340B Drug Pricing Program Database


CH09538H Marin Community Clinic (Active) - information as of 4/28/2025 12:44:17 AM

Main Details
Marin Community Clinic
Marin Community Clinic - 4th Street Dental
HRSA-Funded Health Center
BPS-H80-011038
CH09538H
H80CS00343


Additional Details
Active
10/9/2020
1/1/2021
10/16/2020
2/13/2025

Contacts

Marin Community Clinics
Kathryn E Powell, Interim Chief Executive Officer
(415) 448-1500

Marin Community Clinic
Sheri Dunham, Compliance Coordinator
(415) 376-3255

Addresses

411 4th St STE A
San Rafael, CA 94901-5716

Marin Community Clinic
9 Commercial Blvd, Ste 100
Novato, CA 94949


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA 1154503399,1093292765
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH095380ActiveBPS-H80-014015Marin Community ClinicMarin Community Clinic - Larkspur5 Bon Air Road, Suite 117 LarkspurCA
CH09538AActiveBPS-H80-008138MARIN COMMUNITY CLINICNOVATO6100 REDWOOD BLVD NOVATOCA
CH09538BActiveBPS-H80-007520MARIN COMMUNITY CLINICMarin Community Clinic - San Rafael3110 KERNER BLVD SAN RAFAELCA
CH09538CActiveBPS-H80-010418MARIN COMMUNITY CLINICSAN RAFAEL CAMPUS3260 KERNER BLVD. SAN RAFAELCA
CH09538DActiveBPS-H80-017900MARIN COMMUNITY CLINICMarin Community Clinic - Novato South6090 Redwood Blvd NovatoCA
CH09538EActiveBPS-H80-013619Marin Community ClinicHuckleberry Youth Programs361 3rd Street, Suite G San RafaelCA
CH09538FTerminatedBPS-H80-024858Marin Community ClinicMarin Community Clinic - 4th Street Dental Suite C411 4th St Ste C San RafaelCA
CH09538GTerminatedBPS-H80-009429Marin Community ClinicMarin Community Clinic - Novato Dental6090 Redwood Blvd. STE D NovatoCA
CH09538HActiveBPS-H80-011038Marin Community ClinicMarin Community Clinic - 4th Street Dental411 4th St STE A San RafaelCA
CH09538JActiveBPS-H80-030959Marin Community ClinicMarin Community Clinic - Greenbrae1260 S Eliseo Dr Ste 201 GreenbraeCA
CH09538KActiveBPS-H80-034364Marin Community ClinicMarin Community Clinic - West San Rafael1618 2nd St San RafaelCA
CH09538LActiveBPS-H80-038521MARIN COMMUNITY CLINICMarin Community Clinic - Downtown San Rafael999 Third Street STE A San RafaelCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH095380AVITA PHARMACY 1021PHARMEDQUEST PHARMACY SERVICES DBA AVITA 1260 S ELISEO DR STE 201
GREENBRAECA94904-200902/24/2021 02/25/2022
CH095380AVITA PHARMACY 1022PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3110 KERNER BLVD STE A
SAN RAFAELCA94901-541110/01/2019 08/08/2023
CH09538BAVITA PHARMACY 1022PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3110 KERNER BLVD STE A
SAN RAFAELCA94901-541109/30/2019 08/08/2023
CH09538AAVITA PHARMACY 1023PHARMEDQUEST PHARMACY SERVICES DBA AVITA 6100 REDWOOD BLVD STE A
NOVATOCA94945-450109/30/2019 03/18/2022
CH095380AVITA PHARMACY 1023PHARMEDQUEST PHARMACY SERVICES DBA AVITA 6100 REDWOOD BLVD STE A
NOVATOCA94945-450110/01/2019 03/18/2022
CH09538AAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282107/01/2019 08/08/2023
CH095380AVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282107/01/2019 08/08/2023
CH09538BAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282107/01/2019 08/08/2023
CH095380AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080801/01/2021 08/08/2023
CH095380CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2020  
CH095380CLINIC PHARMACIES, LLCDBA MCC PHARMACY NOVATO 6100 REDWOOD BLVD, SUITE A
NOVATOCA9494501/01/2016 06/28/2019
CH09538ACLINIC PHARMACIES, LLCDBA MCC PHARMACY NOVATO 6100 REDWOOD BLVD, SUITE A
NOVATOCA9494507/01/2015 06/28/2019
CH095380CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2024  
