Covered Entity Details

CH09788M Petaluma Health Center, Inc. (Active) - information as of 6/12/2025 6:08:40 AM

Main Details

Name

Petaluma Health Center, Inc.

Subdivision Name

Petaluma Health Center, Inc. Mobile Unit

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033675

340B ID

CH09788M

Grant Number

H80CS00587

Additional Details

Current Program Status

Active

Registration Date

7/15/2022

Participating Start Date

10/1/2022

Participating Approval Date

7/19/2022

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Petaluma Health Center
Molly Jouaneh, Chief Financial Officer
(707) 559-7500

Primary Contact

Petaluma Health Center
Pedro Toledo, Chief Executive Officer
(707) 326-7551

Addresses

Street Address

5900 State Farm Dr
Rohnert Park, CA 94928-2149

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH097880	Active	BPS-H80-008799	PETALUMA HEALTH CENTER, INC	Petaluma Health Center	1179 N. McDowell Blvd.	Petaluma	CA
CH09788A	Active	BPS-H80-015298	PETALUMA HEALTH CENTER, INC.	Rohnert Park Health Center	5900 State Farm Dr., Suite 200	Rohnert Park	CA
CH09788B	Active	BPS-H80-014051	Petaluma Health Center, Inc.	Mary Isaak Homeless Shelter Clinic	900 HOPPER ST	PETALUMA	CA
CH09788C	Active	BPS-H80-014164	Petaluma Health Center, Inc.	Casa Grande High School Health Clinic	333 Casa Grande Rd	Petaluma	CA
CH09788D	Active	BPS-H80-012778	Petaluma Health Center, Inc.	San Antonio High School Health Clinic	500 Vallejo St	Petaluma	CA
CH09788E	Active	BPS-H80-010373	Petaluma Health Center, Inc.	Santa Rosa Junior College - Petaluma Campus - Student Health Services Clinic - Richard Call Building	680 Sonoma Mountain Pkwy	Petaluma	CA
CH09788F	Terminated	BPS-H80-021164	Petaluma Health Center, Inc.	Rohnert Park Vision Center	4625 Redwood Drive, Suite A	Rohnert Park	CA
CH09788G	Active	BPS-H80-031357	Petaluma Health Center, Inc.	CHA Dental	65 Third Street STE 13	Point Reyes Station	CA
CH09788H	Active	BPS-H80-031356	Petaluma Health Center, Inc.	Point Reyes Community Health Center	3 Sixth Street	Point Reyes	CA
CH09788J	Active	BPS-H80-031358	Petaluma Health Center, Inc.	Bolinas Community Health Center	88 Mesa Rd	Bolinas	CA
CH09788K	Active	BPS-H80-034308	Petaluma Health Center, Inc.	Rohnert Park Community Acupuncture	6040 Commerce Blvd STE 108	Rohnert Park	CA
CH09788L	Active	BPS-H80-034305	Petaluma Health Center, Inc.	Petaluma Eye Care Center	1225 N Mcdowell Blvd	Petaluma	CA
CH09788M	Active	BPS-H80-033675	Petaluma Health Center, Inc.	Petaluma Health Center, Inc. Mobile Unit	5900 State Farm Dr	Rohnert Park	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH097880	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2023
CH097880	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2023
CH097880	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2023
CH097880	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2023
CH097880	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2023
CH097880	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2023
CH097880	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2023
CH097880	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2023
CH097880	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2023
CH097880	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2023
CH097880	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2023
CH097880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16293	475 ROHNERT PARK EXPY W	ROHNERT PARK	CA	94928	01/01/2023
CH097880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17586	401 KENILWORTH DRIVE	PETALUMA	CA	94952	01/01/2023
CH097880	GRAND ST. PAUL CVS, L.L.C.	CVS PHARMACY # 16353	2021 MARKET DR	STILLWATER	MN	55082	10/01/2023
CH097880	IMGRX SONOMA, INC	DBA SONOMA VALLEY COMMUNITY PHARMACY	19270 SONOMA HWY, SUITE A	SONOMA	CA	95476	04/01/2024
CH097880	IMGRX SONOMA, INC. DBA	SONOMA VALLEY COMMUNITY PHARMACY	19270 SONOMA HIGHWAY, SUITE A	SONOMA	CA	95476	04/01/2024
CH09788A	LARK REXALL DRUGS INC	DBA LARK DRUGS PHARMACY	16251 MAIN ST	GUERNEVILLE	CA	95446-8300	10/01/2018
CH097880	LARK REXALL DRUGS INC	DBA LARK DRUGS PHARMACY	16251 MAIN ST	GUERNEVILLE	CA	95446-8300	10/01/2018
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09480	365 E WASHINGTON ST	PETALUMA	CA	94952	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09872	6877 SEBASTOPOL AVENUE	SEBASTOPOL	CA	95472	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09948	2700 YULUPA AVE	SANTA ROSA	CA	95405	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09152	201 W NAPA ST STE 35	SONOMA	CA	95476	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09928	6378 COMMERCE BLVD	ROHNERT PARK	CA	94928	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09163	291 N MCDOWELL BLVD	PETALUMA	CA	94954	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09393	2075 MENDOCINO AVE	SANTA ROSA	CA	95401	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09946	463 STONY POINT RD	SANTA ROSA	CA	95401	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09656	2771 4TH ST	SANTA ROSA	CA	95405	01/01/2023
