340B Drug Pricing Program Database


CH09108AY CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. (Terminated) - information as of 4/29/2025 1:41:36 AM

Main Details
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
San Ysidro Health Tierra Del Rey
HRSA-Funded Health Center
BPS-H80-031999
CH09108AY
H80CS10748


Additional Details
Terminated
4/14/2021
7/1/2021
4/14/2021

4/1/2022
Business decision by the Covered Entity

Contacts

Centro de Salud de la Comunidad de San Ysidro, Inc.
Kevin Mattson, President & CEO
(619) 662-6322

Centro de Salud de la Comunidad de San Ysidro, Inc.
Brian Wallace, VP of Finance & CFO
(619) 662-4100

Addresses

1061 Tierra Del Rey Ste 303-305
Chula Vista, CA 91910-7880

San Ysidro Health San Ysidro Health Center
4004 Beyer Blvd.
San Ysidro, CA 92173


  • 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 1821275132,1952364747,1952429821,1467536326
Shipping Addresses

San Ysidro Health San Ysidro Health Center
4004 Beyer Blvd.
San Ysidro, CA 92173

San Ysidro Health CHC - Ocean View
3177 Ocean View Blvd
San Diego, CA 92113
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH091080ActiveBPS-H80-005050SAN YSIDRO HEALTH CENTERSan Ysidro Health San Ysidro Health Center4004 BEYER BLVD San YsidroCA
CH09108AActiveBPS-H80-001683CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health National City1136 D Ave National CityCA
CH09108AAActiveBPS-H80-018653CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health San Diego PACE/Senior Health Services3364 Beyer Blvd Suite 102 San YsidroCA
CH09108ABActiveBPS-H80-021026CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Wellness Clinic855 Third Avenue Suite 2200 Chula VistaCA
CH09108ACActiveBPS-H80-028255CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Mobile Health Services 1H4004 BEYER BLVD San YsidroCA
CH09108ADActiveBPS-H80-030131CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health San Diego PACE/Senior Health Services Chula Vista880 Third Ave Ste A Chula VistaCA
CH09108AETerminatedBPS-H80-029992CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Mollison505 N Mollison Ave Ste 201 El CajonCA
CH09108AFActiveBPS-H80-029991CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Care View Health Center292 Euclid Ave Ste 210 San DiegoCA
CH09108AGTerminatedBPS-H80-030577CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health- Magnolia411 S Magnolia Ave El CajonCA
CH09108AHActiveBPS-H80-030978CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Sherman Heights316 25th St San DiegoCA
CH09108AJActiveBPS-H80-030979CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Santee Family Medicine120 Town Center Pkwy SanteeCA
CH09108AKActiveBPS-H80-030968CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Community Heights Family Medicine4690 El Cajon Blvd San DiegoCA
CH09108ALActiveBPS-H80-030971CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Mountain Health Family Medicine1388 Buckman Springs Rd CampoCA
CH09108AMTerminatedBPS-H80-030973CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Escondido Family Medicine255 N Ash St Ste 101 EscondidoCA
CH09108ANActiveBPS-H80-030981CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.Alpine Family Medicine Suite 116-1181620 Alpine Blvd Ste 116-118 AlpineCA
CH09108APActiveBPS-H80-030969CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.ALPINE FAMILY MEDICINE1620 Alpine Blvd STE B119 AlpineCA
CH09108AQActiveBPS-H80-030970CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.Alpine Family Medicine Suite 1111620 Alpine Blvd Ste 111 AlpineCA
CH09108ARActiveBPS-H80-030972CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.Alpine Family Medicine Suite 107-1091620 Alpine Blvd STE 107 #109 AlpineCA
CH09108ASActiveBPS-H80-030975CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Alpine Family Medicine1620 Alpine Blvd Ste 110 AlpineCA
CH09108ATActiveBPS-H80-030976CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.Alpine Family Medicine Suite 1141620 Alpine Blvd Ste 114 AlpineCA
CH09108AUActiveBPS-H80-030980CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.MOUNTAIN EMPIRE JR/SIR HIGH SCH3305 Buckman Springs Rd Pine ValleyCA
CH09108AVActiveBPS-H80-031659CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health El Cajon/San Diego PACE875 El Cajon Blvd El CajonCA
CH09108AWToBeTerminatedBPS-H80-027073CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Corporate Office1601 Precision Park Ln San DiegoCA
CH09108AXActiveBPS-H80-031660CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health - Urgent Care333 H St Ste 2080 Chula VistaCA
CH09108AYTerminatedBPS-H80-031999CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Tierra Del Rey1061 Tierra Del Rey Ste 303-305 Chula VistaCA
CH09108AZActiveBPS-H80-032080CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Sports Medicine670 L St Ste G Chula VistaCA
CH09108BAActiveBPS-H80-032719CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Julian Family Medicine2721 Washington St JulianCA
CH09108BBTerminatedBPS-H80-032326CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Alpine Pediatric Medical Clinic2733 Alpine Blvd Ste 200 AlpineCA
CH09108BCActiveBPS-H80-033107CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Escondido Family Medicine704 E Grand Ave EscondidoCA
CH09108BDTerminatedBPS-H80-032453CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Physicians Health Institute for Women550 Washington St Ste 331 San DiegoCA
CH09108BEActiveBPS-H80-034336CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health San Diego PACE Vista1840 West Dr VistaCA
CH09108BFActiveBPS-H80-034393CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Precision Park1666 Precision Park Ln San DiegoCA
CH09108BGActiveBPS-H80-028256CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health South Bay Latino Research Center780 Bay Blvd Ste 200 Chula VistaCA
CH09108BHActiveBPS-H80-036189CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health CASA3045 Beyer STE D-101 San DiegoCA
CH09108BJActiveBPS-H80-036190CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Our Place286 Euclid Ave. STE 309 San DiegoCA
