340B Drug Pricing Program Database


CHC266170-12 Via Care Community Health Center, Inc. (Active) - information as of 5/30/2025 8:14:31 PM

Main Details
Via Care Community Health Center, Inc.
Via Care West LA College
HRSA-Funded Health Center
BPS-H80-033588
CHC266170-12
H80CS26617


Additional Details
Active
1/13/2022
4/1/2022
2/14/2022
2/13/2025

Contacts

Via Care Community Health Center
Nina Falcetti, Director of HR
(323) 268-9191 Ext: 1091

Via Care Community Health Center
Mahsa Female Dadkhah, Pharmacy Director
(323) 268-9191 Ext: 1043

Addresses

9000 Overland Ave
Culver City, CA 90230-5002

Via Care Community Health Center
3601 E. 1st Street
Los Angeles, CA 90063


  • 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
CA14970012261497001226
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC266170-00ActiveBPS-H80-013239Via Care Community Health Center, INC.Via Care 507 Community Health Center507 S. Atlantic Blvd. Los AngelesCA
CHC266170-01ActiveBPS-H80-013257Via Care Community Health CenterVia Care Garfield Wellness Center501 S Woods Ave Los AngelesCA
CHC266170-02ActiveBPS-H80-015531VIA CARE COMMUNITY HEALTH CENTERVIA CARE CHAVEZ COMMUNITY HEALTH CENTER4755 E. Caesar Chavez Avenue Los AngelesCA
CHC266170-03ActiveBPS-H80-018402VIA CARE COMMUNITY HEALTH CENTER, INC.Via Care Whittier Boulevard Health Center5015 Whittier Blvd. Los AngelesCA
CHC266170-04ActiveBPS-H80-018780VIA CARE COMMUNITY HEALTH CENTER, INC.Via Care Primary 607607 S. Atlantic Blvd. Los AngelesCA
CHC266170-05ActiveBPS-H80-027124Via Care Community Health Center, Inc.Via Care Chronic Disease Care Clinic615 S Atlantic Blvd Los AngelesCA
CHC266170-06ActiveBPS-H80-029409Via Care Community Health Center, Inc.Via Care ELAC Health Center1301 Avenida Cesar Chavez Ste F5-302 Monterey ParkCA
CHC266170-07ActiveBPS-H80-027434Via Care Community Health Center, Inc.Via Care Whittier Dental Clinic5017 Whittier Blvd Los AngelesCA
CHC266170-08ActiveBPS-H80-032000Via Care Community Health Center, Inc.Via Care Tweedy Health Center4476 Tweedy Blvd Ste B South GateCA
CHC266170-09ActiveBPS-H80-032667Via Care Community Health Center, Inc.Via Care Los Angeles Trade Tech College400 W Washington Blvd Ste D3-107A Los AngelesCA
CHC266170-10TerminatedBPS-H80-024883Via Care Community Health Center, Inc.Via Care 280 Health Center280 S Atlantic Blvd East Los AngelesCA
CHC266170-11ApprovedBPS-H80-033555VIA CARE COMMUNITY HEALTH CENTERVia Care 284 Family Health Center284 S Atlantic Blvd Los AngelesCA
CHC266170-12ActiveBPS-H80-033588Via Care Community Health Center, Inc.Via Care West LA College9000 Overland Ave Culver CityCA
CHC266170-13ActiveBPS-H80-033904Via Care Community Health Center, Inc.Via Care Rio Hondo College3600 Workman Mill Rd WhittierCA
CHC266170-14ActiveBPS-H80-021042VIA CARE COMMUNITY HEALTH CENTER501 Supportive Services Center501 S Atlantic Blvd Los AngelesCA
CHC266170-15ActiveBPS-H80-036059VIA CARE COMMUNITY HEALTH CENTERVia Care 609 Annex609 S. Atlantic Blvd. Los AngelesCA
CHC266170-16ActiveBPS-H80-036672VIA CARE COMMUNITY HEALTH CENTERVia Care Bellflower Health Center10230 Artesia Blvd BellflowerCA
CHC266170-17ActiveBPS-H80-037619VIA CARE COMMUNITY HEALTH CENTERVia Care Valley Community College5800 Fulton Ave Valley GlenCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC266170-00ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310204/01/2018 12/31/2024
CHC266170-03ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310204/01/2018 01/01/2025