CH097880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09370	880 SIR FRANCIS DRAKE BLVD	SAN ANSELMO	CA	94960	01/01/2023
CH097880	MARIN APOTHECARIES, INC.	PHC PHARMACY	1179 N MCDOWELL BLVD	PETALUMA	CA	94954	04/01/2015
CH097880	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2023
CH097880	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY	445 CASTRO STREET	SAN FRANCISCO	CA	94114	01/01/2023
CH097880	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2023
CH097880	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2023
CH097880	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2023
CH097880	SAFEWAY INC	SAFEWAY PHARMACY #3011	389 S. MCDOWELL BLVD	PETALUMA	CA	94954	10/11/2011	07/05/2016
CH097880	SAFEWAY INC	SAFEWAY PHARMACY #0918	6340 COMMERCE BLVD	ROHNERT PARK	CA	94928	01/01/2017
CH097880	SAFEWAY INC	SAFEWAY PHARMACY #3011	389 S. MCDOWELL BLVD	PETALUMA	CA	94954	01/01/2017
CH097880	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2019
CH097880	WAL-MART PHARMACY 10-1755	4625 REDWOOD DRIVE		ROHNERT PARK	CA	94928	01/01/2017
CH097880	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2019
CH097880	WALGREEN CO.	DBA: WALGREENS # 03084	7800 OLD REDWOOD HWY	COTATI	CA	94931	04/01/2020
CH097880	WALMART PHARMACY 10-2468	901 GOLF COURSE DRIVE		ROHNERT PARK	CA	94928	01/01/2017
CH097880	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH097880	WEST MARIN PHARMACY INC.	WEST MARIN PHARMACY	PO BOX 1510 11 FOURTH STREET	POINT REYES STATION	CA	94956-1510	10/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 3:27:21 PM	2/10/2025 9:41:54 PM	2/10/2025 9:41 PM
Contacts	Primary Contact	Update	Profile Change Request	Toledo, Pedro CAO Petaluma Health Center 7073267551	Toledo, Pedro Chief Executive Officer Petaluma Health Center 7073267551	2/10/2025 5:27 PM
Details	Last Recertification Date	Update	Recertification	2/13/2023 12:22:54 PM	1/29/2024 3:27:21 PM	1/29/2024 3:27 PM
Details	Last Recertification Date	Update	Recertification		2/13/2023 12:22:54 PM	2/13/2023 12:22 PM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Jouaneh, Molly Chief Financial Officer Petaluma Health Center 7075597500	7/19/2022 11:28 AM
Details	340B ID	Update	New Registration		CH09788M	7/19/2022 11:28 AM
Dates	Participating Approval Date	Update	New Registration		7/19/2022 11:28:23 AM	7/19/2022 11:28 AM
Details	State	Update	New Registration	Pending	Approved	7/19/2022 11:28 AM
Dates	Signed By Date	Update	New Registration		7/15/2022 1:08:35 PM	7/19/2022 11:28 AM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	7/19/2022 11:28 AM
Addresses	Main Address	Insert	New Registration		5900 State Farm Dr Rohnert Park, CA 94928-2149	7/15/2022 12:39 AM
Contacts	Primary Contact	Insert	New Registration		Toledo, Pedro CAO Petaluma Health Center 7073267551	7/15/2022 12:39 AM
Contacts	Authorizing Official	Insert	New Registration		Jouaneh, Molly Chief Financial Officer Petaluma Health Center 7075597500	7/15/2022 12:39 AM
Details	Assistance Received From Date	Insert	New Registration			7/15/2022 12:39 AM
Details	Assistance Received To Date	Insert	New Registration			7/15/2022 12:39 AM
Details	Last Recertification Date	Insert	New Registration			7/15/2022 12:39 AM
Details	Grant Number	Insert	New Registration		H80CS00587	7/15/2022 12:39 AM
Details	340B ID	Insert	New Registration			7/15/2022 12:39 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/15/2022 12:39 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/15/2022 12:39 AM
Details	Medicare Provider Number	Insert	New Registration			7/15/2022 12:39 AM
Details	Entity Name	Insert	New Registration		Petaluma Health Center, Inc.	7/15/2022 12:39 AM
Details	NOFO Number	Insert	New Registration			7/15/2022 12:39 AM
Details	Program Code	Insert	New Registration		CH	7/15/2022 12:39 AM
Details	Entity Subname	Insert	New Registration		Petaluma Health Center, Inc. Mobile Unit	7/15/2022 12:39 AM
Dates	Participating Approval Date	Insert	New Registration			7/15/2022 12:39 AM
Details	State	Insert	New Registration		Pending	7/15/2022 12:39 AM
Dates	Registration Date	Insert	New Registration		7/15/2022 12:39:49 AM	7/15/2022 12:39 AM
Dates	Signed By Date	Insert	New Registration			7/15/2022 12:39 AM
Dates	Start Date	Insert	New Registration			7/15/2022 12:39 AM
Terminations	Termination Comments	Insert	New Registration			7/15/2022 12:39 AM
Terminations	Termination Date	Insert	New Registration			7/15/2022 12:39 AM
Terminations	Termination Effective Date	Insert	New Registration			7/15/2022 12:39 AM
Terminations	Termination Reason	Insert	New Registration			7/15/2022 12:39 AM

340B Drug Pricing Program Database