CH09108BKActiveBPS-H80-036859CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health South Bay Pediatrics280 E St Chula VistaCA
CH09108BLActiveBPS-H80-036962CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Julian Family Dental2602 Washington St JulianCA
CH09108BMActiveBPS-H80-037110CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Senior Dental Center1525 Fourth Ave STE 201 San DiegoCA
CH09108BNActiveBPS-H80-037711CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Mobile Health Services 1J4004 BEYER BLVD SAN YSIDROCA
CH09108BPActiveBPS-H80-037712CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health HIV & LGBTQ Mobile Clinic Services4004 BEYER BLVD SAN YSIDROCA
CH09108CActiveBPS-H80-013440CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Euclid286 Euclid Ave STE 302 San DiegoCA
CH09108DActiveBPS-H80-004686CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health CHC - Ocean View3177 Ocean View Blvd San DiegoCA
CH09108EActiveBPS-H80-013436CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Chula Vista678 3rd Ave Chula VistaCA
CH09108FActiveBPS-H80-008546CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Maternal & Child Health Center4050 Beyer Blvd San YsidroCA
CH09108GToBeTerminatedBPS-H80-000067CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Children's Dental Center at Radys Children's Hospital8110 Birmingham Way San DiegoCA
CH09108KActiveBPS-H80-009375CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Paradise Hills2400 E 8th St STE A National CityCA
CH09108LActiveBPS-H80-005064CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Otay1637 3RD AVE STE BF CHULA VISTACA
CH09108MActiveBPS-H80-010000CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Lincoln High School4777 Imperial Ave. San DiegoCA
CH09108NTerminatedBPS-H80-005540CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.YOUTH ENHANCEMENT SERVICES3025 Beyer Blvd STE 101 San DiegoCA
CH09108PActiveBPS-H80-001488CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Mobile Health Services 1F4004 Beyer Blvd San YsidroCA
CH09108QActiveBPS-H80-003812CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Mobile Health Services 1G4004 BEYER BLVD SAN YSIDROCA
CH09108SActiveBPS-H80-009108CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Adult Day Healthcare Center3364 Beyer Blvd San DiegoCA
CH09108TActiveBPS-H80-009280CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health King-Chavez Health Center950 S. Euclid San DiegoCA
CH09108UActiveBPS-H80-009304CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.Southwest High School1685 Hollister St San DiegoCA
CH09108VActiveBPS-H80-009400CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.Palomar High School480 Palomar St Chula VistaCA
CH09108WTerminatedBPS-H80-013436CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.Chula Vista Medical Plaza678 3rd Ave Chula VistaCA
CH09108XActiveBPS-H80-017345CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health South Bay330/340 East 8th Street National CityCA
CH09108YTerminatedBPS-H80-015794CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Chaldean & Middle-Eastern Social Services436 South Magnolia Avenue El CajonCA
CH09108ZTerminatedBPS-H80-014567CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.San Ysidro Health Mi Clinica at Northgate1058 3RD AVE CHULA VISTACA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH091080ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2024  
CH091080ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/01/2024  
CH091080ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2024  
CH091080ACCREDO HEALTH GROUP INC2410 WARDLOW RD STE 101
CORONACA9287804/01/2025  
CH091080ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/01/2024  
CH091080ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/01/2024  
CH091080AD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004806/14/2012 06/22/2016
CH09108AAD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004806/14/2012  
CH09108CAD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004806/14/2012  
CH09108DAD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004806/14/2012  
CH09108EAD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004808/31/2012  
CH09108FAD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004808/31/2012  
CH09108LAD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004808/31/2012  
CH09108KAD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004808/31/2012  
CH09108GAD-RX PHARMACY  6240 WILSHIRE BLVD.
LOS ANGELESCA9004808/31/2012 07/01/2025
CH091080AIDS HEALTHCARE FOUNDATIONAHF PHARMACY 3580 5TH AVE STE 200
SAN DIEGOCA9210307/01/2013  
CH091080AIDS HEALTHCARE FOUNDATIONDBA AHF PHARMACY 19300 S. HAMILTON AVE #170/180
GARDENACA90248-440007/01/2013  
CH091080AIDS HEALTHCARE FOUNDATIONDBA AHF PHARMACY 5417 E. WHITTIER BLVD
LOS ANGELESCA90022-410110/01/2013 02/10/2016
CH091080ALBERTSONS LLCSAV-ON PHARMACY #0757 720 3RD AVE
CHULA VISTACA9191007/01/2017  
CH091080ALBERTSONS LLCSAV-ON PHARMACY # 0745 655 14TH ST
SAN DIEGOCA9210107/01/2017  
CH091080ALBERTSONS LLCSAV-ON PHARMACY #0758 543 SWEETWATER RD
SPRING VALLEYCA9197707/01/2017  
CH091080ALBERTSONS LLCSAV-ON PHARMACY #0723 9831 CAMPO RD
SPRING VALLEYCA9197707/01/2017  
CH091080ALBERTSONS LLCSAV-ON PHARMACY #0704 2955 ALPINE BLVD
ALPINECA9190107/01/2022  
CH091080ALBERTSONS LLCSAV-ON PHARMACY #0725 1459 MAIN ST
RAMONACA9206507/01/2022  
CH091080ALLEN PHARMACY333 C ST STE 100
SAN DIEGOCA92101-520304/01/2021  
CH091080AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291101/01/2022  
CH091080AMAZON PHARMACY #0101331 E 6TH ST
CORONACA9287904/01/2025  
CH091080AVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282101/01/2024  
CH091080AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080801/01/2024  
CH091080AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503401/01/2022  
CH091080BIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284106/14/2012  
CH09108ABIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284106/14/2012  
CH09108CBIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284106/14/2012  
