Covered Entity Details

CHC26624-05 POMONA COMMUNITY HEALTH CENTER (Active) - information as of 6/21/2025 10:45:37 PM

Main Details

Name

POMONA COMMUNITY HEALTH CENTER

Subdivision Name

Holt Dental

Type

HRSA-Funded Health Center

Site ID

BPS-H80-027265

340B ID

CHC26624-05

Grant Number

H80CS26624

Additional Details

Current Program Status

Active

Registration Date

4/2/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/3/2020

Last Recertification Date

2/14/2025

Contacts

Authorizing Official

Pomona Community Health Center
David M Kadar, Chief Executive Officer
(909) 630-7939

Primary Contact

Parktree Community Health Center
Juliet V Dominguez, Director of Risk Management & Compliance
(909) 469-9013 Ext: 6037

Addresses

Street Address

1448 E Holt Ave
Pomona, CA 91767-5822

Billing Address

Pomona Community Health Center dba Parktree Community Health Center
1450 E Holt Ave
Pomona, CA 91767

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?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	CBC MISSION PHARMACY	716 E MISSION BLVD	STE A	POMONA	CA	91766	01/09/2025	04/01/2025			04/01/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC26624-00	Active	BPS-H80-013167	POMONA COMMUNITY HEALTH CENTER	Pomona Community Health Center	750 South Park Avenue, Room 101	Pomona	CA
CHC26624-01	Active	BPS-H80-013210	POMONA COMMUNITY HEALTH CENTER	Pomona Community Health Center	1450 E. Holt Blvd.	Pomona	CA
CHC26624-02	Terminated	BPS-H80-013215	POMONA COMMUNITY HEALTH CENTER	Winter Shelter	600 S. Park Ave.	Pomona	CA
CHC26624-03	Active	BPS-H80-017360	POMONA COMMUNITY HEALTH CENTER	Ontario	1556 S. Sultana Avenue	Ontario	CA
CHC26624-04	Active	BPS-H80-019265	POMONA COMMUNITY HEALTH CENTER	Ontario Archibald	2680 E. Riverside Drive	Ontario	CA
CHC26624-05	Active	BPS-H80-027265	POMONA COMMUNITY HEALTH CENTER	Holt Dental	1448 E Holt Ave	Pomona	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC26624-00	CBC MISSION PHARMACY	CBC PHARMACY	716 E MISSION BLVD SUITE A	POMONA	CA	91766	04/01/2015	01/31/2017
CHC26624-01	CBC MISSION PHARMACY	CBC PHARMACY	716 E MISSION BLVD SUITE A	POMONA	CA	91766	04/01/2015	01/31/2017
CHC26624-01	CBC MISSION PHARMACY	716 E MISSION BLVD	STE A	POMONA	CA	91766	04/01/2025
CHC26624-03	CBC MISSION PHARMACY	716 E MISSION BLVD	STE A	POMONA	CA	91766	04/01/2025
CHC26624-04	CBC MISSION PHARMACY	716 E MISSION BLVD	STE A	POMONA	CA	91766	04/01/2025
CHC26624-05	CBC MISSION PHARMACY	716 E MISSION BLVD	STE A	POMONA	CA	91766	04/01/2025
CHC26624-00	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016
CHC26624-01	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016
CHC26624-02	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016	04/01/2022
CHC26624-03	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2017
CHC26624-00	DEV PHARMA INC	DBA EZRX PHARMACY	731 INDIAN HILL BLVD	POMONA	CA	91767	01/01/2017
CHC26624-01	DEV PHARMA INC	DBA EZRX PHARMACY	731 INDIAN HILL BLVD	POMONA	CA	91767	01/01/2017
CHC26624-02	DEV PHARMA INC	DBA EZRX PHARMACY	731 INDIAN HILL BLVD	POMONA	CA	91767	01/01/2017	04/01/2022
CHC26624-03	DEV PHARMA INC	DBA EZRX PHARMACY	731 INDIAN HILL BLVD	POMONA	CA	91767	01/01/2017
CHC26624-04	DEV PHARMA INC	DBA EZRX PHARMACY	731 INDIAN HILL BLVD	POMONA	CA	91767	07/01/2017
CHC26624-00	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	04/01/2016
CHC26624-01	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	04/01/2016
CHC26624-02	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	04/01/2016	04/01/2022
CHC26624-03	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	04/01/2017
CHC26624-00	WALGREEN CO.	DBA: WALGREENS # 07230	495 E HOLT AVE	POMONA	CA	91767-5539	10/01/2017
CHC26624-00	WALGREEN CO.	DBA: WALGREENS # 04382	795 E. FOOTHILL	POMONA	CA	91767	10/01/2017
CHC26624-00	WALGREEN CO.	DBA: WALGREENS # 06438	12490 CENTRAL AVENUE	CHINO	CA	91710	10/01/2017
CHC26624-00	WALGREEN CO.	DBA: WALGREENS #10202	2245 S EUCLID AVE	ONTARIO	CA	91762	10/01/2017
CHC26624-00	WALGREEN CO.	DBA: WALGREENS # 06147	2950 S ARCHIBALD AVE	ONTARIO	CA	91761-7303	10/01/2017

