Covered Entity Details

CH09901AU BORREGO COMMUNITY HEALTH FOUNDATION (Terminated) - information as of 6/14/2025 10:09:32 AM

Main Details

Name

BORREGO COMMUNITY HEALTH FOUNDATION

Subdivision Name

METROPOLITAN FAMILY MEDICAL CLINIC- FONTANA

Type

HRSA-Funded Health Center

Site ID

BPS-H80-030153

340B ID

CH09901AU

Grant Number

H80CS00287

Additional Details

Current Program Status

Terminated

Registration Date

4/14/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/21/2020

Last Recertification Date

2/24/2021

Termination Date
Termination Reason

1/1/2022
Business decision by the Covered Entity

Contacts

Authorizing Official

Borrego Community Health Foundation
Edgar Bulloch, Interim CEO
(760) 767-6641

Primary Contact

Borrego Community Health Foundation
Mark Connelly, COO
(760) 767-6422

Addresses

Street Address

7965 SIERRA AVE # E
FONTANA, CA 92336-3329

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	1780038042	1780038042

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH099010	Terminated	BPS-H80-000521	BORREGO COMMUNITY HEALTH FOUNDATION	BORREGO COMMUNITY HEALTH FOUNDATION	4343 YAQUI PASS ROAD	BORREGO SPRINGS	CA
CH09901A	Terminated	BPS-H80-014450	BORREGO COMMUNITY HEALTH FOUNDATION	Centro Medico El Cajon	133 W Main Street	EL CAJON	CA
CH09901AA	Terminated	BPS-H80-018832	BORREGO COMMUNITY HEALTH FOUNDATION	JAY HOFFMAN HEALTH CENTER	29490 LAKEVIEW AVE	NUEVO	CA
CH09901AB	Terminated	BPS-H80-018778	BORREGO COMMUNITY HEALTH FOUNDATION	MOBILE DENTAL UNIT #3	69175 Ramon Road Bldg A	Cathedral City	CA
CH09901AC	Terminated	BPS-H80-018773	BORREGO COMMUNITY HEALTH FOUNDATION	Mobile Unit #4 - Riverside	1970 University Ave	Riverside	CA
CH09901AD	Terminated	BPS-H80-019056	BORREGO COMMUNITY HEALTH FOUNDATION	STONEWALL MEDICAL CENTER	68555 RAMON ROAD	CATHEDRAL CITY	CA
CH09901AE	Terminated	BPS-H80-019365	BORREGO COMMUNITY HEALTH FOUNDATION	MOBILE UNIT #5	590 NORTH D STREET	SAN BERNARDINO	CA
CH09901AF	Terminated	BPS-H80-019266	BORREGO COMMUNITY HEALTH FOUNDATION	Barstow Community Health Center	750 E Main ST	BARSTOW	CA
CH09901AG	Terminated	BPS-H80-021037	BORREGO COMMUNITY HEALTH FOUNDATION	EASTSIDE HEALTH CENTER BUILDING B	1971 UNIVERSITY AVENUE	RIVERSIDE	CA
CH09901AH	Terminated	BPS-H80-028305	BORREGO COMMUNITY HEALTH FOUNDATION	COD STUDENT HEALTH CENTER	43500 MONTEREY AVE	PALM DESERT	CA
CH09901AJ	Terminated	BPS-H80-022004	BORREGO COMMUNITY HEALTH FOUNDATION	VISTA VILLAGE PEDIATRICS	950 CIVIC CENTER DRIVE, STE A	VISTA	CA
CH09901AK	Terminated	BPS-H80-027192	BORREGO COMMUNITY HEALTH FOUNDATION	LAKE ELSINORE CLINICA MEDICA FAMILIAR	31739 RIVERSIDE DR, STE A-1	LAKE ELSINORE	CA
CH09901AL	Terminated	BPS-H80-030154	BORREGO COMMUNITY HEALTH FOUNDATION	METROPOLITAN FAMILY MEDICAL CLINIC- RIVERSIDE	4990 ARLINGTON AVE # D	RIVERSIDE	CA
CH09901AM	Terminated	BPS-H80-030152	BORREGO COMMUNITY HEALTH FOUNDATION	METROPOLITAN FAMILY MEDICAL CLINIC- FOOTHILL	425 E FOOTHILL BLVD	RIALTO	CA
CH09901AN	Terminated	BPS-H80-027496	BORREGO COMMUNITY HEALTH FOUNDATION	LA MESA FAMILY MEDICAL GROUP	8881 FLETCHER PKWY STE 205	LA MESA	CA
CH09901AP	Terminated	BPS-H80-029987	BORREGO COMMUNITY HEALTH FOUNDATION	MARTHAS VILLAGE CLINIC	83791 Date Ave	Indio	CA
CH09901AQ	Terminated	BPS-H80-030151	BORREGO COMMUNITY HEALTH FOUNDATION	METROPOLITAN FAMILY MEDICAL CLINIC- HIGHLAND	7576 STERLING AVE # C & D	SAN BERNARDINO	CA
CH09901AR	Terminated	BPS-H80-027629	BORREGO COMMUNITY HEALTH FOUNDATION	Stanley H Schwartz, M.D., Inc.	264 N Highland Springs Avenue STE 1-A, 1-B	Banning	CA
CH09901AS	Terminated	BPS-H80-030155	BORREGO COMMUNITY HEALTH FOUNDATION	METROPOLITAN FAMILY MEDICAL CLINIC- BASELINE	1574 W BASELINE AVE # 107	SAN BERNARDINO	CA
CH09901AT	Terminated	BPS-H80-030150	BORREGO COMMUNITY HEALTH FOUNDATION	METROPOLITAN FAMILY MEDICAL CLINIC- SAN BERNARDINO	742 W HIGHLAND AVE	SAN BERNARDINO	CA
CH09901AU	Terminated	BPS-H80-030153	BORREGO COMMUNITY HEALTH FOUNDATION	METROPOLITAN FAMILY MEDICAL CLINIC- FONTANA	7965 SIERRA AVE # E	FONTANA	CA
CH09901AV	Terminated	BPS-H80-030316	BORREGO COMMUNITY HEALTH FOUNDATION	EAST COUNTY MEDICAL BEHAVIORAL HEALTH CENTER	8770 CUYAMACA ST STE 4	SANTEE	CA
CH09901AW	Terminated	BPS-H80-029726	BORREGO COMMUNITY HEALTH FOUNDATION	BORREGO HEALTH ESCONDIDO PEDIATRICS	1111 Washington Street STE A,B,G	ESCONDIDO	CA
CH09901AX	Terminated	BPS-H80-030317	BORREGO COMMUNITY HEALTH FOUNDATION	PALM SPRINGS FAMILY HEALTH	1100 N. PALM CANYON DRIVE STE 104-106	PALM SPRINGS	CA
CH09901AY	Terminated	BPS-H80-029725	BORREGO COMMUNITY HEALTH FOUNDATION	40/30 MAIN STREET DENTAL BY BORREGO HEALTH	124 W. MAIN ST	EL CAJON	CA
CH09901AZ	Terminated	BPS-H80-031304	BORREGO COMMUNITY HEALTH FOUNDATION	Medical and Dental Mobile Unit #9	590 N D St	San Bernardino	CA
CH09901B	Terminated	BPS-H80-002400	BORREGO COMMUNITY HEALTH FOUNDATION	Centro Medico Cathedral City	69-175 RAMON ROAD BLDG A	CATHEDRAL CITY	CA
CH09901BA	Terminated	BPS-H80-030138	BORREGO COMMUNITY HEALTH FOUNDATION	MOBILE UNIT # 7	750 E MAIN ST	BARSTOW	CA
CH09901BB	Terminated	BPS-H80-031103	BORREGO COMMUNITY HEALTH FOUNDATION	MOBILE UNIT # 8	58581 US HIGHWAY 371 STE F, G, H	ANZA	CA
CH09901BC	Terminated	BPS-H80-034357	BORREGO COMMUNITY HEALTH FOUNDATION	COACHELLA VALLEY COMMUNITY HEALTH CENTER	49869 CALHOUN ST FL 1	COACHELLA	CA