CH09108DBIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284106/14/2012  
CH09108EBIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284108/31/2012  
CH09108FBIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284108/31/2012  
CH09108LBIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284108/31/2012  
CH09108KBIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284108/31/2012  
CH09108GBIOPLUS SPECIALTY PHARMACY CA7373 LINCOLN WAY
GARDEN GROVECA9284108/31/2012 07/01/2025
CH091080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2025  
CH091080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2025  
CH091080BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2025  
CH091080BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/01/2025  
CH091080BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620304/01/2025  
CH091080BRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410607/01/2018  
CH091080BRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET
AVONMA0232207/01/2018  
CH091080CAREKINESIS228 STRAWBRIDGE DR STE 200
MOORESTOWNNJ08057-460010/01/2016 02/15/2017
CH09108ECAREKINESIS228 STRAWBRIDGE DR STE 200
MOORESTOWNNJ08057-460010/01/2016  
CH09108SCAREKINESIS228 STRAWBRIDGE DR STE 200
MOORESTOWNNJ08057-460010/01/2016  
CH09108TCAREKINESIS228 STRAWBRIDGE DR STE 200
MOORESTOWNNJ08057-460010/01/2016  
CH091080CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2021  
CH091080CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2021  
CH091080CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2021  
CH091080CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2021  
CH091080CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2021  
CH091080CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2021  
CH091080CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813304/01/2021  
CH091080CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237404/01/2021  
CH091080CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2021  
CH091080CHULAVISTA PHARMACY LLC384 H ST # 100
CHULA VISTACA91910-551307/01/2017  
CH091080COMMUNITY MEDICAL CENTER PHARMACY  750 MEDICAL CENTER CRT
STE. 1
CHULA VISTACA91911-663406/15/2012 02/08/2017
CH09108ACOMMUNITY MEDICAL CENTER PHARMACY  750 MEDICAL CENTER CRT
STE. 1
CHULA VISTACA91911-663406/14/2012 05/03/2022
CH09108CCOMMUNITY MEDICAL CENTER PHARMACY  750 MEDICAL CENTER CRT
STE. 1
CHULA VISTACA91911-663406/14/2012 05/03/2022
CH09108DCOMMUNITY MEDICAL CENTER PHARMACY  750 MEDICAL CENTER CRT
STE. 1
CHULA VISTACA91911-663406/14/2012 05/03/2022
CH091080COMMUNITY MEDICAL PHARMACYIN-HOUSE PHARMACIES, INC. 610 GATEWAY CENTER WAY NO. A
SAN DIEGOCA92102-454806/15/2012 07/01/2018
CH09108ACOMMUNITY MEDICAL PHARMACYIN-HOUSE PHARMACIES, INC. 610 GATEWAY CENTER WAY NO. A
SAN DIEGOCA92102-454806/14/2012 05/03/2022
CH09108CCOMMUNITY MEDICAL PHARMACYIN-HOUSE PHARMACIES, INC. 610 GATEWAY CENTER WAY NO. A
SAN DIEGOCA92102-454806/14/2012 05/03/2022
CH09108DCOMMUNITY MEDICAL PHARMACYIN-HOUSE PHARMACIES, INC. 610 GATEWAY CENTER WAY NO. A
SAN DIEGOCA92102-454806/14/2012 05/03/2022
CH091080CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2022  
CH091080CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2022  
CH091080CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2021  
CH091080CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/01/2024  
CH091080DIB PHARMACEUTICAL INCDBA: BETTER LIFE PHARMACY 528 E MAIN ST
EL CAJONCA9202010/01/2023  
CH091080DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654104/01/2025  
CH091080ELDAHMY WELLNESS PHARMACY INC.1985 NATIONAL AVE STE 1103
SAN DIEGOCA92113-215501/01/2020 02/28/2023
CH091080ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/01/2024  
CH091080EXPRESS PHARMACY1111 E WASHINGTON AVE STE C
ESCONDIDOCA92025-222601/01/2020  
CH091080EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/01/2024  
CH091080EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/01/2024  
CH091080EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/01/2024  
CH091080FAMILY PHARMACY250 E CHASE AVE STE 108
EL CAJONCA9202010/01/2024  
CH091080FAMILY PHARMACY 2480 4TH AVE STE 100
CHULA VISTACA9191010/01/2024  
CH091080FAMILY PHARMACY CENTER220 W MAIN ST STE 102
EL CAJONCA9202010/01/2024  
CH091080GALLOWAY'S MEDICAL CENTER PHARMACY2995 NATIONAL AVENUE
SAN DIEGOCA9211306/15/2012 07/01/2018
CH09108AGALLOWAY'S MEDICAL CENTER PHARMACY2995 NATIONAL AVENUE
SAN DIEGOCA9211306/14/2012 05/03/2022
CH09108CGALLOWAY'S MEDICAL CENTER PHARMACY2995 NATIONAL AVENUE
SAN DIEGOCA9211306/14/2012 05/03/2022
CH09108DGALLOWAY'S MEDICAL CENTER PHARMACY2995 NATIONAL AVENUE
SAN DIEGOCA9211306/14/2012 05/03/2022
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09196 1376 3RD AVE
CHULA VISTACA9191101/01/2016 03/27/2017
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09138 1201 E. PLAZA BLVD
NATIONAL CITYCA9195010/01/2018  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09193 1380 43RD ST.
SAN DIEGOCA9211310/01/2018  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09196 1376 3RD AVE
CHULA VISTACA9191110/01/2018 02/18/2024
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04768 510 C STREET
SAN DIEGOCA9210101/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08842 426 EAST CHASE AVENUE
EL CAJONCA9202001/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08859 16 3RD AVENUE EXT.
CHULA VISTACA9191001/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09112 7100 BROADWAY
LEMON GROVECA9194501/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09113 645 E. PALOMAR ST.
CHULA VISTACA9191101/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09115 645 SATURN BLVD
SAN DIEGOCA9215401/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09120 800 PALM AVE.
IMPERIAL BEACHCA9193201/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09121 4404 EL CAJON BLVD
SAN DIEGOCA9211501/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09140 555 BROADWAY STE 1054
CHULA VISTACA9191001/01/2019 02/02/2024
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09141 3151 UNIVERSITY AVE.