CHC266170-04ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310204/01/2018 01/01/2025
CHC266170-02ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310204/01/2018 01/01/2025
CHC266170-01ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310204/01/2018 01/01/2025
CHC266170-06ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310201/01/2020 01/01/2025
CHC266170-07ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310201/01/2020 01/01/2025
CHC266170-05ACARIAHEALTH PHARMACY #13, INC3302 GARFIELD AVE.
COMMERCECA90040-310204/01/2020 01/01/2025
CHC266170-00ATLANTIC PHARMACY  5119 E. BEVERLY BLVD.
LOS ANGELESCA90022-173407/01/2016  
CHC266170-01ATLANTIC PHARMACY  5119 E. BEVERLY BLVD.
LOS ANGELESCA90022-173407/01/2016  
CHC266170-02ATLANTIC PHARMACY  5119 E. BEVERLY BLVD.
LOS ANGELESCA90022-173410/01/2017  
CHC266170-03ATLANTIC PHARMACY  5119 E. BEVERLY BLVD.
LOS ANGELESCA90022-173410/01/2017  
CHC266170-04ATLANTIC PHARMACY  5119 E. BEVERLY BLVD.
LOS ANGELESCA90022-173404/01/2017  
CHC266170-06ATLANTIC PHARMACY  5119 E. BEVERLY BLVD.
LOS ANGELESCA90022-173401/01/2020  
CHC266170-07ATLANTIC PHARMACY  5119 E. BEVERLY BLVD.
LOS ANGELESCA90022-173401/01/2020  
CHC266170-05ATLANTIC PHARMACY  5119 E. BEVERLY BLVD.
LOS ANGELESCA90022-173404/01/2020  
CHC266170-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2020  
CHC266170-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2020  
CHC266170-04COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260204/01/2017  
CHC266170-06COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260201/01/2020  
CHC266170-07COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260201/01/2020  
CHC266170-05COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260204/01/2020  
CHC266170-00EAST L.A. PHARMACY, CORP.4968 WHITTIER BLVD.
LOS ANGELESCA9002210/01/2017 12/31/2019
CHC266170-01EAST L.A. PHARMACY, CORP.4968 WHITTIER BLVD.
LOS ANGELESCA9002210/01/2017 12/31/2019
CHC266170-02EAST L.A. PHARMACY, CORP.4968 WHITTIER BLVD.
LOS ANGELESCA9002210/01/2017 12/31/2019
CHC266170-03EAST L.A. PHARMACY, CORP.4968 WHITTIER BLVD.
LOS ANGELESCA9002210/01/2017 12/31/2019
CHC266170-04EAST L.A. PHARMACY, CORP.4968 WHITTIER BLVD.
LOS ANGELESCA9002210/01/2017 12/31/2019
CHC266170-06EAST L.A. PHARMACY, CORP.4968 WHITTIER BLVD.
LOS ANGELESCA9002201/01/2020 12/31/2019
CHC266170-07EAST L.A. PHARMACY, CORP.4968 WHITTIER BLVD.
LOS ANGELESCA9002201/01/2020 12/31/2019
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 4524 5176 E. WHITTIER BLVD.
LOS ANGELESCA9002207/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09617 2103 SOUTH ATLANTIC BOULEVARD
MONTEREY PARKCA9175407/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16043 5600 WHITTIER BLVD
COMMERCECA9002207/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04792 15232 SHERMAN WAY
VAN NUYSCA9140507/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10509 3627 EAST CESAR EAST CHAVEZ AVENUE
LOS ANGELESCA9006307/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09122 700 S. GAFFEY ST.
SAN PEDROCA9073107/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09857 800 W. WHITTIER BLVD.
MONTEBELLOCA9064007/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08892 5822 SOUTH VERMONT AVENUE
LOS ANGELESCA9004407/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09625 9089 WOODMAN AVE.
ARLETACA9133107/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #4019 5837 S. CENTRAL AVE.