CH09901C	Terminated	BPS-H80-004088	BORREGO COMMUNITY HEALTH FOUNDATION	Centro Medico Oasis	88-775 AVENUE 76 STE 1	THERMAL	CA
CH09901D	Terminated	BPS-H80-010612	BORREGO COMMUNITY HEALTH FOUNDATION	Eastside Family Health Center	1970 University Ave	Riverside	CA
CH09901E	Terminated	BPS-H80-007051	BORREGO COMMUNITY HEALTH FOUNDATION	JULIAN MEDICAL CENTER	2721 WASHINGTON STREET	JULIAN	CA
CH09901F	Terminated	BPS-H80-014195	BORREGO COMMUNITY HEALTH FOUNDATION	CENTRO MEDICO, COACHELLA	55497 VAN BUREN ST	THERMAL	CA
CH09901G	Terminated	BPS-H80-010838	BORREGO COMMUNITY HEALTH FOUNDATION	Arlanza Family Health Center	8856 Arlington Ave	Riverside	CA
CH09901H	Terminated	BPS-H80-013980	BORREGO COMMUNITY HEALTH FOUNDATION	Centro Medico, Escondido	1121 E WASHINGTON AVE	ESCONDIDO	CA
CH09901J	Terminated	BPS-H80-014137	BORREGO COMMUNITY HEALTH FOUNDATION	Women's Health and Wellness Center	8851 CENTER DRIVE, SUITE 210	La Mesa	CA
CH09901K	Terminated	BPS-H80-013670	BORREGO COMMUNITY HEALTH FOUNDATION	SAN JACINTO HEALTH CENTER	651 N STATE ST	SAN JACINTO	CA
CH09901L	Terminated	BPS-H80-013690	BORREGO COMMUNITY HEALTH FOUNDATION	Desert Hot Springs Community Medical Center - Main Campus	66675 Pierson Blvd	Desert Hot Springs	CA
CH09901M	Terminated	BPS-H80-013652	BORREGO COMMUNITY HEALTH FOUNDATION	ANZA COMMUNITY HEALTH CENTER	58581 US HIGHWAY 371 STE F,G,H	ANZA	CA
CH09901N	Terminated	BPS-H80-005116	BORREGO COMMUNITY HEALTH FOUNDATION	BORREGO MEDICAL CENTER	4343 YAQUI PASS RD PO BOX2369	BORREGO SPRINGS	CA
CH09901P	Terminated	BPS-H80-009413	BORREGO COMMUNITY HEALTH FOUNDATION	Mobile Dental Trailer #1	69-175 RAMON ROAD BLDG A	CATHEDRAL CITY	CA
CH09901Q	Terminated	BPS-H80-009412	BORREGO COMMUNITY HEALTH FOUNDATION	Mobile Dental Trailer #2	69-175 RAMON ROAD BLDG A	CATHEDRAL CITY	CA
CH09901R	Terminated	BPS-H80-006857	BORREGO COMMUNITY HEALTH FOUNDATION	Centro Medico Mobile Clinic	55497 Van Buren Street	Thermal	CA
CH09901T	Terminated	BPS-H80-014139	BORREGO COMMUNITY HEALTH FOUNDATION	WOOLCOTT DENTAL CLINIC	590 PALM CANYON DRIVE, SUITE 212	BORREGO SPRINGS	CA
CH09901U	Terminated	BPS-H80-014075	BORREGO COMMUNITY HEALTH FOUNDATION	BORREGO HEALTH SPECIALTY CARE CENTER	12520 PALM DR	DESERT HOT SPRINGS	CA
CH09901V	Terminated	BPS-H80-014493	BORREGO COMMUNITY HEALTH FOUNDATION	DESERT HOT SPRINGS HEALTH AND WELLNESS CENTER	11750 Cholla Drive, Suite B	Desert Hot Springs	CA
CH09901W	Terminated	BPS-H80-014264	BORREGO COMMUNITY HEALTH FOUNDATION	DESERT OASIS WOMENS HEALTH CENTER	1180 N INDIAN CANYON, SUITE W-300	PALM SPRINGS	CA
CH09901X	Terminated	BPS-H80-017995	BORREGO COMMUNITY HEALTH FOUNDATION	TROTH STREET ELEMENTARY CLINIC	5565 TROTH ST	JURUPA VALLEY	CA
CH09901Y	Terminated	BPS-H80-017459	BORREGO COMMUNITY HEALTH FOUNDATION	D STREET MEDICAL CENTER	590 NORTH D STREET	SAN BERNARDINO	CA
CH09901Z	Terminated	BPS-H80-017734	BORREGO COMMUNITY HEALTH FOUNDATION	LA MESA PEDIATRICS	8881 Fletcher Pkwy, Suite 200	La Mesa	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH099010	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2023	04/01/2024
CH099010	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2023	04/01/2024
CH099010	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2023	04/01/2024
CH099010	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2023	04/01/2024
CH099010	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2023	04/01/2024
CH099010	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2023	04/01/2024
CH099010	ACCREDO HEALTH GROUP, INC.		PHARMACY 2 BOULDEN CIRCLE SUITE 1	NEW CASTLE	DE	19720	04/01/2023	04/01/2024
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #2783	2899 JAMACHA RD	EL CAJON	CA	92019	07/01/2017	04/01/2024
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #1569	1751 N SUNRISE WAY #1	PALM SPRINGS	CA	92262	07/01/2017	04/01/2024
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #0758	543 SWEETWATER RD	SPRING VALLEY	CA	91977	07/01/2017	09/28/2018
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #0704	2955 ALPINE BLVD	ALPINE	CA	91901	07/01/2017	04/01/2024
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #0725	1459 MAIN ST	RAMONA	CA	92065	07/01/2017	04/01/2024
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #0723	9831 CAMPO RD	SPRING VALLEY	CA	91977	07/01/2017	04/01/2024
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #1319	450 E CYPRESS AVE	REDLANDS	CA	92373	07/01/2017	11/19/2018
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #2586	40101 MONTEREY AVE	RANCHO MIRAGE	CA	92270	07/01/2017	04/01/2024
CH099010	ALBERTSONS LLC	SAV-ON PHARMACY #4713	1509 E VALLEY PKWY	ESCONDIDO	CA	92027	07/01/2017	04/01/2024
CH099010	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2020	04/01/2024
CH099010	AMBROSIA HEALTHCARE INC	75060 GERALD FORD DR STE 2		PALM DESERT	CA	92211-2080	01/01/2019	04/01/2024
CH099010	ANZA VALLEY PHARMACY	56555 HIGHWAY 371	PO BOX 390415	ANZA	CA	92539	04/01/2016	09/01/2017
CH099010	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2020	04/01/2024
CH099010	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2020	04/01/2024
CH099010	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/01/2020	04/01/2024
CH099010	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/27/2021	04/01/2024
CH099010	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/27/2021	04/01/2024