SAN DIEGOCA9210401/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09524 3350 PALM AVE.
SAN DIEGOCA9215401/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16052 1240 BROADWAY
CHULA VISTACA9191101/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09109 6265 EL CAJON BLVD
SAN DIEGOCA9211507/01/2019  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09173 2760 FLETCHER PKY
EL CAJONCA9202001/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08836 1631 S MELROSE DR
VISTACA9208101/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09103 318 W EL NORTE PARKWAY
ESCONDIDOCA9202601/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09104 2427 E. VALLEY PKWY
ESCONDIDOCA9202701/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09145 9730 MISSION GORGE RD.
SANTEECA9207101/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09574 883 S. SANTA FE AVENUE
VISTACA9208301/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09166 734 S. RANCHO SANTA FE RD.
SAN MARCOSCA9207801/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08857 1441 N SANTA FE
VISTACA9208401/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09194 1810 MAIN ST.
RAMONACA9206501/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09108 1655 S. CENTRE CITY PKWY.
ESCONDIDOCA9202501/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08818 997 WOODLAND PKWY.
SAN MARCOSCA9206901/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 07127 1302 WEST MISSION RD.
SAN MARCOSCA9206901/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 10931 1745 S. IMPERIAL AVE
EL CENTROCA9224301/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16817 9846 MISSION GORGE RD
SANTEECA9207101/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16937 2295 N IMPERIAL AVE
EL CENTROCA9224301/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17644 280 E VIA RANCHO PKWY
ESCONDIDOCA9202501/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16083 1280 AUTO PARKWAY SOUTH
ESCONDIDOCA9202901/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16425 1751 UNIVERSITY DR
VISTACA9208301/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17245 3150 BUSINESS PARK DR
VISTACA9208101/01/2020  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09114 1299 BROADWAY
EL CAJONCA9202104/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09131 10560-4S COMMONS DR.
SAN DIEGOCA9212704/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09148 313 WASHINGTON ST.
SAN DIEGOCA9210304/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09165 3327 ROSECRANS ST.
SAN DIEGOCA9211004/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09585 3925 N. RIVER RD.
OCEANSIDECA9205804/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05551 109 SOUTH WEST ST.
TULARECA9327404/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08816 11950 DE PALMA RD.
CORONACA9288304/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08833 3332 SANDROCK ROAD
SAN DIEGOCA9212304/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09175 4829 CLAIREMONT DR
SAN DIEGOCA9211704/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09177 8260 MIRA MESA BLVD.
SAN DIEGOCA9212604/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY #11141 420 E 2ND ST
CALEXICOCA9223104/01/2021  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09105 12358 POWAY ROAD
POWAYCA9206407/01/2022  
CH091080GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10919 9665 CAMPO RD.
SPRING VALLEYCA9197707/01/2022  
CH091080GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #11331 101 PARK PLAZA STE 155
SAN DIEGOCA9210107/01/2022  
CH091080GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09626 1701 SOUTH WESTERN AVENUE
LOS ANGELESCA9000607/01/2022  
CH091080GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10182 866 EASTLAKE PKWY
CHULA VISTACA9191407/01/2024  
CH091080GRANE SUPPLY105 GAMMA DR SUITE 100
PITTSBURGHPA15238-295001/01/2022  
CH091080GRANE SUPPLY550 E UNION ST STE B
WEST CHESTERPA19382-390801/01/2022  
CH091080GRANE SUPPLY D/B/A GRANE RX3251 REVERE ST STE 205
AURORACO80011-184701/01/2022  
CH091080HABIBIS PHARMACY LLCFAMILY PHARMACY 3 340 4TH AVE STE 1
CHULA VISTACA9191010/01/2024  
CH091080HILLCREST PHARMACY120 UNIVERSITY AVE
SAN DIEGOCA9210306/27/2012  
CH091080LA PHARMACY LLC1048 S GARFIELD AVE STE 101
ALHAMBRACA9180101/01/2022  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09820 444 E SAN YSIDRO BLVD
SAN YSIDROCA9217301/01/2016 05/16/2017
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09632 691 3RD AVE
CHULA VISTACA9191010/01/2018  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06332 645 MARKET ST
SAN DIEGOCA9210107/01/2019  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07962 5685 BALBOA AVE
SAN DIEGOCA9211107/01/2019  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09162 3749 AVOCADO BLVD
LA MESACA9194107/01/2019  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09240 380 E H ST
CHULA VISTACA9191007/01/2019  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09783 1730 SWEETWATER RD
NATIONAL CITYCA9195007/01/2019  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09818 572 FLETCHER PKWY
EL CAJONCA9202001/01/2020  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09900 2690 MOUNT VERNON AVE
BAKERSFIELDCA9330601/01/2020  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09558 320 S TWIN OAKS VALLEY RD
SAN MARCOSCA9207801/01/2020  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09961 191 WOODLAND PKWY
SAN MARCOSCA9206901/01/2020  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06368 635 S MELROSE DR
VISTACA9208101/01/2020  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09959 1560 W VALLEY PKWY
ESCONDIDOCA9202901/01/2020  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09693 1665 E VALLEY PKWY
ESCONDIDOCA9202701/01/2020 10/15/2019
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09167 790 JAMACHA RD
EL CAJONCA9201904/01/2021  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09169 5500 GROSSMONT CENTER DR BLDG P
LA MESACA9194204/01/2021  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09963 5644 MISSION CENTER RD
SUITE 201
SAN DIEGOCA9210804/01/2021  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09157 23791 WASHINGTON AVE
MURRIETACA9256204/01/2021  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09937 4445 MISSION BLVD
SAN DIEGOCA9210904/01/2021  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09502 43418 STATE HIGHWAY 74
HEMETCA9254401/01/2022  
CH091080LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03025 1385 TAVERN RD
ALPINECA9190107/01/2022  
CH091080LONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D
LEXINGTONSC29072-245301/01/2024  
CH091080M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312601/01/2022  
CH091080MEDICAL CENTER PHARMACYPARK MEDICAL PHARMACY 480 4TH AVE STE 100
CHULA VISTACA9191006/15/2012 07/01/2018
CH091080MEDICAL CENTER PHARMACYMEDICAL CENTER PHARMACY 855 THIRD AVENUE
SUITE 1102
CHULA VISTACA91911-921006/15/2012 02/08/2017
CH091080MEDICAL CENTER PHARMACY  765 MEDICAL CENTER CRT.