LOS ANGELESCA9000107/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09757 2525 VIA CAMPO ST.
MONTEBELLOCA9064007/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 01176 25829 NARBONNE AVE.
LOMITACA9071707/01/2020 05/14/2024
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08875 3644 EAST OLYMPIC BOULEVARD
LOS ANGELESCA9002307/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04789 10945 VICTORY BOULEVARD
NORTH. HOLLYWOODCA9160607/01/2020  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 03986 8400 FIRESTONE BLVD.
DOWNEYCA9024107/01/2021 05/16/2023
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08853 1645 EAST 103RD STREET
LOS ANGELESCA9000207/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08858 7101 ATLANTIC AVENUE
BELLCA9020107/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09504 8008 FIRESTONE BOULEVARD
DOWNEYCA9024107/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09507 650 EAST EL SEGUNDO BOULEVARD
LOS ANGELESCA9005907/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #11073 3208 EAST FLORENCE AVENUE
HUNTINGTON PARKCA9025507/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17481 6750 CHERRY AVE
LONG BEACHCA9080507/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08867 7915 FLORENCE AVENUE
DOWNEYCA9024007/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08898 7300 S ALAMEDA ST
WALNUT PARKCA9025507/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09123 3800 MARTIN LUTHER KING JR. BOULEVARD
LYNWOODCA9026207/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09495 220 EAST COMPTON BOULEVARD
COMPTONCA9022007/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09501 2655 SANTA ANA STREET
SOUTH GATECA9028007/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08835 3710 TWEEDY BOULEVARD
SOUTH GATECA9028007/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09594 901 S. CENTRAL AVENUE
COMPTONCA9022007/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16044 5700 FIRESTONE BLVD
SOUTH GATECA9028007/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09596 5960 PACIFIC BOULEVARD
HUNTINGTON PARKCA9025507/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17349 1621 S ALAMEDA ST
COMPTONCA9022007/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08870 8859 ALONDRA BLVD.
PARAMOUNTCA9072307/01/2021  
CHC266170-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09543 2001 PACIFIC COAST HIGHWAY
LOMITACA9071710/01/2024  
CHC266170-00GRACE CARE PHARMACY3414 W BEVERLY BLVD
MONTEBELLOCA9064007/01/2020 01/01/2022
CHC266170-00LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY313 N FIGUEROA STREET SUITE 1225
LOS ANGELESCA9001207/01/2015  
CHC266170-01LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY313 N FIGUEROA STREET SUITE 1225
LOS ANGELESCA9001210/01/2016  
CHC266170-02LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY313 N FIGUEROA STREET SUITE 1225
LOS ANGELESCA9001204/01/2018  
CHC266170-04LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY313 N FIGUEROA STREET SUITE 1225
LOS ANGELESCA9001204/01/2018  
CHC266170-03LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY313 N FIGUEROA STREET SUITE 1225
LOS ANGELESCA9001204/01/2018  
CHC266170-05LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY313 N FIGUEROA STREET SUITE 1225
LOS ANGELESCA9001210/01/2019  
CHC266170-06LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY313 N FIGUEROA STREET SUITE 1225
LOS ANGELESCA9001201/01/2020  
