340B Drug Pricing Program Database


FQHC638015 RIVERSIDE - SAN BERNARDINO COUNTY INDIAN HEALTH INC (Active) - information as of 4/29/2025 11:51:06 PM

Main Details
RIVERSIDE - SAN BERNARDINO COUNTY INDIAN HEALTH INC
Morongo Indian Health Clinic
Tribal Contract/Compact with IHS (P.L. 93-638)
FQHC638015


Additional Details
Active
1/1/1995
1/1/1995
1/1/1995
2/23/2025

Contacts

Riverside-San Bernardino County Indian Health, Inc.
Bill Thomsen, CEO
(909) 864-1097 Ext: 4703

Riverside-San Bernardino County Indian Health, Inc.
Jeevan s Dhouni, Pharmacy Director
(909) 864-1097 Ext: 4776

Addresses

11555 1/2 POTRERO RD
Banning, CA 92220

Same as Street Address


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

Yes
StateMedicaid NumberNPI Number
CAFHC03854F1902954944
Shipping Addresses

Morongo Indian Helath Clinic Pharmacy
11555 1/2 Potrero Rd
Banning, CA 92220
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailANZA VALLEY PHARMACY56555 HIGHWAY 371 PO BOX 390415
ANZACA9253904/01/201507/01/2015 08/03/202008/13/2020
Contract DetailTHE VONS COMPANIES INCVONS PHARMACY #2376 1270 EAST MAIN STREET
BARSTOWCA9231104/12/201807/01/2018 05/27/201905/12/2020
Contract DetailWALGREEN CODBA: WALGREENS #09021 1811 S SAN JACINTO AVE
SAN JACINTOCA92583-560501/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CODBA: WALGREENS #09781 82-955 AVENUE 48, BLDG B
INDIOCA9220101/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CODBA: WALGREENS #10467 1236 N WATERMAN AVE
SAN BERNARDINOCA92404-531101/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 01995 40420 MURRIETA HOT SPRINGS
MURRIETACA9256301/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05182 60 N HIGHLAND SPRINGS AVE
BANNINGCA9222001/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05300 27951 BASELINE
HIGHLANDCA9234601/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05349 1311 E. FLORIDA AVE.
HEMETCA9254401/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05527 25011 ALESSANDRO BLVD
MORENO VALLEYCA9255301/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 05555 550 S RIVERSIDE AVE
RIALTOCA9237601/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 06685 1634 E HIGHLAND AVE
SAN BERNARDINOCA92404-461601/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 07410 29910-A MURRIETA HOT SPRINGS ROAD
MURRIETACA9256301/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.WALGREENS #09884 40663 CALIFORNIA OAKS RD
MURRIETACA92562-572901/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREEN CO.DBA: WALGREENS #10172 1181 N STATE ST
SAN JACINTOCA9258301/30/201404/01/2014 08/24/201508/24/2015
Contract DetailWALGREEN CO.DBA: WALGREENS #11611 50040 CESAR CHAVEZ ST
COACHELLACA9223601/30/201404/01/2014 07/10/202008/13/2020
Contract DetailWALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528401/30/201404/01/2014 07/07/201507/09/2015
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/31/2024 11:53:43 AM2/23/2025 2:00:55 PM2/23/2025 2:00 PM
DetailsEntity NameUpdateRecertificationRIVERSIDE/SAN BERNARDINO COUNTY INDIAN HEALTH INCRIVERSIDE - SAN BERNARDINO COUNTY INDIAN HEALTH INC2/23/2025 2:00 PM
DetailsLast Recertification DateUpdateRecertification1/31/2023 10:50:48 AM1/31/2024 11:53:43 AM1/31/2024 11:53 AM
DetailsLast Recertification DateUpdateRecertification2/4/2022 11:23:20 AM1/31/2023 10:50:48 AM1/31/2023 10:50 AM
AddressesShipping AddressDeleteChange RequestPechanga Indian Health Clinic Pharmacy 12784 Pechanga Rd Temecula, CA 92390 2/8/2022 10:35 AM
AddressesMain AddressUpdateChange Request 11980 Mt. Vernon Ave Grand Terrace,, CA 92313 11555 1/2 POTRERO RD Banning, CA 922202/8/2022 10:35 AM
DetailsEntity NameUpdateChange RequestRIVERSIDE/SAN BERNARDINO COUNTYRIVERSIDE/SAN BERNARDINO COUNTY INDIAN HEALTH INC2/8/2022 10:35 AM
DetailsEntity SubnameUpdateChange RequestINDIAN HEALTH INCMorongo Indian Health Clinic2/8/2022 10:35 AM