NO 208
CHULA VISTACA9191106/15/2012 02/10/2016
CH091080MEDICAL CENTER PHARMACY4074 FAIRMONT AVENUE
SAN DIEGOCA9210506/15/2012 07/01/2018
CH091080MEDICAL CENTER PHARMACY340 4TH AVENUE SUITE 1
CHULA VISTACA9191006/15/2012 07/01/2018
CH091080MEDICAL CENTER PHARMACY3904 PARK BLVD
SAN DIEGOCA9210306/15/2012 07/01/2018
CH091080MEDICAL CENTER PHARMACY  7910 FROST STREET
SUITE 130
SAN DIEGOCA9212307/01/2013 06/17/2016
CH091080MEDICAL CENTER PHARMACYMCP16 286 EUCLID AVE, #206
SAN DIEGOCA9211404/01/2015 07/01/2018
CH09108AMEDICAL CENTER PHARMACY340 4TH AVENUE SUITE 1
CHULA VISTACA9191006/14/2012 05/03/2022
CH09108AMEDICAL CENTER PHARMACYPARK MEDICAL PHARMACY 480 4TH AVE STE 100
CHULA VISTACA9191006/14/2012 05/03/2022
CH09108AMEDICAL CENTER PHARMACYMEDICAL CENTER PHARMACY 855 THIRD AVENUE
SUITE 1102
CHULA VISTACA91911-921006/14/2012 05/03/2022
CH09108AMEDICAL CENTER PHARMACY  1635 3RD AVENUE
CHULA VISTACA9191106/14/2012 05/03/2022
CH09108AMEDICAL CENTER PHARMACY3904 PARK BLVD
SAN DIEGOCA9210306/14/2012 05/03/2022
CH09108AMEDICAL CENTER PHARMACY  765 MEDICAL CENTER CRT.
NO 208
CHULA VISTACA9191106/14/2012 05/03/2022
CH09108AMEDICAL CENTER PHARMACY4074 FAIRMONT AVENUE
SAN DIEGOCA9210506/14/2012 05/03/2022
CH09108CMEDICAL CENTER PHARMACY340 4TH AVENUE SUITE 1
CHULA VISTACA9191006/14/2012 05/03/2022
CH09108CMEDICAL CENTER PHARMACYPARK MEDICAL PHARMACY 480 4TH AVE STE 100
CHULA VISTACA9191006/14/2012 05/03/2022
CH09108CMEDICAL CENTER PHARMACYMEDICAL CENTER PHARMACY 855 THIRD AVENUE
SUITE 1102
CHULA VISTACA91911-921006/14/2012 05/03/2022
CH09108CMEDICAL CENTER PHARMACY  1635 3RD AVENUE
CHULA VISTACA9191106/14/2012 05/03/2022
CH09108CMEDICAL CENTER PHARMACY3904 PARK BLVD
SAN DIEGOCA9210306/14/2012 05/03/2022
CH09108CMEDICAL CENTER PHARMACY  765 MEDICAL CENTER CRT.
NO 208
CHULA VISTACA9191106/14/2012 05/03/2022
CH09108CMEDICAL CENTER PHARMACY4074 FAIRMONT AVENUE
SAN DIEGOCA9210506/14/2012 05/03/2022
CH09108DMEDICAL CENTER PHARMACY340 4TH AVENUE SUITE 1
CHULA VISTACA9191006/14/2012 05/03/2022
CH09108DMEDICAL CENTER PHARMACYPARK MEDICAL PHARMACY 480 4TH AVE STE 100
CHULA VISTACA9191006/14/2012 05/03/2022
CH09108DMEDICAL CENTER PHARMACYMEDICAL CENTER PHARMACY 855 THIRD AVENUE
SUITE 1102
CHULA VISTACA91911-921006/14/2012 05/03/2022
CH09108DMEDICAL CENTER PHARMACY  1635 3RD AVENUE
CHULA VISTACA9191106/14/2012 05/03/2022
CH09108DMEDICAL CENTER PHARMACY3904 PARK BLVD
SAN DIEGOCA9210306/14/2012 05/03/2022
CH09108DMEDICAL CENTER PHARMACY  765 MEDICAL CENTER CRT.
