| Details | Last Recertification Date | Update | Recertification | 1/31/2024 4:19:01 PM | 2/26/2025 5:46:08 PM | 2/26/2025 5:46 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2023 7:53:55 PM | 1/31/2024 4:19:01 PM | 1/31/2024 4:19 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Monterola, Trina
Director of Finance and Controller
Bay Area Community Health
5102526804 | Monterola, Trina
Director of Finance and Controller
Bay Area Community Health
5103045360 | 12/27/2023 4:12 PM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2022 12:58:38 PM | 2/9/2023 7:53:55 PM | 2/9/2023 7:53 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Page, Zettie D.
CEO
Bay Area
5102525881 | Page, Zettie D
CEO
Bay Area Community Health
7609025249 | 7/14/2022 3:41 PM |
| Contacts | Signed By | Update | Profile Change Request | Page, Zettie D.
CEO
Bay Area
5102525881 | Page, Zettie D
CEO
Bay Area Community Health
7609025249 | 7/14/2022 3:41 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Page, Zettie D.
CEO
Tri-City Health Center
5102525881 | Page, Zettie D.
CEO
Bay Area
5102525881 | 7/14/2022 6:32 AM |
| Contacts | Signed By | Update | Profile Change Request | Page, Zettie D.
CEO
Tri-City Health Center
5102525881 | Page, Zettie D.
CEO
Bay Area
5102525881 | 7/14/2022 6:32 AM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 1245719129 (CA) | | 2/4/2022 12:58 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/4/2022 12:58 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 1780054379 | 2/4/2022 12:58 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | CA | 2/4/2022 12:58 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1245719129 (CA) | | 2/4/2022 12:58 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1780054379 | 2/4/2022 12:58 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | CA | 2/4/2022 12:58 PM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2021 11:37:08 AM | 2/4/2022 12:58:38 PM | 2/4/2022 12:58 PM |
| Details | Entity Name | Update | Change Request | TRI-CITY HEALTH CENTER | BAY AREA COMMUNITY HEALTH | 10/13/2021 7:48 AM |
| Details | Entity Subname | Update | Change Request | TCHC Irvington Dave Clinic II - Medical Services | Irvington Dave Clinic II | 10/13/2021 7:48 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Monterola, Trina
Controller
Tri-City Health Center
5102526804 | Monterola, Trina
Director of Finance and Controller
Bay Area Community Health
5102526804 | 10/13/2021 7:42 AM |
| Details | Last Recertification Date | Update | Recertification | | 2/8/2021 11:37:08 AM | 2/8/2021 11:37 AM |
| Details | State | Update | | Approved | Active | 10/1/2020 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Page, Zettie D.
CEO
Tri-City Health Center
5102525881 | 8/27/2020 9:26 AM |
| Details | 340B ID | Update | New Registration | | CH09122Z | 8/27/2020 9:26 AM |
| Dates | Participating Approval Date | Update | New Registration | | 8/27/2020 9:26:59 AM | 8/27/2020 9:26 AM |
| Details | State | Update | New Registration | Pending | Approved | 8/27/2020 9:26 AM |
| Dates | Signed By Date | Update | New Registration | | 8/26/2020 3:28:31 PM | 8/27/2020 9:26 AM |
| Dates | Start Date | Update | New Registration | | 10/1/2020 12:00:00 AM | 8/27/2020 9:26 AM |
| Addresses | Main Address | Insert | New Registration | |
40930 Fremont Blvd
Fremont, CA 94538-4375 | 8/25/2020 4:10 PM |
| Addresses | Billing Address | Insert | New Registration | | Bay Area Community Health
40910 Frmont Blvd.
Fremont, CA 94538 | 8/25/2020 4:10 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 8/25/2020 4:10 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 1245719129 | 8/25/2020 4:10 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 8/25/2020 4:10 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1245719129 | 8/25/2020 4:10 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 8/25/2020 4:10 PM |
| Contacts | Primary Contact | Insert | New Registration | | Monterola, Trina
Controller
Tri-City Health Center
5102526804 | 8/25/2020 4:10 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Page, Zettie D.
CEO
Tri-City Health Center
5102525881 | 8/25/2020 4:10 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Details | Grant Number | Insert | New Registration | | H80CS02326 | 8/25/2020 4:10 PM |
| Details | 340B ID | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Details | Entity Name | Insert | New Registration | | TRI-CITY HEALTH CENTER | 8/25/2020 4:10 PM |
| Details | NOFO Number | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Details | Program Code | Insert | New Registration | | CH | 8/25/2020 4:10 PM |
| Details | Entity Subname | Insert | New Registration | | TCHC Irvington Dave Clinic II - Medical Services | 8/25/2020 4:10 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Details | State | Insert | New Registration | | Pending | 8/25/2020 4:10 PM |
| Dates | Registration Date | Insert | New Registration | | 8/25/2020 4:10:04 PM | 8/25/2020 4:10 PM |
| Dates | Signed By Date | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Dates | Start Date | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Terminations | Termination Date | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 8/25/2020 4:10 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 8/25/2020 4:10 PM |