CHC266170-07LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY313 N FIGUEROA STREET SUITE 1225
LOS ANGELESCA9001201/01/2020  
CHC266170-00ORANGE EXPRESS PHARMACYGNB SERVICES INC 1233 N TUSTIN ST
ORANGECA92867-514710/01/2017 04/02/2019
CHC266170-01ORANGE EXPRESS PHARMACYGNB SERVICES INC 1233 N TUSTIN ST
ORANGECA92867-514710/01/2017 04/02/2019
CHC266170-02ORANGE EXPRESS PHARMACYGNB SERVICES INC 1233 N TUSTIN ST
ORANGECA92867-514710/01/2017 04/02/2019
CHC266170-03ORANGE EXPRESS PHARMACYGNB SERVICES INC 1233 N TUSTIN ST
ORANGECA92867-514710/01/2017  
CHC266170-04ORANGE EXPRESS PHARMACYGNB SERVICES INC 1233 N TUSTIN ST
ORANGECA92867-514710/01/2017 04/02/2019
CHC266170-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2020  
CHC266170-00RX E-FILL SOLUTIONS28341 CONSTELLATION RD
SANTA CLARITACA9135507/01/2016 12/31/2019
CHC266170-01RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135510/01/2016  
CHC266170-04RX E-FILL SOLUTIONS28341 CONSTELLATION RD
SANTA CLARITACA9135504/01/2017  
CHC266170-03RX E-FILL SOLUTIONS28341 CONSTELLATION RD
SANTA CLARITACA9135504/01/2018  
CHC266170-02RX E-FILL SOLUTIONS28341 CONSTELLATION RD
SANTA CLARITACA9135504/01/2018  
CHC266170-05RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135510/01/2019  
CHC266170-06RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135501/01/2020  
CHC266170-06RX E-FILL SOLUTIONS28341 CONSTELLATION RD
SANTA CLARITACA9135501/01/2020  
CHC266170-07RX E-FILL SOLUTIONS28341 CONSTELLATION RD
SANTA CLARITACA9135501/01/2020  
CHC266170-07RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135501/01/2020  
CHC266170-00RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135510/01/2020  
CHC266170-04US BIOSERVICESPHARM PLUS ACQUISITION, INC. 5100 E HUNTER AVE
SUITE 101 		ANAHEIMCA92807-204904/01/2018 12/31/2019
CHC266170-02US BIOSERVICESPHARM PLUS ACQUISITION, INC. 5100 E HUNTER AVE
SUITE 101 		ANAHEIMCA92807-204904/01/2018 12/31/2019
CHC266170-01US BIOSERVICESPHARM PLUS ACQUISITION, INC. 5100 E HUNTER AVE
SUITE 101 		ANAHEIMCA92807-204904/01/2018 12/31/2019
CHC266170-00US BIOSERVICESUS BIOSERVICE CORPORATION 5025 PLANO PARKWAY
STE 100 		CARROLLTONTX7501004/01/2018 12/31/2019
CHC266170-04US BIOSERVICESUS BIOSERVICE CORPORATION 5025 PLANO PARKWAY
STE 100 		CARROLLTONTX7501004/01/2018 12/31/2019
CHC266170-02US BIOSERVICESUS BIOSERVICE CORPORATION 5025 PLANO PARKWAY
STE 100 		CARROLLTONTX7501004/01/2018 12/31/2019
CHC266170-01US BIOSERVICESUS BIOSERVICE CORPORATION 5025 PLANO PARKWAY
STE 100 		CARROLLTONTX7501004/01/2018 12/31/2019
CHC266170-03US BIOSERVICESUS BIOSERVICE CORPORATION 5025 PLANO PARKWAY
STE 100 		CARROLLTONTX7501004/01/2018 12/31/2019
CHC266170-03US BIOSERVICESPHARM PLUS ACQUISITION, INC. 5100 E HUNTER AVE
SUITE 101 		ANAHEIMCA92807-204904/01/2018 12/31/2019
CHC266170-00US BIOSERVICESPHARM PLUS ACQUISITION, INC. 5100 E HUNTER AVE
SUITE 101 		ANAHEIMCA92807-204904/01/2018 12/31/2019
CHC266170-06US BIOSERVICESUS BIOSERVICE CORPORATION 5025 PLANO PARKWAY
STE 100 		CARROLLTONTX7501001/01/2020 12/31/2019
CHC266170-06US BIOSERVICESPHARM PLUS ACQUISITION, INC. 5100 E HUNTER AVE
SUITE 101 		ANAHEIMCA92807-204901/01/2020 12/31/2019
CHC266170-07US BIOSERVICESPHARM PLUS ACQUISITION, INC. 5100 E HUNTER AVE
SUITE 101 		ANAHEIMCA92807-204901/01/2020 12/31/2019
CHC266170-07US BIOSERVICESUS BIOSERVICE CORPORATION 5025 PLANO PARKWAY
STE 100 		CARROLLTONTX7501001/01/2020 12/31/2019