CH095380CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2024  
CH095380EVERGREEN PHARMACEUTICAL OF CALIFORNIA,OMNICARE OF SANTA ROSA EVERGREEN PHARMACEUTICAL CA
879 2ND STREET 		SANTA ROSACA95404-462101/01/2023  
CH095380GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17629 125 SHORELINE PKWY
SAN RAFAELCA9490107/01/2019  
CH095380GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04952 909 GRAND ST.
SAN RAFAELCA9490107/01/2019 03/09/2022
CH095380GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16212 200 VINTAGE WAY
NOVATOCA9494507/01/2019  
CH095380GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16746 133 SERRAMONTE CTR
DALY CITYCA9401501/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 1483 1599 TIBURON BLVD
TIBURONCA9492001/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567007/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10368 400 SUTTER ST.
SAN FRANCISCOCA9410810/01/2020 02/07/2022
CH095380GARFIELD BEACH CVS, L.L.C.CVS/PHARMACY # 17694 180 DONAHUE STREET
SAUSALITOCA9496510/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 4675 377 32ND AVENUE
SAN FRANCISCOCA9412110/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #5131 1900 19TH AVENUE
SAN FRANCISCOCA9411601/01/2022  
CH095380GARFIELD BEACH CVS, L.L.C.CVS/PHARMACY #10924 3010 BERNAL AVENUE
PLEASANTONCA9456601/01/2022  
CH095380GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17586 401 KENILWORTH DRIVE
PETALUMACA9495201/01/2022  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09529 442 LAS GALLINAS AVE
SAN RAFAELCA9490307/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09370 880 SIR FRANCIS DRAKE BLVD
SAN ANSELMOCA9496007/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09316 1707 GRANT AVE
NOVATOCA9494507/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09947 2035 NOVATO BLVD
NOVATOCA9494707/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09913 759 E BLITHEDALE AVE
MILL VALLEYCA9494107/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09219 330 BON AIR SHOPPING CTR
GREENBRAECA9490407/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09962 150 DONAHUE ST
SAUSALITOCA9496507/01/2019 01/31/2022
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09480 365 E WASHINGTON ST
PETALUMACA9495201/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09928 6378 COMMERCE BLVD
ROHNERT PARKCA9492801/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09163 291 N MCDOWELL BLVD
PETALUMACA9495401/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09904 3667 CASTRO VALLEY BLVD
CASTRO VALLEYCA9454604/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09656 2771 4TH ST
SANTA ROSACA9540507/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07955 2025 VAN NESS AVE
SAN FRANCISCOCA9410907/01/2020 02/07/2022
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09818 572 FLETCHER PKWY
EL CAJONCA9202007/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09086 670 EL CERRITO PLZ
EL CERRITOCA9453010/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450110/01/2020 03/20/2023
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09152 201 W NAPA ST STE 35
SONOMACA9547610/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09929 2000 MOUNTAIN BLVD
OAKLANDCA9461110/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09393 2075 MENDOCINO AVE
SANTA ROSACA9540110/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460210/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09872 6877 SEBASTOPOL AVENUE
SEBASTOPOLCA9547210/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09832 3678 SONOMA BLVD
VALLEJOCA9459001/01/2022  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09099 4020 FREMONT HUB
