| Details | Last Recertification Date | Update | Recertification | 2/14/2024 11:23:49 AM | 2/17/2025 11:27:49 PM | 2/17/2025 11:27 PM |
| Contacts | Primary Contact | Update | Group Change Request | Pereira, Aubrie Rose
340B Program Coordinator
Mountain Valleys Health Centers
5309999010-5187 | Watkins, Brandon
Chief Financial Officer
Mountain Valleys Health Centers
5302496857 | 1/6/2025 12:46 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 2:51:13 PM | 2/14/2024 11:23:49 AM | 2/14/2024 11:23 AM |
| Contacts | Primary Contact | Update | Group Change Request | Watkins, Brandon
Chief Financial Officer
Mountain Valleys Health Centers
5302496857 | Pereira, Aubrie Rose
340B Program Coordinator
Mountain Valleys Health Centers
5309999010-5187 | 1/24/2024 2:40 PM |
| Details | Last Recertification Date | Update | Recertification | 2/23/2022 4:18:59 PM | 1/30/2023 2:51:13 PM | 1/30/2023 2:51 PM |
| Details | Last Recertification Date | Update | Recertification | 2/11/2021 9:02:18 AM | 2/23/2022 4:18:59 PM | 2/23/2022 4:18 PM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2020 4:59:31 PM | 2/11/2021 9:02:18 AM | 2/11/2021 9:02 AM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2019 2:24:10 PM | 2/21/2020 4:59:31 PM | 2/21/2020 4:59 PM |
| Contacts | Primary Contact | Update | Change Request | Hawkins, Lydia Joyce
340b Coordinator
Mountain Valleys Health Centers
5302945241-3500 | Watkins, Brandon
Chief Financial Officer
Mountain Valleys Health Centers
5302496857 | 12/13/2019 2:52 PM |
| Contacts | Authorizing Official | Update | Change Request | Watkins, Brandon
Chief Financial Officer
Mountain Valleys Health Centers
5302496857 | Gerig, Shannon
CEO
Mountain Valleys Health Centers
5309999010 | 10/10/2019 3:44 PM |
| Contacts | Authorizing Official | Update | Change Request | JONES, DAVE
CEO
Mountain Valleys Health Centers
5302945241 | Watkins, Brandon
Chief Financial Officer
Mountain Valleys Health Centers
5302496857 | 2/28/2019 5:26 PM |
| Contacts | Primary Contact | Update | Change Request | Watkins, Brandon
Chief Financial Officer
Mountain Valleys Health Centers
5302496857 | Hawkins, Lydia Joyce
340b Coordinator
Mountain Valleys Health Centers
5302945241-3500 | 2/28/2019 5:26 PM |
| Details | Last Recertification Date | Update | Recertification | 3/1/2018 1:30:09 PM | 2/14/2019 2:24:10 PM | 2/14/2019 2:24 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Watkins, Brandon
340b Program Director
Mountain Valleys Health Centers
5308393402 | Watkins, Brandon
Chief Financial Officer
Mountain Valleys Health Centers
5302496857 | 1/15/2019 5:42 PM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2017 12:00:00 AM | 3/1/2018 1:30:09 PM | 3/1/2018 1:30 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1356438261 ( ) | | 2/7/2018 1:37 PM |
| Contacts | Primary Contact | Update | Change Request | Gerig, Shannon
Director of Quality
Mountain Valleys Health Centers
5302945241 | Watkins, Brandon
340b Program Director
Mountain Valleys Health Centers
5308393402 | 2/7/2018 1:37 PM |
| Contacts | Authorizing Official | Update | | JONES, DAVE
CEO
5302945241 | JONES, DAVE
CEO
Mountain Valleys Health Centers
5302945241 | 10/3/2017 11:56 AM |
| Contacts | Primary Contact | Update | | Gerig, Shannon
Director of Quality
5302945241 | Gerig, Shannon
Director of Quality
Mountain Valleys Health Centers
5302945241 | 10/3/2017 11:54 AM |
| Contacts | Authorizing Official | Insert | | | JONES, DAVE
CEO
5302945241 | 7/25/2017 1:39 PM |
| Contacts | Primary Contact | Insert | | | Gerig, Shannon
Director of Quality
5302945241 | 3/16/2017 11:34 AM |
| Addresses | Main Address | Insert | | |
554-850 MEDICAL CENTER DRIVE
BIEBER, CA 96009-0277 | 2/8/2017 3:08 PM |
| Details | Last Recertification Date | Update | | 3/1/2016 12:00:00 AM | 2/8/2017 12:00:00 AM | 2/8/2017 3:07 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1356438261 | 3/1/2016 2:57 PM |
| Details | Last Recertification Date | Update | | 3/5/2015 12:00:00 AM | 3/1/2016 12:00:00 AM | 3/1/2016 2:57 PM |
| Details | Last Recertification Date | Update | | 3/14/2014 12:00:00 AM | 3/5/2015 12:00:00 AM | 3/5/2015 3:11 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/14/2014 12:00:00 AM | 3/14/2014 6:04 AM |
| Details | Entity Name | Update | | MOUNTAIN VALLEYS HEALTH CENTERS, INC. | MOUNTAIN VALLEYS HEALTH CENTERS | 3/14/2014 6:04 AM |
| Details | Entity Subname | Update | | BIG VALLEY HEALTH CENTER | BIG VALLEY MEDICAL CENTER | 3/14/2014 6:04 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/25/2013 12:17 PM |
| Addresses | Billing Address | Insert | | | MOUNTAIN VALLEYS HEALTH CENTERS, INC.
PO BOX 277
BIEBER, CA 96009 | 8/28/2006 2:12 PM |
| Details | Last Recertification Date | Insert | | | | 8/28/2006 2:12 PM |
| Details | Grant Number | Insert | | | H80CS00260 | 8/28/2006 2:12 PM |
| Details | 340B ID | Insert | | | CH091750 | 8/28/2006 2:12 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 8/28/2006 2:12 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 8/28/2006 2:12 PM |
| Details | Medicare Provider Number | Insert | | | | 8/28/2006 2:12 PM |
| Details | Entity Name | Insert | | | MOUNTAIN VALLEYS HEALTH CENTERS, INC. | 8/28/2006 2:12 PM |
| Details | Program Code | Insert | | | CH | 8/28/2006 2:12 PM |
| Details | Entity Subname | Insert | | | BIG VALLEY HEALTH CENTER | 8/28/2006 2:12 PM |
| Dates | Participating Approval Date | Insert | | | 5/9/2005 12:00:00 AM | 8/28/2006 2:12 PM |
| Details | State | Insert | | | Active | 8/28/2006 2:12 PM |
| Dates | Registration Date | Insert | | | 4/1/2000 12:00:00 AM | 8/28/2006 2:12 PM |
| Dates | Signed By Date | Insert | | | | 8/28/2006 2:12 PM |
| Dates | Start Date | Insert | | | 4/1/2000 12:00:00 AM | 8/28/2006 2:12 PM |
| Terminations | Termination Comments | Insert | | | | 8/28/2006 2:12 PM |
| Terminations | Termination Date | Insert | | | | 8/28/2006 2:12 PM |
| Terminations | Termination Effective Date | Insert | | | | 8/28/2006 2:12 PM |
| Terminations | Termination Reason | Insert | | | | 8/28/2006 2:12 PM |
| Details | Comments Public | Insert | | | ADMIN CORRECTION - WAS 340B ID #FQHCLA078 | 8/28/2006 2:12 PM |