CH099010	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2020	04/01/2024
CH099010	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2022	04/01/2024
CH099010	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2022	04/01/2024
CH099010	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2022	04/01/2024
CH099010	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2022	04/01/2024
CH099010	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2022	04/01/2024
CH099010	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2020	04/01/2024
CH099010	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2022	04/01/2024
CH099010	COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY	STE A - E	SAN DIEGO	CA	92102-4548	10/01/2019	04/01/2024
CH099010	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00938	8 EAST WASHINGTON STREET	NORTH ATTLEBORO	MA	02760	01/01/2022	04/01/2024
CH099010	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/27/2021	04/01/2024
CH099010	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/27/2021	04/01/2024
CH099010	DELTA DRUGS	YALAMANCHILI PHARMACY INC	1666 MEDICAL CENTER DR. STE 1	SAN BERNARDINO	CA	92411-1257	10/01/2016	04/01/2024
CH099010	DESERT HOSPITAL OUTPATIENT PHARMACY	1180 N INDIAN CANYON DR STE E140		PALM SPRINGS	CA	92262-4883	04/01/2016	04/01/2024
CH099010	DIB PHARMACEUTICAL INC	DBA: BETTER LIFE PHARMACY	528 E MAIN ST	EL CAJON	CA	92020	07/01/2021	04/01/2024
CH099010	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	04/01/2020	04/01/2024
CH099010	DONS DRUGS	1222 WEST 5TH STREET		SAN BERNARDINO	CA	92411	10/01/2016	04/01/2024
CH099010	EL CAJON EXPRESS PHARMACY		330 SOUTH MAGNOLIA AVE SUITE 102	EL CAJON	CA	92020-5213	07/01/2016	03/07/2017
CH099010	EL NUDO, LLC DBA NUDO'S PHARMACY	NA	455 N MAGNOLIA AVE	EL CAJON	CA	92020-3606	10/27/2021	04/01/2024
CH099010	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2023	04/01/2024
CH099010	EXPRESS PHARMACY	1111 E WASHINGTON AVE STE C		ESCONDIDO	CA	92025-2226	10/01/2019	04/01/2024
CH099010	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2023	04/01/2024
CH099010	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2023	04/01/2024
CH099010	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2023	04/01/2024
CH099010	GARDEN GROVE COMMUNITY PHARMACY	12665 GARDEN GROVE BLVD STE 108		GARDEN GROVE	CA	92843-1915	01/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05497	84010 AVE 50	COACHELLA	CA	92236	01/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09114	1299 BROADWAY	EL CAJON	CA	92021	01/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09616	31575 DATE PALM DR.	CATHEDRAL CITY	CA	92234	01/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09137	7393 JACKSON DR.	SAN DIEGO	CA	92119	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09524	3350 PALM AVE.	SAN DIEGO	CA	92154	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09173	2760 FLETCHER PKY	EL CAJON	CA	92020	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08862	12031 BROOKHURST STREET	GARDEN GROVE	CA	92840	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09115	645 SATURN BLVD	SAN DIEGO	CA	92154	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09754	1823 WEST ORANGETHORPE AVENUE	FULLERTON	CA	92833	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17625	2675 GEARY BLVD	SAN FRANCISCO	CA	94118	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08833	3332 SANDROCK ROAD	SAN DIEGO	CA	92123	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 07127	1302 WEST MISSION RD.	SAN MARCOS	CA	92069	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09103	318 W EL NORTE PARKWAY	ESCONDIDO	CA	92026	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	CVS/PHARMACY # 17709	233 WINSTON DRIVE	SAN FRANCISCO	CA	94132	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16937	2295 N IMPERIAL AVE	EL CENTRO	CA	92243	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09145	9730 MISSION GORGE RD.	SANTEE	CA	92071	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09740	15210 ROSECRANS AVENUE	LA MIRADA	CA	90638	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08866	1706 OCEANSIDE BLVD	OCEANSIDE	CA	92054	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY # 3055	38012 47TH STREET EAST	PALMDALE	CA	93552	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08857	1441 N SANTA FE	VISTA	CA	92084	07/01/2019	03/27/2023
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09140	555 BROADWAY STE 1054	CHULA VISTA	CA	91910	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09104	2427 E. VALLEY PKWY	ESCONDIDO	CA	92027	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09166	734 S. RANCHO SANTA FE RD.	SAN MARCOS	CA	92078	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09194	1810 MAIN ST.	RAMONA	CA	92065	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09668	727 S. ARROYO PARKWAY	PASADENA	CA	91105	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09109	6265 EL CAJON BLVD	SAN DIEGO	CA	92115	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09561	17625 HARVARD AVENUE	IRVINE	CA	92614	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09574	883 S. SANTA FE AVENUE	VISTA	CA	92083	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08842	426 EAST CHASE AVENUE	EL CAJON	CA	92020	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09175	4829 CLAIREMONT DR	SAN DIEGO	CA	92117	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09580	5101 OBAMA BLVD	LOS ANGELES	CA	90016	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09634	2521 EAST AVENUE S	PALMDALE	CA	93550	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09549	1980 COLLEGE BLVD	OCEANSIDE	CA	92056	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09196	1376 3RD AVE	CHULA VISTA	CA	91911	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY # 10931	1745 S. IMPERIAL AVE	EL CENTRO	CA	92243	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 04768	510 C STREET	SAN DIEGO	CA	92101	07/01/2019	03/27/2023