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/8/2024 1:55:16 PM2/13/2025 1:13:49 PM2/13/2025 1:13 PM
AddressesBilling AddressUpdateRecertificationVia Care Community Health Center 501 S. Atlantic Blvd. East Los Angeles, CA 90022Via Care Community Health Center 3601 E. 1st Street Los Angeles, CA 900632/8/2024 1:55 PM
DetailsLast Recertification DateUpdateRecertification2/3/2023 4:33:59 PM2/8/2024 1:55:16 PM2/8/2024 1:55 PM
DetailsLast Recertification DateUpdateRecertification 2/3/2023 4:33:59 PM2/3/2023 4:33 PM
DetailsStateUpdate ApprovedActive4/1/2022 12:01 AM
ContactsSigned ByInsertNew Registration Falcetti, Nina Director of HR Via Care Community Health Center 3232689191-10912/14/2022 7:40 AM
Details340B IDUpdateNew Registration CHC266170-122/14/2022 7:40 AM
DatesParticipating Approval DateUpdateNew Registration 2/14/2022 7:40:06 AM2/14/2022 7:40 AM
DetailsStateUpdateNew RegistrationPendingApproved2/14/2022 7:40 AM
DatesSigned By DateUpdateNew Registration 1/13/2022 2:08:57 PM2/14/2022 7:40 AM
DatesStart DateUpdateNew Registration 4/1/2022 12:00:00 AM2/14/2022 7:40 AM
AddressesMain AddressInsertNew Registration  9000 Overland Ave Culver City, CA 90230-50021/13/2022 2:08 PM
AddressesBilling AddressInsertNew Registration Via Care Community Health Center 501 S. Atlantic Blvd. East Los Angeles, CA 900221/13/2022 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/13/2022 2:08 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 14970012261/13/2022 2:08 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA1/13/2022 2:08 PM
Medicaid BillingNPI: NumberInsertNew Registration 14970012261/13/2022 2:08 PM
Medicaid BillingNPI: StateInsertNew Registration CA1/13/2022 2:08 PM
ContactsAuthorizing OfficialInsertNew Registration Falcetti, Nina Director of HR Via Care Community Health Center 3232689191-10911/13/2022 2:08 PM
ContactsPrimary ContactInsertNew Registration Dadkhah, Mahsa Female Pharmacy Director Via Care Community Health Center 3232689191-10431/13/2022 2:08 PM
DetailsAssistance Received From DateInsertNew Registration  1/13/2022 2:08 PM
DetailsAssistance Received To DateInsertNew Registration  1/13/2022 2:08 PM
DetailsLast Recertification DateInsertNew Registration  1/13/2022 2:08 PM
DetailsGrant NumberInsertNew Registration H80CS266171/13/2022 2:08 PM
Details340B IDInsertNew Registration  1/13/2022 2:08 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/13/2022 2:08 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/13/2022 2:08 PM
DetailsMedicare Provider NumberInsertNew Registration  1/13/2022 2:08 PM
DetailsEntity NameInsertNew Registration Via Care Community Health Center, Inc.1/13/2022 2:08 PM
DetailsNOFO NumberInsertNew Registration  1/13/2022 2:08 PM
DetailsProgram CodeInsertNew Registration CH1/13/2022 2:08 PM
DetailsEntity SubnameInsertNew Registration Via Care West LA College1/13/2022 2:08 PM
DatesParticipating Approval DateInsertNew Registration  1/13/2022 2:08 PM
DetailsStateInsertNew Registration Pending1/13/2022 2:08 PM
DatesRegistration DateInsertNew Registration 1/13/2022 2:08:54 PM1/13/2022 2:08 PM
DatesSigned By DateInsertNew Registration  1/13/2022 2:08 PM
DatesStart DateInsertNew Registration  1/13/2022 2:08 PM
TerminationsTermination CommentsInsertNew Registration  1/13/2022 2:08 PM
TerminationsTermination DateInsertNew Registration  1/13/2022 2:08 PM
TerminationsTermination Effective DateInsertNew Registration  1/13/2022 2:08 PM
TerminationsTermination ReasonInsertNew Registration  1/13/2022 2:08 PM