NO 208
CHULA VISTACA9191106/14/2012 05/03/2022
CH09108DMEDICAL CENTER PHARMACY4074 FAIRMONT AVENUE
SAN DIEGOCA9210506/14/2012 05/03/2022
CH091080MEDPILOT PHARMACY INCORPORATED9323 CHESAPEAKE DR STE C1
SAN DIEGOCA92123-103404/01/2020  
CH091080MI FARMACIA SAN YSIDRO4630 BORDER VILLAGE RD STE K-L
SAN YSIDROCA92173-312110/01/2019  
CH09108AMODERN HEALTH PHARMACY - SD13220 EVENING CREEK DRIVE #109-110
SAN DIEGOCA9212806/14/2012  
CH09108CMODERN HEALTH PHARMACY - SD13220 EVENING CREEK DRIVE #109-110
SAN DIEGOCA9212806/14/2012  
CH09108DMODERN HEALTH PHARMACY - SD13220 EVENING CREEK DRIVE #109-110
SAN DIEGOCA9212806/14/2012  
CH09108EMODERN HEALTH PHARMACY - SD13220 EVENING CREEK DRIVE #109-110
SAN DIEGOCA9212808/31/2012  
CH09108FMODERN HEALTH PHARMACY - SD13220 EVENING CREEK DRIVE #109-110
SAN DIEGOCA9212808/31/2012  
CH09108LMODERN HEALTH PHARMACY - SD13220 EVENING CREEK DRIVE #109-110
SAN DIEGOCA9212808/31/2012  
CH09108KMODERN HEALTH PHARMACY - SD13220 EVENING CREEK DRIVE #109-110
SAN DIEGOCA9212808/31/2012  
CH09108GMODERN HEALTH PHARMACY - SD13220 EVENING CREEK DRIVE #109-110
SAN DIEGOCA9212808/31/2012 07/01/2025
CH091080MOLLISON PHARMACY505 N MOLLISON AVE STE 101A
EL CAJONCA92021-615910/01/2018 12/06/2019
CH091080NUDO PHARMACIES INC  PJ'S PRESCRIPTION SHOPPE
3405 KENYON STREET
SAN DIEGOCA9211010/01/2015 02/09/2016
CH091080OPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/01/2018  
CH091080OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2018  
CH091080OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/01/2018  
CH091080OPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110107/01/2018  
CH091080OVERLAKE PHARMACY, LLC4124 148TH AVE NE STE JA
REDMONDWA9805201/01/2022  
CH091080PALM CARE PHARMACY505 N MOLLISON AVE STE 102
EL CAJONCA92021-615910/01/2018  
CH091080PARADISE PHARMACY502 EUCLID AVE STE 100
NATIONAL CITYCA91950-294801/01/2018  
CH091080PHARMEDQUEST PHARMACY SERVICESDBA AVITA PHARMACY 1072 26800 CROWN VALLEY PKWY STE 185
MISSION VIEJOCA9269101/01/2024  
CH091080PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310101/01/2022  
CH091080PILLPACK LLCAMAZON PHARMACY #005 20416 72ND AVE S
KENTWA98032-231904/01/2025  
CH091080PRIDE PHARMACYFEMININE PHARM-D INC DBA 1270 UNIVERSITY AVE
SAN DIEGOCA92103-331207/01/2024  
CH091080PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2021  
CH091080PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2021  
CH091080PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681304/01/2021  
CH091080PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2021  
CH091080PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 1010 UNIVERSITY AVENUE
SAN DIEGOCA9210307/01/2022  
CH091080RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255004/01/2025  
CH091080RALPHS GROCERY CODBA RALPHS #108 8657 VILLA LA JOLLA DR
#108
LA JOLLACA9203710/01/2013 02/10/2016
CH091080RALPHS GROCERY CODBA RALPHS #123 101 G ST.
SAN DIEGOCA9210110/01/2013 03/09/2025
CH091080RALPHS GROCERY CO  DBA RALPHS #138
3533 CANNON RD
OCEANSIDECA9205610/01/2013 06/11/2015
CH091080RALPHS GROCERY CODBA RALPHS #201 3345 SPORTS ARENA BLVD
SAN DIEGOCA9211010/01/2013 06/11/2015
CH091080RALPHS GROCERY CODBA RALPHS #207 4315 MISSION BLVD
SAN DIEGOCA9210910/01/2013 02/10/2016
CH091080RALPHS GROCERY CODBA RALPHS #235 659 E. PALOMAR STREET
CHULA VISTACA9191110/01/2013  
CH091080RALPHS GROCERY CODBA RALPHS #298 4251 OCEANSIDE BLVD
OCEANSIDECA9205610/01/2013 02/10/2016
CH091080RALPHS GROCERY CODBA RALPHS #51 1020 UNIVERSITY AVE
SAN DIEGOCA9210310/01/2013 03/09/2025
CH091080RALPHS GROCERY CODBA RALPHS #54 101 OLD GROVE RD
OCEANSIDECA9205710/01/2013 02/10/2016
CH091080RALPHS GROCERY CODBA RALPHS #683 306 TWIN OAKS VALLEY RD
SAN MARCOSCA9207810/01/2013 02/10/2016
CH091080RALPHS GROCERY CO.DBA: RALPHS #105 10525 4S COMMONS DRIVE
SAN DIEGOCA9212710/01/2013 02/10/2016
CH091080RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2025  
CH091080SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2025  
CH091080SEMCA PHARMACY INCSOUTHEAST MEDICAL CENTER 286 NORTH EUCLID AVE
SUITE 206
SAN DIEGOCA9211408/24/2012 02/08/2017
CH091080TALAMI HEALTH CARE LLCDBA: PALM CARE PHARMACY 101 N HIGHLAND AVE
SUITE EFG
NATIONAL CITYCA91950-140001/01/2020  
CH091080THE VONS COMPANIES INCVONS PHARMACY #2115 620 DENNERY ROAD
SAN DIEGOCA9215407/01/2013  
CH091080THRIFTY PAYLESS INC.RITE AID #5643 427 C STREET SUITE 100
SAN DIEGOCA9210107/01/2017 06/19/2018
CH091080THRIFTY PAYLESS, INC.RITE AID #5668 1854 CORONADO AVENUE
SAN DIEGOCA9215401/01/2017  
CH091080THRIFTY PAYLESS, INC.RITE AID #5620 661 SWEETWATER ROAD