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08836	1631 S MELROSE DR	VISTA	CA	92081	07/01/2019	03/27/2023
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09108	1655 S. CENTRE CITY PKWY.	ESCONDIDO	CA	92025	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09120	800 PALM AVE.	IMPERIAL BEACH	CA	91932	07/01/2019	03/27/2023
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09657	44430 CHALLENGER WAY	LANCASTER	CA	93535	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09483	10011 ADAMS AVENUE	HUNTINGTON BEACH	CA	92646	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09193	1380 43RD ST.	SAN DIEGO	CA	92113	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08859	16 3RD AVENUE EXT.	CHULA VISTA	CA	91910	07/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09721	1401 S. BALDWIN AVE.	ARCADIA	CA	91007	10/01/2019	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09112	7100 BROADWAY	LEMON GROVE	CA	91945	01/01/2020	03/27/2023
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09648	82-270 HIGHWAY 111	INDIO	CA	92201	07/01/2020	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09728	1322 W. 6TH ST.	CORONA	CA	92882	07/01/2020	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 01520	68-010 VISTA CHINO	CATHEDRAL CITY	CA	92234	07/01/2020	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16083	1280 AUTO PARKWAY SOUTH	ESCONDIDO	CA	92029	07/01/2020	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09804	425 S. SUNRISE WAY	PALM SPRINGS	CA	92262	07/01/2020	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09746	6840 LINCOLN AVENUE	RIVERSIDE	CA	92506	01/01/2022	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09799	6215 RIVERSIDE AVE.	RIVERSIDE	CA	92506	10/27/2021	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08897	3361 MARKET ST.	RIVERSIDE	CA	92501	10/27/2021	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16053	3520 TYLER ST	RIVERSIDE	CA	92503	01/01/2022	03/27/2023
CH099010	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16094	3333 ARLINGTON AVE	RIVERSIDE	CA	92506	10/27/2021	04/01/2024
CH099010	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09849	8280 MAGNOLIA AVE.	RIVERSIDE	CA	92504	01/01/2022	04/01/2024
CH099010	HILLCREST PHARMACY	120 UNIVERSITY AVE		SAN DIEGO	CA	92103	10/01/2019	04/01/2024
CH099010	HILLCREST PHARMACY INC	HILLCREST PHARMACY	1988 HACIENDA DR	VISTA	CA	92081-6026	10/01/2019	04/01/2024
CH099010	KMART PHARMACY		14011 PALM DRIVE	DESERT HOT SPRINGS	CA	92240	10/01/2016	11/02/2016
CH099010	KMART PHARMACY		26471 YNEZ ROAD	TEMECULA	CA	92591	10/01/2016	11/02/2016
CH099010	KMART PHARMACY	1670 EAST FOURTH		ONTARIO	CA	91764	10/01/2016	09/10/2017
CH099010	LA BUENA VIDA PHARMACY INC	DBA LA BUENA VIDA PHARMACY	51-335 CESAR CHAVEZ ST STE 116	COACHELLA	CA	92236	07/01/2020	03/05/2023
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09506	1140 S MAIN ST	SALINAS	CA	93901	07/01/2019	03/27/2023
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09632	691 3RD AVE	CHULA VISTA	CA	91910	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09961	191 WOODLAND PKWY	SAN MARCOS	CA	92069	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09818	572 FLETCHER PKWY	EL CAJON	CA	92020	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09167	790 JAMACHA RD	EL CAJON	CA	92019	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09240	380 E H ST	CHULA VISTA	CA	91910	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09969	7850 TELEGRAPH RD	VENTURA	CA	93004	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09162	3749 AVOCADO BLVD	LA MESA	CA	91941	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09286	581 W CHANNEL ISLANDS BLVD	PORT HUENEME	CA	93041	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09169	5500 GROSSMONT CENTER DR BLDG P	LA MESA	CA	91942	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09167	790 JAMACHA RD	EL CAJON	CA	92019	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 06368	635 S MELROSE DR	VISTA	CA	92081	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09282	1471 W COVELL BLVD	DAVIS	CA	95616	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09973	1595 MAIN STREET	WEAVERVILLE	CA	96093	07/01/2019	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09959	1560 W VALLEY PKWY	ESCONDIDO	CA	92029	01/01/2020	04/01/2024
CH099010	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09134	49980 JEFFERSON ST	INDIO	CA	92201	10/27/2021	04/01/2024
CH099010	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2020	04/01/2024
CH099010	MECCA COMMUNITY PHARMACY		91275 AVENUE 66 SUITE 200	MECCA	CA	92254	10/01/2016	05/23/2017
