LOS ANGELES	CA	90011	10/01/2016	01/01/2017
CHC30722-01	OLIVE BRANCH PHARMACY	OLIVE BRANCH PHARMACY	2070 S CENTRAL AVE	LOS ANGELES	CA	90011	07/01/2022
CHC30722-02	OLIVE BRANCH PHARMACY	2811 S. SAN PEDRO ST		LOS ANGELES	CA	90011	07/01/2022
CHC30722-01	OLIVE BRANCH PHARMACY	2811 S. SAN PEDRO ST		LOS ANGELES	CA	90011	07/01/2022
CHC30722-00	OLIVE BRANCH PHARMACY	OLIVE BRANCH PHARMACY	2070 S CENTRAL AVE	LOS ANGELES	CA	90011	07/01/2022
CHC30722-02	OLIVE BRANCH PHARMACY	OLIVE BRANCH PHARMACY	2070 S CENTRAL AVE	LOS ANGELES	CA	90011	07/01/2022
CHC30722-00	OLIVE BRANCH PHARMACY	2811 S. SAN PEDRO ST		LOS ANGELES	CA	90011	07/01/2022
FQHCLA308	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	04/01/2016	07/01/2019
FQHCLA308A	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	10/01/2016	07/01/2019
CHC30722-00	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	07/01/2019	02/29/2024
CHC30722-01	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	07/01/2019	02/29/2024
CHC30722-02	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	01/01/2022	02/29/2024
CHC30722-00	THRIFTY PAYLESS, INC.	RITE AID #5445	4322 SOUTH FIGUEROA STREET	LOS ANGELES	CA	90037	10/01/2023
CHC30722-00	THRIFTY PAYLESS, INC.	RITE AID #5430	446 EAST WASHINGTON BLVD.	LOS ANGELES	CA	90015	10/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 3:39:30 PM	2/12/2025 12:13:00 AM	2/12/2025 12:13 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/15/2025 9:00 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1932757820	1/15/2025 9:00 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	1/15/2025 9:00 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1932757820	1/15/2025 9:00 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	1/15/2025 9:00 AM
Details	Entity Subname	Update	Change Request	Universal Community Health Center- Central Ave	Universal Community Health Center- Central	1/15/2025 9:00 AM
Contacts	Primary Contact	Update	Group Change Request	Robinson, Angela Chief Finance Officer Universal Community Health Center 3232333100	Luna Jones, Vanessa Director of Compliance/Risk Universal Community Health Center 3235330612	1/13/2025 7:13 AM
Contacts	Authorizing Official	Update	Profile Change Request	Chavez, Edgar Alexander CEO Universal Community Health Center 3232333100-303	Chavez, Edgar Alexander CEO Universal Community Health Center 3234850467	1/11/2025 11:09 AM
Contacts	Signed By	Update	Profile Change Request	Chavez, Edgar Alexander CEO Universal Community Health Center 3232333100-303	Chavez, Edgar Alexander CEO Universal Community Health Center 3234850467	1/11/2025 11:09 AM
Contacts	Primary Contact	Update	PC Change Request	Reynoso, Alfredo 3233135588 Chief Operations Officer Universal Community Health Center 3232333100-144	Robinson, Angela Chief Finance Officer Universal Community Health Center 3232333100	5/30/2024 8:41 AM
Details	Last Recertification Date	Update	Recertification	2/7/2023 3:17:52 PM	2/1/2024 3:39:30 PM	2/1/2024 3:39 PM
Contacts	Primary Contact	Update	Profile Change Request	Reynoso, Alfredo 3233135588 Director of Operations Universal Community Health Center 3232333100-144	Reynoso, Alfredo 3233135588 Chief Operations Officer Universal Community Health Center 3232333100-144	1/30/2024 11:12 AM
Details	Last Recertification Date	Update	Recertification	2/4/2022 1:04:20 PM	2/7/2023 3:17:52 PM	2/7/2023 3:17 PM
Details	Last Recertification Date	Update	Recertification	2/8/2021 12:42:42 PM	2/4/2022 1:04:20 PM	2/4/2022 1:04 PM
Details	Last Recertification Date	Update	Recertification		2/8/2021 12:42:42 PM	2/8/2021 12:42 PM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Chavez, Edgar Alexander CEO Universal Community Health Center 3232333100-303	4/21/2020 10:20 AM
Details	340B ID	Update	New Registration		CHC30722-02	4/21/2020 10:20 AM
Dates	Participating Approval Date	Update	New Registration		4/21/2020 10:20:15 AM	4/21/2020 10:20 AM
Details	State	Update	New Registration	Pending	Approved	4/21/2020 10:20 AM
Dates	Signed By Date	Update	New Registration		4/1/2020 2:25:20 PM	4/21/2020 10:20 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/21/2020 10:20 AM
Addresses	Main Address	Insert	New Registration		2098 S Central Ave Los Angeles, CA 90011-1235	4/1/2020 2:25 PM
Addresses	Billing Address	Insert	New Registration		Universal Community Health Center 2801 S. San Pedro St. Los Angeles, CA 90011	4/1/2020 2:25 PM
Contacts	Primary Contact	Insert	New Registration		Reynoso, Alfredo 3233135588 Director of Operations Universal Community Health Center 3232333100-144	4/1/2020 2:25 PM
Contacts	Authorizing Official	Insert	New Registration		Chavez, Edgar Alexander CEO Universal Community Health Center 3232333100-303	4/1/2020 2:25 PM
Details	Last Recertification Date	Insert	New Registration			4/1/2020 2:25 PM
Details	Grant Number	Insert	New Registration		H80CS30722	4/1/2020 2:25 PM
Details	340B ID	Insert	New Registration			4/1/2020 2:25 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2020 2:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2020 2:25 PM
Details	Medicare Provider Number	Insert	New Registration			4/1/2020 2:25 PM
Details	Entity Name	Insert	New Registration		UNIVERSAL COMMUNITY HEALTH CENTER	4/1/2020 2:25 PM
Details	Program Code	Insert	New Registration		CH	4/1/2020 2:25 PM
Details	Entity Subname	Insert	New Registration		Universal Community Health Center- Central Ave	4/1/2020 2:25 PM
Dates	Participating Approval Date	Insert	New Registration			4/1/2020 2:25 PM
Details	State	Insert	New Registration		Pending	4/1/2020 2:25 PM
Dates	Registration Date	Insert	New Registration		4/1/2020 2:25:16 PM	4/1/2020 2:25 PM
Dates	Signed By Date	Insert	New Registration			4/1/2020 2:25 PM
Dates	Start Date	Insert	New Registration			4/1/2020 2:25 PM
Terminations	Termination Comments	Insert	New Registration			4/1/2020 2:25 PM
Terminations	Termination Date	Insert	New Registration			4/1/2020 2:25 PM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2020 2:25 PM
Terminations	Termination Reason	Insert	New Registration			4/1/2020 2:25 PM

340B Drug Pricing Program Database