SPRING VALLEYCA9197701/01/2017  
CH091080THRIFTY PAYLESS, INC.RITE AID #5615 507 TELEGRAPH CANYON ROAD
CHULA VISTACA9191001/01/2017  
CH091080THRIFTY PAYLESS, INC.RITE AID #5644 535 ROBINSON AVENUE
SAN DIEGOCA9210307/01/2017  
CH091080THRIFTY PAYLESS, INC.RITE AID #5646 1735 EUCLID AVENUE
SAN DIEGOCA9210507/01/2017  
CH091080THRIFTY PAYLESS, INC.RITE AID #5618 7224 BROADWAY
LEMON GROVECA9194507/01/2017  
CH091080THRIFTY PAYLESS, INC.RITE AID #5617 2230 OTAY LAKES ROAD
CHULA VISTACA9191507/01/2017  
CH091080THRIFTY PAYLESS, INC.RITE AID #6225 1665 ALPINE BOULEVARD
ALPINECA9190110/01/2020  
CH091080TRUEPILL3121 DIABLO AVE
HAYWARDCA9454501/01/2022  
CH091080TRUEPILL NY LLC850 3RD AVE STE 404
BROOKLYNNY11232-152301/01/2022  
CH091080WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2017  
CH091080WAL-MART PHARMACY 10-15552150 N. WATERMAN AVE
EL CENTROCA9224310/01/2020  
CH091080WAL-MART PHARMACY 10-170013425 COMMUNITY ROAD
POWAYCA9206401/01/2020  
CH091080WAL-MART PHARMACY 10-1917170 TOWN CENTER PARKWAY
SANTEECA9207110/01/2020  
CH091080WAL-MART PHARMACY 10-20941800 UNIVERSITY DR
VISTACA9208301/01/2020  
CH091080WAL-MART PHARMACY 10-2150710 DENNERY RD
SAN DIEGOCA9215410/01/2015 02/10/2016
CH091080WAL-MART PHARMACY 10-225313487 CAMINO CANADA
EL CAJON (EAST)CA9202110/01/2015 02/10/2016
CH091080WAL-MART PHARMACY 10-229175 NORTH BROADWAY
CHULA VISTA (W)CA9191010/01/2014  
CH091080WAL-MART PHARMACY 10-3494732 CENTER DR
SAN MARCOSCA9206901/01/2020  
CH091080WAL-MART PHARMACY 10-3524605 FLETCHER PKWY
EL CAJON (C)CA9202010/01/2015 02/10/2016
CH091080WAL-MART PHARMACY 10-50231200 HIGHLAND AVE
NATIONAL CITYCA9195010/01/2014  
CH091080WAL-MART PHARMACY 10-50753405 MARRON RD
OCEANSIDECA9205601/01/2020 10/15/2019
CH091080WAL-MART PHARMACY 10-53051150 BROADWAY
CHULA VISTA(S)CA9191110/01/2014  
CH091080WAL-MART PHARMACY 10-58861550 LEUCADIA BLVD
ENCINITASCA9202401/01/2020 10/15/2019
CH091080WAL-MART PHARMACY 10-5938575 SATURN BLVD
SAN DIEGOCA9215410/01/2015 02/10/2016
CH091080WAL-MART PHARMACY 10-59961330 EAST GRAND AVE
ESCONDIDOCA9202701/01/2020  
CH091080WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2017  
CH091080WALGREEN CO.DBA: WALGREENS # 06255 621 I STREET
CHULA VISTACA9191004/13/2012  
CH091080WALGREEN CO.DBA: WALGREENS # 02623 1111 THIRD AVE
CHULA VISTACA91911-310504/13/2012  
CH091080WALGREEN CO.DBA: WALGREENS # 07869 885 EUCLID AVE
NATIONAL CITYCA9195004/13/2012  
CH091080WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #13434 640 UNIVERSITY AVE
SAN DIEGOCA9210304/13/2012  
CH091080WALGREEN CO.DBA: WALGREENS # 06656 3222 UNIVERSITY AVENUE
SAN DIEGOCA92104-201004/13/2012 11/15/2023
CH091080WALGREEN CO.DBA: WALGREENS # 07867 1430 EASTLAKE PKWY
CHULA VISTACA9191504/13/2012  
CH091080WALGREEN CO.DBA: WALGREENS #11990 9728 WINTER GARDENS BLVD
LAKESIDECA9204004/13/2012  
CH091080WALGREEN CO.DBA: WALGREENS # 05844 215 NORTH 2ND STREET
EL CAJONCA9202104/13/2012  
CH091080WALGREEN CO.DBA: COMMUNITY A WALGREENS PHARMACY 3900 FIFTH AVENUE SUITE 110
SAN DIEGOCA9210310/01/2013 04/03/2015
CH091080WALGREEN CO.DBA: WALGREENS #12915 7195 BROADWAY
LEMON GROVECA91945-140804/01/2015  
CH091080WALGREEN CO.DBA: WALGREENS #13161 4029 43RD ST. STE 700
SAN DIEGOCA9210504/01/2015  
CH091080WALGREEN CO.DBA: WALGREENS #13834 602 EUCLID AVE
SAN DIEGOCA9211410/01/2015  
CH091080WALGREEN CO.DBA: WALGREENS #09817 9305 MISSION GORGE RD
SANTEECA92071-381504/01/2020  
CH091080WALGREEN CO.DBA: WALGREENS # 05455 111 W WASHINGTON AVE
ESCONDIDOCA9202504/01/2020  
CH091080WALGREEN CO.DBA: WALGREENS # 05700 1574 E VALLEY PKWY
ESCONDIDOCA9202704/01/2020  
CH091080WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/2024  
CH091080WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/2024  
CH091080WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/01/2024  
CH091080WALMART PHARMACY 10-30841266 E VALLEY PKWY
ESCONDIDOCA9202701/01/2020  
CH091080WELLPARTNER, INC20800 SW 115TH AVE SUITE 100
TUALATINOR9706210/01/2014 07/04/2018
CH091080WESTERN PHARMACY GROUP LLCDBA MEDICAL CENTER PHARMACY 340 4TH AVE STE 1
CHULA VISTACA91910-388207/01/2018 05/03/2022
CH091080WESTERN PHARMACY GROUP LLCDBA MEDICAL CENTER PHARMACY 480 4TH AVE STE 100
CHULA VISTACA91910-441107/01/2018 05/03/2022
CH091080WESTERN PHARMACY GROUP LLCDBA MEDICAL CENTER PHARMACY 3904 PARK BLVD
SAN DIEGOCA92103-350207/01/2018 05/03/2022
CH091080WESTERN PHARMACY GROUP LLCDBA MEDICAL CENTER PHARMACY 4074 FAIRMOUNT AVE
SAN DIEGOCA92105-160807/01/2018 09/13/2021
CH091080WESTERN PHARMACY GROUP LLCDBA GALLOWAY'S MEDICAL CENTER PHARMACY 2995 NATIONAL AVE
SAN DIEGOCA92113-241907/01/2018 05/03/2022