CH099010	MEDICAL CENTER PHARMACY	4074 FAIRMONT AVENUE		SAN DIEGO	CA	92105	10/01/2019	09/13/2021
CH099010	MEDICAL CENTER PHARMACY AT FATHER JOE'S	CONDUCTED BY MCP/SVDPV LLC	16 15TH STREET	SAN DIEGO	CA	92101	07/01/2020	08/30/2021
CH099010	MEDICAL CENTER PHARMACY LTC	CONDUCTED BY WESTERN PHARMACY GROUP LLC	610 GATEWAY CENTER WAY STE H-I	SAN DIEGO	CA	92102-4533	07/01/2020	04/01/2024
CH099010	MEDICINE CARE PHARMACY II	1685 E MAIN ST	SUITE 101	EL CAJON	CA	92021	04/01/2016	06/22/2016
CH099010	MEDPILOT PHARMACY INCORPORATED	9323 CHESAPEAKE DR STE C1		SAN DIEGO	CA	92123-1034	04/01/2020	04/01/2024
CH099010	MERCY CARE PHARMACY	488 E VALLEY PKWY STE 101		ESCONDIDO	CA	92025	04/01/2017	04/01/2024
CH099010	MOLLISON PHARMACY	505 N MOLLISON AVE STE 101A		EL CAJON	CA	92021-6159	04/01/2017	04/01/2024
CH099010	NORTH RIALTO SHOPPING CENTER DRUG	DBA NORTH RIALTO DRUG	531 E FOOTHILL BLVD	RIALTO	CA	92376	01/01/2017	11/03/2016
CH099010	NSKAPE INC	DBA: INDIANA PHARMACY	6780 INDIANA AVE STE 145	RIVERSIDE	CA	92506-4270	07/01/2021	04/01/2024
CH099010	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	01/01/2020	04/01/2024
CH099010	OPTUM INFUSION SERVICES 401, LLC	4610 NORTHGATE BLVD.	STE. 130	SACRAMENTO	CA	95834-1154	04/01/2020	04/01/2024
CH099010	OPTUM INFUSION SERVICES 402, LLC	2300 MAIN ST STE 150		IRVINE	CA	92614-6223	01/01/2020	04/01/2024
CH099010	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2020	04/01/2024
CH099010	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2020	04/01/2024
CH099010	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2021	04/01/2024
CH099010	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	07/01/2021	04/01/2024
CH099010	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	04/01/2020	04/01/2024
CH099010	PALM CARE PHARMACY	505 N MOLLISON AVE STE 102		EL CAJON	CA	92021-6159	01/01/2017	04/01/2024
CH099010	PARKE VISTA PHARMACY	3838 SHERMAN DRIVE, STE 1		RIVERSIDE	CA	92503	04/01/2016	11/01/2017
CH099010	PARKVIEW MEDICAL PLAZA PHMCY	3975 JACKSON ST STE 109		RIVERSIDE	CA	92503-3946	04/01/2016	04/01/2024
CH099010	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2020	04/01/2024
CH09901A	PJN PHARMACIES	DBA NUDOS PHARMACY	455 NORTH MAGNOLIA AVENUE	EL CAJON	CA	92020	01/08/2010	07/14/2021
CH099010	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	01/01/2019	04/01/2024
CH099010	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	01/01/2019	04/01/2024
CH099010	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/01/2022	04/01/2024
CH099010	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2020	04/01/2024
CH099010	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2022	04/01/2024
CH099010	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/27/2021	04/01/2024
CH099010	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/27/2021	04/01/2024
CH099010	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/01/2020	04/01/2024
CH099010	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/01/2020	04/01/2024
CH099010	THRIFTY PAYLESS INC.	RITE AID #5628	315 WEST WASHINGTON AVENUE	ESCONDIDO	CA	92025	10/01/2016	02/05/2019
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5676	69155 RAMON ROAD	CATHEDRAL CITY	CA	92234	10/01/2016	04/01/2024
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5678	51101 CESAR CHAVEZ ST	COACHELLA	CA	92236	10/01/2016	04/01/2024
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5716	3849 CHICAGO AVENUE	RIVERSIDE	CA	92507	10/01/2016	04/01/2024
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5684	111 S SUNRISE WAY	PALM SPRINGS	CA	92262	10/01/2016	04/01/2024
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5712	6150 VAN BUREN BOULEVARD	RIVERSIDE	CA	92503	10/01/2016	04/01/2024
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5683	366 SOUTH PALM CANYON DRIVE	PALM SPRINGS	CA	92262	10/01/2016	04/01/2024
CH099010	THRIFTY PAYLESS, INC.	RITE AID #6246	41800 WASHINGTON ST STE 113B	BERMUDA DUNES	CA	92203	10/01/2016	07/14/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #6532	47985 MONROE STREET BLDG A	INDIO	CA	92201	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5681	72-875 HIGHWAY 111	PALM DESERT	CA	92260	10/01/2016	04/01/2024
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5632	9532 WINTER GARDENS BLVD.	LAKESIDE	CA	92040	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5623	2516 JAMACHA ROAD	EL CAJON	CA	92019	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5618	7224 BROADWAY	LEMON GROVE	CA	91945	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5660	10631 TIERRASANTA BOULEVARD	SAN DIEGO	CA	92124	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5718	8015 LIMONITE AVENUE	RIVERSIDE	CA	92509	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5670	82451-C HIGHWAY 111	INDIO	CA	92201	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5625	1135 AVOCADO BOULEVARD	EL CAJON	CA	92020	10/01/2016	04/01/2024
CH099010	THRIFTY PAYLESS, INC.	RITE AID #6486	1180 N STATE STREET	SAN JACINTO	CA	92583	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5682	74958 COUNTRY CLUB DRIVE	PALM DESERT	CA	92260	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5694	1133 N.MOUNT VERNON AVE.	COLTON	CA	92324	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5656	8694 LAKE MURRAY BOULEVARD	SAN DIEGO	CA	92119	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5620	661 SWEETWATER ROAD	SPRING VALLEY	CA	91977	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5651	6405 EL CAJON BOULEVARD	SAN DIEGO	CA	92115	10/01/2016	08/15/2020