FREMONTCA9453801/01/2022  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09946 463 STONY POINT RD
SANTA ROSACA9540101/01/2022  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09957 344 THOMAS L. BERKLEY WAY
OAKLANDCA9461201/01/2022 03/30/2022
CH095380LONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245301/01/2021 08/08/2023
CH095380MARIN APOTHECARIES, INC.MCC PHARMACY 3110 KERNER BLVD STE A
SAN RAFAELCA9490101/01/2016 06/28/2019
CH09538BMARIN APOTHECARIES, INC.MCC PHARMACY 3110 KERNER BLVD STE A
SAN RAFAELCA9490104/01/2015 06/28/2019
CH09538BMCC PHARMACY  3110 KERNER BLVD
SAN RAFAELCA9490102/14/2012 06/28/2019
CH095380MISSION WELLNESS PHARMACY  2424 MISSION STREET
SAN FRANCISCOCA9411007/01/2024  
CH095380OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2024  
CH095380OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/01/2024  
CH095380PHARMEDQUEST PHARMACYPHARMEDQUEST PHARMACY SERVICES 451 W. LAMBERT RD STE 209
BREACA92821-928201/01/2021 12/30/2022
CH09538BPHARMEDQUEST PHARMACY SERVICES451 W LAMBERT RD STE 208
BREACA92821-392007/01/2019 08/08/2023
CH095380PHARMEDQUEST PHARMACY SERVICES451 W LAMBERT RD STE 208
BREACA92821-392007/01/2019 12/30/2022
CH09538APHARMEDQUEST PHARMACY SERVICES451 W LAMBERT RD STE 208
BREACA92821-392007/01/2019 08/08/2023
CH095380ROSS VALLEY PHARMACY  1525 EAST FRANCISCO BLVD
SUITE #1 		SAN RAFAELCA9490108/01/2002 02/07/2019
CH09538BROSS VALLEY PHARMACY  1525 EAST FRANCISCO BLVD
SUITE #1 		SAN RAFAELCA9490109/26/2012 02/07/2019
CH095380RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135510/01/2018 06/28/2019
CH095380SAFEWAY INCSAFEWAY PHARMACY #2718 800 REDWOOD HWY FRONTAGE RD. STE 110
MILL VALLEYCA9494110/01/2018  
CH095380SAFEWAY INCSAFEWAY PHARMACY #2828 5720 NAVE DRIVE
NOVATOCA9494910/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5958 1500 NORTHGATE MALL
SAN RAFAELCA9490310/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5957 471 3RD STREET
SAN RAFAELCA9490110/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5961 701 EAST BLITHEDALE AVE.
MILL VALLEYCA9494110/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5959 431 CORTE MADERA TOWN CENTER
CORTE MADERACA9492510/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5963 910 DIABLO AVENUE
NOVATOCA9494710/01/2018 05/15/2024
CH095380WALGREEN CO.DBA: WALGREENS # 03084 7800 OLD REDWOOD HWY
COTATICA9493111/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 04491 15650 SAN PABLO AVE.
SAN PABLOCA9480611/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 04559 227 SHORELINE HWY
MILL VALLEYCA9494111/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 04625 830 3RD STREET
SAN RAFAELCA9490111/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 06625 2141 CHESTNUT STREET
SAN FRANCISCOCA94123-270811/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 07445 820 SIR FRANCIS DRAKE BLVD
SAN ANSELMOCA9496011/09/2011 06/08/2023
CH095380WALGREEN CO.DBA: WALGREENS #13584 155 NORTHGATE ONE
SAN RAFAELCA94903-341711/09/2011  
CH095380WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15296 2262 MARKET ST
SAN FRANCISCOCA9411407/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/30/2024 12:42:09 PM2/13/2025 6:19:18 PM2/13/2025 6:19 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestFadoo, Farhan CEO Marin Community Clinic 4154481500Powell, Kathryn E Interim Chief Executive Officer Marin Community Clinics 415448150011/18/2024 8:18 AM
ContactsPrimary ContactUpdateGroup Change RequestMihai, Isabela Compliance Officer Marin Community Clinic 4157552509Dunham, Sheri Compliance Coordinator Marin Community Clinic 415376325511/18/2024 8:18 AM