CH091080WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E
SAN DIEGOCA9210207/01/2018 05/03/2022
CH091080WESTERN PHARMACY GROUP LLCDBA MEDICAL CENTER PHARMACY 286 EUCLID AVE STE 206
SAN DIEGOCA92114-361207/01/2018 09/13/2021
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateProfile Change RequestWallace, Brian VP of Finance & CFO Centro de Salud de la Comunidad de San Ysidro, Inc. 6196626322Wallace, Brian VP of Finance & CFO Centro de Salud de la Comunidad de San Ysidro, Inc. 61966241004/23/2025 4:29 PM
DetailsStateUpdate To Be TerminatedTerminated4/1/2022 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 1/1/2022 12:00:00 AM1/18/2022 7:00 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated1/18/2022 7:00 AM
TerminationsTermination DateUpdateTermination Request 4/1/2022 12:00:00 AM1/18/2022 7:00 AM
TerminationsTermination Effective DateUpdateTermination Request 1/1/2022 12:00:00 AM1/18/2022 7:00 AM
TerminationsTermination ReasonUpdateTermination Request Business decision by the Covered Entity1/18/2022 7:00 AM
DetailsStateUpdate ApprovedActive7/1/2021 12:01 AM
ContactsSigned ByInsertNew Registration Mattson, Kevin President & CEO Centro de Salud de la Comunidad de San Ysidro, Inc. 61966263224/14/2021 2:58 PM
Details340B IDUpdateNew Registration CH09108AY4/14/2021 2:58 PM
DatesParticipating Approval DateUpdateNew Registration 4/14/2021 2:58:53 PM4/14/2021 2:58 PM
DetailsStateUpdateNew RegistrationPendingApproved4/14/2021 2:58 PM
DatesSigned By DateUpdateNew Registration 4/14/2021 2:45:17 PM4/14/2021 2:58 PM
DatesStart DateUpdateNew Registration 7/1/2021 12:00:00 AM4/14/2021 2:58 PM
AddressesMain AddressInsertNew Registration  1061 Tierra Del Rey Ste 303-305 Chula Vista, CA 91910-78804/14/2021 2:45 PM
AddressesBilling AddressInsertNew Registration San Ysidro Health San Ysidro Health Center 4004 Beyer Blvd. San Ysidro, CA 921734/14/2021 2:45 PM
AddressesShipping AddressInsertNew Registration San Ysidro Health San Ysidro Health Center 4004 Beyer Blvd. San Ysidro, CA 921734/14/2021 2:45 PM
AddressesShipping AddressInsertNew Registration San Ysidro Health CHC - Ocean View 3177 Ocean View Blvd San Diego, CA 921134/14/2021 2:45 PM
Medicaid BillingNPI: NumberInsertNew Registration 18212751324/14/2021 2:45 PM
Medicaid BillingNPI: StateInsertNew Registration CA4/14/2021 2:45 PM
Medicaid BillingNPI: NumberInsertNew Registration 19523647474/14/2021 2:45 PM
Medicaid BillingNPI: StateInsertNew Registration CA4/14/2021 2:45 PM
Medicaid BillingNPI: NumberInsertNew Registration 19524298214/14/2021 2:45 PM
Medicaid BillingNPI: StateInsertNew Registration CA4/14/2021 2:45 PM
Medicaid BillingNPI: NumberInsertNew Registration 14675363264/14/2021 2:45 PM
Medicaid BillingNPI: StateInsertNew Registration CA4/14/2021 2:45 PM
ContactsPrimary ContactInsertNew Registration Wallace, Brian VP of Finance & CFO Centro de Salud de la Comunidad de San Ysidro, Inc. 61966263224/14/2021 2:45 PM
ContactsAuthorizing OfficialInsertNew Registration Mattson, Kevin President & CEO Centro de Salud de la Comunidad de San Ysidro, Inc. 61966263224/14/2021 2:45 PM
DetailsAssistance Received From DateInsertNew Registration  4/14/2021 2:45 PM
DetailsAssistance Received To DateInsertNew Registration  4/14/2021 2:45 PM
DetailsLast Recertification DateInsertNew Registration  4/14/2021 2:45 PM
DetailsGrant NumberInsertNew Registration H80CS107484/14/2021 2:45 PM
Details340B IDInsertNew Registration  4/14/2021 2:45 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/14/2021 2:45 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/14/2021 2:45 PM
DetailsMedicare Provider NumberInsertNew Registration  4/14/2021 2:45 PM
DetailsEntity NameInsertNew Registration CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.4/14/2021 2:45 PM
DetailsNOFO NumberInsertNew Registration  4/14/2021 2:45 PM
DetailsProgram CodeInsertNew Registration CH4/14/2021 2:45 PM
DetailsEntity SubnameInsertNew Registration San Ysidro Health Tierra Del Rey4/14/2021 2:45 PM
DatesParticipating Approval DateInsertNew Registration  4/14/2021 2:45 PM
DetailsStateInsertNew Registration Pending4/14/2021 2:45 PM
DatesRegistration DateInsertNew Registration 4/14/2021 2:45:14 PM4/14/2021 2:45 PM
DatesSigned By DateInsertNew Registration  4/14/2021 2:45 PM
DatesStart DateInsertNew Registration  4/14/2021 2:45 PM
TerminationsTermination CommentsInsertNew Registration  4/14/2021 2:45 PM
TerminationsTermination DateInsertNew Registration  4/14/2021 2:45 PM
TerminationsTermination Effective DateInsertNew Registration  4/14/2021 2:45 PM
TerminationsTermination ReasonInsertNew Registration  4/14/2021 2:45 PM