CH099010	THRIFTY PAYLESS, INC.	RITE AID #5679	12900 PALM DRIVE	DESERT HOT SPRINGS	CA	92240	10/01/2016	04/01/2024
CH099010	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	04/01/2020	04/01/2024
CH099010	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-1555	2150 N. WATERMAN AVE		EL CENTRO	CA	92243	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-1600	201 EAST BOWMAN RD.		RIDGECREST	CA	93555	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-1692	1120 SOUTH MT VERNON AVE		COLTON	CA	92324	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-1756	17251 FOOTHILL BLVD		FONTANA	CA	92335	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-1805	79295 HWY 111		LAQUINTA	CA	92253	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-1832	5601 E RAMON RD		PALM SPRINGS	CA	92264	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-1859	2540 ROCKWOOD AVENUE		CALEXICO	CA	92231	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-1862	1366 SOUTH RIVERSIDE AVE		RIALTO	CA	92376	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-1879	301 MONTARA RD		BARSTOW	CA	92311	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-1899	6250 VALLEY SPRINGS PKWY		RIVERSIDE	CA	92507	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-1917	170 TOWN CENTER PARKWAY		SANTEE	CA	92071	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-1922	12549 FOOTHILL BLVD		RANCHO CUCAMONGA	CA	91739	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-2028	5200 VAN BUREN BOULEVARD		RIVERSIDE	CA	92503	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-2150	710 DENNERY RD		SAN DIEGO	CA	92154	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-2181	82-491 AVENUE 42		INDIO	CA	92203	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-2253	13487 CAMINO CANADA		EL CAJON (EAST)	CA	92021	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-2479	3412 COLLEGE AVENUE		SAN DIEGO (E)	CA	92115	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-2708	32225 TEMECULA PKWY		TEMECULA	CA	92592	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-3131	300 WEST BASELINE RD		RIALTO	CA	92376	10/01/2016	09/30/2019
CH099010	WAL-MART PHARMACY 10-3276	4001 HALLMARK PKWY		SAN BERNARDINO (N)	CA	92407	10/01/2016	09/30/2019
CH099010	WAL-MART PHARMACY 10-3276	4001 HALLMARK PKWY		SAN BERNARDINO (N)	CA	92407	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-3464	3943 GRAND AVENUE		CHINO	CA	91710	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-3494	732 CENTER DR		SAN MARCOS	CA	92069	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-3524	605 FLETCHER PKWY		EL CAJON (C)	CA	92020	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-5096	34500 MONTEREY AVE.		PALM DESERT(C. CITY)	CA	92260	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-5193	12721 MORENO BEACH DRIVE		MORENO VALLEY	CA	92555	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2017	09/30/2019
CH099010	WAL-MART PHARMACY 10-5425	1861 SOUTH SAN JACINTO AVENUE		SAN JACINTO	CA	92583	01/01/2020	04/01/2024
CH099010	WAL-MART PHARMACY 10-5690		2045 E HIGHLAND AVE.	SAN BERNARDINO	CA	92404	10/01/2016	09/13/2016
CH099010	WAL-MART PHARMACY 10-5996	1330 EAST GRAND AVE		ESCONDIDO	CA	92027	04/01/2016	04/01/2024
CH099010	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2016	04/01/2024
CH099010	WALGREEN CO	DBA: WALGREENS #10368	2261 W ESPLANADE AVE	SAN JACINTO	CA	92582	08/03/2012	04/01/2024
CH099010	WALGREEN CO	DBA: WALGREENS #09885	2465 E. PALM CANYON DR, BLDG 14	PALM SPRINGS	CA	92264	08/03/2012	04/01/2024
CH099010	WALGREEN CO	DBA: WALGREENS #12143	5504 BALBOA AVE	SAN DIEGO	CA	92111	08/03/2012	04/01/2024
CH099010	WALGREEN CO	DBA: WALGREENS #09781	82-955 AVENUE 48, BLDG B	INDIO	CA	92201	08/03/2012	04/01/2024
CH099010	WALGREEN CO	DBA: WALGREENS	2370 E MAIN STREET	WOODLAND	CA	95776	09/27/2012	08/17/2015
CH099010	WALGREEN CO	DBA: WALGREENS	17500 PERRIS BLVD	MORENO VALLEY	CA	92551-9547	09/27/2012	08/17/2015
CH099010	WALGREEN CO	DBA: WALGREENS #09641	72027 DINAH SHORE DR	RANCHO MIRAGE	CA	92270-1739	10/01/2014	04/01/2024
CH099010	WALGREEN CO	DBA: WALGREENS #10703	82900 AVENUE 42 STE D	INDIO	CA	92203	10/01/2014	04/01/2024
CH099010	WALGREEN CO	DBA: WALGREENS #09021	1811 S SAN JACINTO AVE	SAN JACINTO	CA	92583-5605	04/01/2017	04/01/2024
CH099010	WALGREEN CO	DBA: WALGREENS #10467	1236 N WATERMAN AVE	SAN BERNARDINO	CA	92404-5311	07/01/2018	04/01/2024
CH099010	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #07577	1695 N SUNRISE WAY	PALM SPRINGS	CA	92262	10/18/2011	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #07991	6444 VAN BUREN BLVD	RIVERSIDE	CA	92503	10/18/2011	11/05/2019
CH099010	WALGREEN CO.	DBA: WALGREENS #11611	50040 CESAR CHAVEZ ST	COACHELLA	CA	92236	10/18/2011	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 07262	6600 MAGNOLIA AVE	RIVERSIDE	CA	92506-2903	10/18/2011	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05037	14001 PALM DR	DESERT HOT SPRINGS	CA	92240	10/18/2011	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 09229	30-015 DATE PALM	CATHEDRAL CITY	CA	92234	10/18/2011	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #11406	10512 MISSION GORGE RD	SANTEE	CA	92071-3146	08/03/2012	02/21/2017