DetailsLast Recertification DateUpdateRecertification2/1/2023 12:37:21 PM1/30/2024 12:42:09 PM1/30/2024 12:42 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestAndrews, Leigha Interim CEO Marin Community Clinic 4154481500Fadoo, Farhan CEO Marin Community Clinic 415448150012/7/2023 9:40 AM
DetailsLast Recertification DateUpdateRecertification2/2/2022 2:58:04 PM2/1/2023 12:37:21 PM2/1/2023 12:37 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestPopat, Mitesh CEO Marin Community Clinics 4157552581Andrews, Leigha Interim CEO Marin Community Clinic 415448150012/29/2022 9:40 AM
Medicaid BillingNPI: NumberInsertRecertification 10932927652/2/2022 2:58 PM
Medicaid BillingNPI: StateInsertRecertification CA2/2/2022 2:58 PM
DetailsLast Recertification DateUpdateRecertification2/3/2021 4:13:43 PM2/2/2022 2:58:04 PM2/2/2022 2:58 PM
DetailsLast Recertification DateUpdateRecertification 2/3/2021 4:13:43 PM2/3/2021 4:13 PM
DetailsStateUpdate ApprovedActive1/1/2021 12:01 AM
ContactsSigned ByInsertNew Registration Popat, Mitesh CEO Marin Community Clinics 415755258110/16/2020 12:02 PM
Details340B IDUpdateNew Registration CH09538H10/16/2020 12:02 PM
DatesParticipating Approval DateUpdateNew Registration 10/16/2020 12:02:43 PM10/16/2020 12:02 PM
DetailsStateUpdateNew RegistrationPendingApproved10/16/2020 12:02 PM
DatesSigned By DateUpdateNew Registration 10/9/2020 8:59:46 PM10/16/2020 12:02 PM
DatesStart DateUpdateNew Registration 1/1/2021 12:00:00 AM10/16/2020 12:02 PM
AddressesMain AddressInsertNew Registration  411 4th St STE A San Rafael, CA 94901-571610/9/2020 6:24 PM
AddressesBilling AddressInsertNew Registration Marin Community Clinic 9 Commercial Blvd, Ste 100 Novato, CA 9494910/9/2020 6:24 PM
Medicaid BillingNPI: NumberInsertNew Registration 115450339910/9/2020 6:24 PM
Medicaid BillingNPI: StateInsertNew Registration CA10/9/2020 6:24 PM
ContactsAuthorizing OfficialInsertNew Registration Popat, Mitesh CEO Marin Community Clinics 415755258110/9/2020 6:24 PM
ContactsPrimary ContactInsertNew Registration Mihai, Isabela Compliance Officer Marin Community Clinic 415755250910/9/2020 6:24 PM
DetailsAssistance Received From DateInsertNew Registration  10/9/2020 6:24 PM
DetailsAssistance Received To DateInsertNew Registration  10/9/2020 6:24 PM
DetailsLast Recertification DateInsertNew Registration  10/9/2020 6:24 PM
DetailsGrant NumberInsertNew Registration H80CS0034310/9/2020 6:24 PM
Details340B IDInsertNew Registration  10/9/2020 6:24 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/9/2020 6:24 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/9/2020 6:24 PM
DetailsMedicare Provider NumberInsertNew Registration  10/9/2020 6:24 PM
DetailsEntity NameInsertNew Registration Marin Community Clinic10/9/2020 6:24 PM
DetailsNOFO NumberInsertNew Registration  10/9/2020 6:24 PM
DetailsProgram CodeInsertNew Registration CH10/9/2020 6:24 PM
DetailsEntity SubnameInsertNew Registration Marin Community Clinic - 4th Street Dental10/9/2020 6:24 PM
DatesParticipating Approval DateInsertNew Registration  10/9/2020 6:24 PM
DetailsStateInsertNew Registration Pending10/9/2020 6:24 PM
DatesRegistration DateInsertNew Registration 10/9/2020 6:24:38 PM10/9/2020 6:24 PM
DatesSigned By DateInsertNew Registration  10/9/2020 6:24 PM
DatesStart DateInsertNew Registration  10/9/2020 6:24 PM
TerminationsTermination CommentsInsertNew Registration  10/9/2020 6:24 PM
TerminationsTermination DateInsertNew Registration  10/9/2020 6:24 PM
TerminationsTermination Effective DateInsertNew Registration  10/9/2020 6:24 PM
TerminationsTermination ReasonInsertNew Registration  10/9/2020 6:24 PM