DetailsLast Recertification DateUpdateRecertification2/6/2021 3:26:53 PM2/4/2022 11:23:20 AM2/4/2022 11:23 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestThomsen, Bill COO Riverside-San Bernardino County Indian Health, Inc. 9098641097-4703Thomsen, Bill CEO Riverside-San Bernardino County Indian Health, Inc. 9098641097-47039/7/2021 7:08 AM
Medicaid BillingNPI: NumberInsertRecertification 19029549442/6/2021 3:26 PM
Medicaid BillingNPI: StateInsertRecertification CA2/6/2021 3:26 PM
Medicaid BillingNPI: NumberDeleteRecertification1902954944 ( ) 2/6/2021 3:26 PM
DetailsLast Recertification DateUpdateRecertification2/1/2020 3:33:15 PM2/6/2021 3:26:53 PM2/6/2021 3:26 PM
DetailsLast Recertification DateUpdateRecertification1/29/2019 5:25:14 PM2/1/2020 3:33:15 PM2/1/2020 3:33 PM
DetailsLast Recertification DateUpdateRecertification2/7/2018 10:40:46 AM1/29/2019 5:25:14 PM1/29/2019 5:25 PM
AddressesMain AddressUpdateChange Request 11555 1/2 POTRERO ROAD BANNING, CA 92220 11980 Mt. Vernon Ave Grand Terrace,, CA 923131/23/2019 7:36 AM
ContactsPrimary ContactUpdateChange RequestYoon, Sue PHARMACY DIRECTOR riverside san bernardino county indian health 9098641097-4706Dhouni, Jeevan s Pharmacy Director Riverside-San Bernardino County Indian Health, Inc. 9098641097-47761/23/2019 7:36 AM
DetailsLast Recertification DateUpdateRecertification1/30/2017 12:00:00 AM2/7/2018 10:40:46 AM2/7/2018 10:40 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False11/30/2017 11:11 AM
Medicaid BillingMedicaid: NumberInsertChange Request FHC03854F11/30/2017 11:11 AM
Medicaid BillingMedicaid: StateInsertChange Request CA11/30/2017 11:11 AM
Medicaid BillingNPI: NumberInsertChange Request 190295494411/30/2017 11:11 AM
ContactsAuthorizing OfficialUpdate Thomsen, Bill COO 9098641097-4703Thomsen, Bill COO Riverside-San Bernardino County Indian Health, Inc. 9098641097-470311/30/2017 11:05 AM
ContactsPrimary ContactUpdate Yoon, Sue PHARMACY DIRECTOR 9098641097-4706Yoon, Sue PHARMACY DIRECTOR riverside san bernardino county indian health 9098641097-470611/28/2017 11:03 AM
AddressesMain AddressInsert   11555 1/2 POTRERO ROAD BANNING, CA 922201/30/2017 3:11 PM
ContactsPrimary ContactInsert  Yoon, Sue PHARMACY DIRECTOR 9098641097-47061/30/2017 3:11 PM
ContactsAuthorizing OfficialInsert  Thomsen, Bill COO 9098641097-47031/30/2017 3:11 PM
DetailsLast Recertification DateUpdate 2/12/2016 12:00:00 AM1/30/2017 12:00:00 AM1/30/2017 3:11 PM
DetailsLast Recertification DateUpdate 2/5/2015 12:00:00 AM2/12/2016 12:00:00 AM2/12/2016 10:19 AM
DetailsLast Recertification DateUpdate 2/18/2014 12:00:00 AM2/5/2015 12:00:00 AM2/5/2015 10:56 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM2/18/2014 12:00:00 AM2/18/2014 8:34 AM
AddressesShipping AddressInsert  Pechanga Indian Health Clinic Pharmacy 12784 Pechanga Rd Temecula, CA 923906/28/2013 2:02 PM
AddressesShipping AddressInsert  Morongo Indian Helath Clinic Pharmacy 11555 1/2 Potrero Rd Banning, CA 922206/28/2013 2:02 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/6/2013 2:40 PM
DetailsLast Recertification DateInsert   1/1/1995 12:00 AM
DetailsGrant NumberInsert   1/1/1995 12:00 AM
Details340B IDInsert  FQHC6380151/1/1995 12:00 AM
DetailsIs Authorizing Official EHB DataInsert   1/1/1995 12:00 AM
DatesLast Date That 340B Drugs PurchasedInsert   1/1/1995 12:00 AM
DetailsMedicare Provider NumberInsert   1/1/1995 12:00 AM
DetailsEntity NameInsert  RIVERSIDE/SAN BERNARDINO COUNTY1/1/1995 12:00 AM
DetailsProgram CodeInsert  FQHC6381/1/1995 12:00 AM
DetailsEntity SubnameInsert  INDIAN HEALTH INC1/1/1995 12:00 AM
DatesParticipating Approval DateInsert  1/1/1995 12:00:00 AM1/1/1995 12:00 AM
DetailsStateInsert  Active1/1/1995 12:00 AM
DatesRegistration DateInsert  1/1/1995 12:00:00 AM1/1/1995 12:00 AM
DatesSigned By DateInsert   1/1/1995 12:00 AM
DatesStart DateInsert  1/1/1995 12:00:00 AM1/1/1995 12:00 AM
TerminationsTermination CommentsInsert   1/1/1995 12:00 AM
TerminationsTermination DateInsert   1/1/1995 12:00 AM
TerminationsTermination Effective DateInsert   1/1/1995 12:00 AM
TerminationsTermination ReasonInsert   1/1/1995 12:00 AM