CH099010	WALGREEN CO.	DBA: WALGREENS # 01081	1101 S SANDERSON AVE	HEMET	CA	92545	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05455	111 W WASHINGTON AVE	ESCONDIDO	CA	92025	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #10172	1181 N STATE ST	SAN JACINTO	CA	92583	08/03/2012	08/20/2015
CH099010	WALGREEN CO.	DBA: WALGREENS # 01870	12109 APPLE VALLEY RD	APPLE VALLEY	CA	92308	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05349	1311 E. FLORIDA AVE.	HEMET	CA	92544	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #11653	1320 ENCINITAS BLVD	ENCINITAS	CA	92024	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05700	1574 E VALLEY PKWY	ESCONDIDO	CA	92027	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 01079	1700 E VISTA CHINO ROAD	PALM SPRINGS	CA	92262	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05556	17051 BEAR VALLEY ROAD	HESPERIA	CA	92345	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 02223	17383 MAIN STREET	HESPERIA	CA	92345-6117	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #07990	1745 UNIVERSITY AVE.	RIVERSIDE	CA	92507	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05844	215 NORTH 2ND STREET	EL CAJON	CA	92021	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 06656	3222 UNIVERSITY AVENUE	SAN DIEGO	CA	92104-2010	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05301	33975 DATE PALM DR	CATHEDRAL CITY	CA	92234	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05348	34503 YUCAIPA BLVD	YUCAIPA	CA	92399	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 04757	42010 WASHINGTON ST.	BERMUDA DUNES	CA	92203	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 01080	43200 STATE HWY 74	HEMET	CA	92544	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 01254	44100 JEFFERSON ST	INDIO	CA	92201	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 04756	44840 MONTEREY AVE.	PALM DESERT	CA	92260	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 10142	460 W FELICITA AVENUE	ESCONDIDO	CA	92025-6518	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 07765	47900 WASHINGTON STREET	LA QUINTA	CA	92253	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13435	555 S SUNRISE WAY STE 112-113	PALM SPRINGS	CA	92264	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05182	60 N HIGHLAND SPRINGS AVE	BANNING	CA	92220	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 07976	800 E LUGONIA AVENUE	REDLANDS	CA	92374	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 02712	8044 LIMONITE AVE	RIVERSIDE	CA	92509	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 09080	80925 US HIGHWAY 111	INDIO	CA	92201	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 07176	8766 NAVAJO RD	SAN DIEGO	CA	92119-2722	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #09817	9305 MISSION GORGE RD	SANTEE	CA	92071-3815	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #11990	9728 WINTER GARDENS BLVD	LAKESIDE	CA	92040	08/03/2012	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 05038	1661 W FLORIDA AVE	HEMET	CA	92543	10/01/2014	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 06399	58133 29 PALMS HWY	YUCCA VALLEY	CA	92284	10/01/2014	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 06856	100 N IMPERIAL AVE	EL CENTRO	CA	92243	10/01/2014	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #12387	1306 BROADWAY	EL CAJON	CA	92021	10/01/2014	02/28/2017
CH099010	WALGREEN CO.	DBA: WALGREENS #12915	7195 BROADWAY	LEMON GROVE	CA	91945-1408	10/01/2014	04/01/2024
CH099010	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16490	4130 LA JOLLA VILLAGE DR STE 103	LA JOLLA	CA	92037	04/01/2017	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS #15539	39000 BOB HOPE DRIVE SUITE #114	RANCHO MIRAGE	CA	92270	04/01/2017	09/13/2017
CH099010	WALGREEN CO.	DBA: WALGREENS # 05527	25011 ALESSANDRO BLVD	MORENO VALLEY	CA	92553	04/01/2017	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 06685	1634 E HIGHLAND AVE	SAN BERNARDINO	CA	92404-4616	04/01/2017	04/01/2024
CH099010	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #12694	10990 WARNER AVE STE A	FOUNTAIN VALLEY	CA	92708	10/01/2018	04/01/2024
CH099010	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16554	7000 INDIANA AVE STE 112	RIVERSIDE	CA	92506	10/01/2018	04/01/2024
CH099010	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15294	8490 SANTA MONICA BLVD STE 1	WEST HOLLYWOOD	CA	90069	01/01/2022	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 13833	10992 MAGNOLIA AVENUE	RIVERSIDE	CA	92505	10/27/2021	04/01/2024
CH099010	WALGREEN CO.	DBA: WALGREENS # 01995	40420 MURRIETA HOT SPRINGS	MURRIETA	CA	92563	01/01/2022	04/01/2024
CH099010	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	04/01/2024
CH099010	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	08/17/2015
CH099010	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/01/2018	04/01/2024
CH099010	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2022	04/01/2024
CH099010	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2022	04/01/2024
CH099010	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/27/2021	04/01/2024