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/14/2024 12:40:02 PM	2/14/2025 4:17:31 AM	2/14/2025 4:17 AM
Details	Last Recertification Date	Update	Recertification	2/6/2023 11:11:39 AM	2/14/2024 12:40:02 PM	2/14/2024 12:40 PM
Details	Last Recertification Date	Update	Recertification	2/7/2022 11:59:06 AM	2/6/2023 11:11:39 AM	2/6/2023 11:11 AM
Details	Last Recertification Date	Update	Recertification	2/10/2021 6:46:46 PM	2/7/2022 11:59:06 AM	2/7/2022 11:59 AM
Details	Last Recertification Date	Update	Recertification		2/10/2021 6:46:46 PM	2/10/2021 6:46 PM
Contacts	Primary Contact	Update	Profile Change Request	Dominguez, Juliet V HR & Compliance Manager Parktree Community Health Center 9094699013-6037	Dominguez, Juliet V Director of Risk Management & Compliance Parktree Community Health Center 9094699013-6037	11/11/2020 3:19 PM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Kadar, David M Chief Executive Officer Pomona Community Health Center 9096307939	4/3/2020 10:35 AM
Details	340B ID	Update	New Registration		CHC26624-05	4/3/2020 10:35 AM
Dates	Participating Approval Date	Update	New Registration		4/3/2020 10:35:58 AM	4/3/2020 10:35 AM
Details	State	Update	New Registration	Pending	Approved	4/3/2020 10:35 AM
Dates	Signed By Date	Update	New Registration		4/2/2020 2:44:51 PM	4/3/2020 10:35 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/3/2020 10:35 AM
Addresses	Main Address	Insert	New Registration		1448 E Holt Ave Pomona, CA 91767-5822	4/2/2020 12:41 PM
Addresses	Billing Address	Insert	New Registration		Pomona Community Health Center dba Parktree Community Health Center 1450 E Holt Ave Pomona, CA 91767	4/2/2020 12:41 PM
Contacts	Primary Contact	Insert	New Registration		Dominguez, Juliet V HR & Compliance Manager Parktree Community Health Center 9094699013-6037	4/2/2020 12:41 PM
Contacts	Authorizing Official	Insert	New Registration		Kadar, David M Chief Executive Officer Pomona Community Health Center 9096307939	4/2/2020 12:41 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2020 12:41 PM
Details	Grant Number	Insert	New Registration		H80CS26624	4/2/2020 12:41 PM
Details	340B ID	Insert	New Registration			4/2/2020 12:41 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2020 12:41 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2020 12:41 PM
Details	Medicare Provider Number	Insert	New Registration			4/2/2020 12:41 PM
Details	Entity Name	Insert	New Registration		POMONA COMMUNITY HEALTH CENTER	4/2/2020 12:41 PM
Details	Program Code	Insert	New Registration		CH	4/2/2020 12:41 PM
Details	Entity Subname	Insert	New Registration		Holt Dental	4/2/2020 12:41 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2020 12:41 PM
Details	State	Insert	New Registration		Pending	4/2/2020 12:41 PM
Dates	Registration Date	Insert	New Registration		4/2/2020 12:41:17 PM	4/2/2020 12:41 PM
Dates	Signed By Date	Insert	New Registration			4/2/2020 12:41 PM
Dates	Start Date	Insert	New Registration			4/2/2020 12:41 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2020 12:41 PM
Terminations	Termination Date	Insert	New Registration			4/2/2020 12:41 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2020 12:41 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2020 12:41 PM

340B Drug Pricing Program Database