CH099010	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/01/2018	04/01/2024
CH099010	WALMART PHARMACY #10-4169	300 N. 2ND ST		EL CAJON	CA	92021	04/01/2016	04/01/2024
CH099010	WALMART PHARMACY 10-2826	83053 AVENUE 48		COACHELLA	CA	92236	01/01/2020	04/01/2024
CH099010	WALMART PHARMACY 10-3026	72314 HIGHWAY 111		PALM DESERT	CA	92260	01/01/2020	04/01/2024
CH099010	WALMART PHARMACY 10-3084	1266 E VALLEY PKWY		ESCONDIDO	CA	92027	04/01/2016	04/01/2024
CH099010	WALMART PHARMACY 10-5663	8844 LIMONITE AVE		JURUPA VALLEY	CA	92509-5021	01/01/2020	04/01/2024
CH099010	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	04/01/2016	07/04/2018
CH099010	WESTERN PHARMACY GROUP LLC	DBA COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY SUITES A--E	SAN DIEGO	CA	92102	04/01/2020	04/01/2024
CH099010	WESTERN PHARMACY GROUP LLC	DBA GALLOWAY'S MEDICAL CENTER PHARMACY	2995 NATIONAL AVE	SAN DIEGO	CA	92113-2419	04/01/2020	04/01/2020
CH099010	WESTERN PHARMACY GROUP LLC	DBA MEDICAL CENTER PHARMACY	480 4TH AVE STE 100	CHULA VISTA	CA	91910-4411	07/01/2020	04/01/2024
CH099010	WESTERN PHARMACY GROUP LLC	DBA MEDICAL CENTER PHARMACY	3904 PARK BLVD	SAN DIEGO	CA	92103-3502	07/01/2020	04/01/2024
CH099010	WESTERN PHARMACY GROUP LLC	DBA MEDICAL CENTER PHARMACY	286 EUCLID AVE STE 206	SAN DIEGO	CA	92114-3612	07/01/2020	09/13/2021
CH099010	WESTERN PHARMACY GROUP LLC	DBA MEDICAL CENTER PHARMACY	340 4TH AVE STE 1	CHULA VISTA	CA	91910-3882	07/01/2020	04/01/2024
CH099010	WESTERN PHARMACY GROUP LLC	DBA GALLOWAY'S MEDICAL CENTER PHARMACY	2995 NATIONAL AVE	SAN DIEGO	CA	92113-2419	07/01/2020	04/01/2024
CH099010	WHITE CROSS PHARMACY #1	1717 E VISTA CHINO	STE B2	PALM SPRINGS	CA	92262-3700	01/01/2017	04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/31/2021 12:00:00 AM	10/19/2021 2:33 PM
Details	State	Update	Termination Request	Active	To Be Terminated	10/19/2021 2:33 PM
Terminations	Termination Date	Update	Termination Request		1/1/2022 12:00:00 AM	10/19/2021 2:33 PM
Terminations	Termination Effective Date	Update	Termination Request		6/1/2021 12:00:00 AM	10/19/2021 2:33 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	10/19/2021 2:33 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1780038042 ( )		2/24/2021 10:50 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1780038042	2/24/2021 10:50 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	2/24/2021 10:50 AM
Details	Last Recertification Date	Update	Recertification		2/24/2021 10:50:12 AM	2/24/2021 10:50 AM
Contacts	Authorizing Official	Update	AO Change Request	Wallis, Mikia Chief Executive Officer Borrego Community Health Foundation 7607676641	Bulloch, Edgar Interim CEO Borrego Community Health Foundation 7607676641	2/23/2021 8:00 AM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Wallis, Mikia Chief Executive Officer Borrego Community Health Foundation 7607676641	4/21/2020 11:58 AM
Details	340B ID	Update	New Registration		CH09901AU	4/21/2020 11:58 AM
Dates	Participating Approval Date	Update	New Registration		4/21/2020 11:58:19 AM	4/21/2020 11:58 AM
Details	State	Update	New Registration	Pending	Approved	4/21/2020 11:58 AM
Dates	Signed By Date	Update	New Registration		4/15/2020 1:12:52 PM	4/21/2020 11:58 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/21/2020 11:58 AM
Addresses	Main Address	Insert	New Registration		7965 SIERRA AVE # E FONTANA, CA 92336-3329	4/14/2020 7:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2020 7:03 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1780038042	4/14/2020 7:03 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	4/14/2020 7:03 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1780038042	4/14/2020 7:03 PM
Contacts	Primary Contact	Insert	New Registration		Connelly, Mark COO Borrego Community Health Foundation 7607676422	4/14/2020 7:03 PM
Contacts	Authorizing Official	Insert	New Registration		Wallis, Mikia Chief Executive Officer Borrego Community Health Foundation 7607676641	4/14/2020 7:03 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2020 7:03 PM
Details	Grant Number	Insert	New Registration		H80CS00287	4/14/2020 7:03 PM
Details	340B ID	Insert	New Registration			4/14/2020 7:03 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2020 7:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2020 7:03 PM
Details	Medicare Provider Number	Insert	New Registration			4/14/2020 7:03 PM
Details	Entity Name	Insert	New Registration		BORREGO COMMUNITY HEALTH FOUNDATION	4/14/2020 7:03 PM
Details	Program Code	Insert	New Registration		CH	4/14/2020 7:03 PM
Details	Entity Subname	Insert	New Registration		METROPOLITAN FAMILY MEDICAL CLINIC- FONTANA	4/14/2020 7:03 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2020 7:03 PM
Details	State	Insert	New Registration		Pending	4/14/2020 7:03 PM
Dates	Registration Date	Insert	New Registration		4/14/2020 7:03:34 PM	4/14/2020 7:03 PM
Dates	Signed By Date	Insert	New Registration			4/14/2020 7:03 PM
Dates	Start Date	Insert	New Registration			4/14/2020 7:03 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2020 7:03 PM
Terminations	Termination Date	Insert	New Registration			4/14/2020 7:03 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2020 7:03 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2020 7:03 PM

340B Drug Pricing Program Database