340B Drug Pricing Program Database


CHC24113-21 ELICA HEALTH CENTERS (Active) - information as of 5/20/2025 11:37:57 PM

Main Details
ELICA HEALTH CENTERS
Elica Health Centers - Glendale
HRSA-Funded Health Center
BPS-H80-035379
CHC24113-21
H80CS24113


Additional Details
Active
4/4/2023
7/1/2023
4/5/2023
2/10/2025

Contacts

Elica Health Centers
David E Hughes, COO/CFO
(916) 569-8484 Ext: 312

Elica Health Centers
Christina Osman, Project Director
(916) 569-8484 Ext: 802

Addresses

2400 Glendale Ln
Sacramento, CA 95825

Elica Health Centers
1860 Howe Avenue Suite 440
Sacramento, CA 95825


  • 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
CA13660511201790419059
Shipping Addresses

Same as Street Address
Contract Pharmacies
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC24113-00ActiveBPS-H80-012850Elica Health CentersElica Health Centers155 15th St West SacramentoCA
CHC24113-01ActiveBPS-H80-012849Elica Health CentersElica Health Centers - Midtown3701 J St Ste 201 SacramentoCA
CHC24113-02ActiveBPS-H80-019271ELICA HEALTH CENTERSElica Health Centers - Midtown Medical Center3701 J St Ste 100 SacramentoCA
CHC24113-03TerminatedBPS-H80-019567ELICA HEALTH CENTERSRevere Medical Center752 Revere Street, Unit B SacramentoCA
CHC24113-04ActiveBPS-H80-013843ELICA HEALTH CENTERSElica Health Centers Health on Wheels3701 J ST SacramentoCA
CHC24113-05TerminatedBPS-H80-019173ELICA HEALTH CENTERSNorth Avenue Medical Center1281 North Avenue SacramentoCA
CHC24113-06ActiveBPS-H80-019272ELICA HEALTH CENTERSElica Health Centers - Midtown Medical Center3701 J St Ste 103 SacramentoCA
CHC24113-07ActiveBPS-H80-019270ELICA HEALTH CENTERSElica Health Centers - Midtown Medical Center3701 J St Ste 104 SacramentoCA
CHC24113-08ActiveBPS-H80-019174ELICA HEALTH CENTERSElica Health Centers - V Street Medical Center923 V St SacramentoCA
CHC24113-09ActiveBPS-H80-019172ELICA HEALTH CENTERSElica Health Centers - Franklin Medical Center5385 Franklin Blvd Ste K SacramentoCA
CHC24113-10ActiveBPS-H80-014922ELICA HEALTH CENTERSElica Health Centers - Arden Arcade1750 Wright St Ste 1 SacramentoCA
CHC24113-11TerminatedBPS-H80-019604ELICA HEALTH CENTERSHarbor Medical Center804 Harbor Blvd. West SacramentoCA
CHC24113-12TerminatedBPS-H80-021770ELICA HEALTH CENTERSElica Health Centers - Watt Avenue Medical Center5708 Watt Avenue North HighlandsCA
CHC24113-13ActiveBPS-H80-021617ELICA HEALTH CENTERSElica Health Centers - Halyard Medical Center1276 Halyard Dr West SacramentoCA
CHC24113-14ActiveBPS-H80-021243ELICA HEALTH CENTERSElica Health Centers Health On Wheels 21276 Halyard Dr West SacramentoCA
CHC24113-15ActiveBPS-H80-027350ELICA HEALTH CENTERSElica Health Centers - Marysville3234 Marysville Blvd SacramentoCA
CHC24113-16ActiveBPS-H80-029856ELICA HEALTH CENTERSElica Health Centers Health On Wheels 31276 Halyard Dr West SacramentoCA
CHC24113-17ActiveBPS-H80-031038ELICA HEALTH CENTERSElica Health Centers - Cadillac Drive77 Cadillac Drive STE 200 SacramentoCA
CHC24113-18ActiveBPS-H80-030573ELICA HEALTH CENTERSElica Health Centers Health On Wheels 41276 Halyard Dr West SacramentoCA
CHC24113-19ActiveBPS-H80-031296ELICA HEALTH CENTERSElica Health Centers - Mack Road6339 Mack Rd SacramentoCA
CHC24113-20ActiveBPS-H80-031037ELICA HEALTH CENTERSElica Health Centers North Highlands4815 Watt Ave North HighlandsCA
CHC24113-21ActiveBPS-H80-035379ELICA HEALTH CENTERSElica Health Centers - Glendale2400 Glendale Ln SacramentoCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC24113-00ALABAMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03095 6891 VAUGHN ROAD
MONTGOMERYAL3611610/01/2020  
CHC24113-00ALABAMA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04873 1431 11TH AVENUE SO.
BIRMINGHAMAL3520510/01/2020  
CHC24113-00BEL AIR PHARMACY #5147465 RUSH RIVER DRIVE
SACRAMENTOCA9583101/01/2021  
CHC24113-00BEL AIR PHARMACY #5283250 ARENA BLVD.
SACRAMENTOCA9583401/01/2021 05/26/2025
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/01/2025  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/01/2025  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620301/01/2025  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522601/01/2025  
CHC24113-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/01/2025  
CHC24113-00CAPITAL CITY PHARMACY500 UNIVERSITY AVE STE 110
SACRAMENTOCA95825-650407/01/2014 07/19/2015
CHC24113-00CAPITOL PHARMACY, INC.CAPITOL PHARMACY 1250 HARBOR BLVD STE 600
WEST SACRAMENTOCA9569104/01/2021  
CHC24113-13CAPITOL PHARMACY, INC.CAPITOL PHARMACY 1250 HARBOR BLVD STE 600
WEST SACRAMENTOCA9569101/01/2024  
CHC24113-00CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2021  
CHC24113-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2021  
CHC24113-00CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2021  
CHC24113-00CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2021  
CHC24113-00CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2021  
CHC24113-00CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2021  
CHC24113-00CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2021  
CHC24113-00CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/01/2021  
CHC24113-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/01/2020  
CHC24113-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2021  
CHC24113-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2021  
CHC24113-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2021  
CHC24113-00CVS PHARMACY, INC.DBA: CVS/PHARMACY # 06746 1514 N ALEXANDER
BAYTOWNTX7752007/01/2020  
CHC24113-00CVS PHARMACY, INC.DBA: CVS/PHARMACY # 00357 1701 E. PARMER LN.
AUSTINTX7875410/01/2020  
CHC24113-00CVS PHARMACY, INC.DBA: CVS/PHARMACY # 01792 4201 E. PARK AVE.
PLANOTX7507401/01/2022  
CHC24113-00CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2021  
CHC24113-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2024  
CHC24113-00DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654101/01/2025  
CHC24113-00DOLPHIN HEALTH PHARMACY7400 MACARTHUR BLVD SUITE A
OAKLANDCA9460501/01/2020 05/02/2025
CHC24113-00EVERGREEN PHARMACEUTICAL OF CALIFORNIA,OMNICARE OF SACRAMENTO 3630 BUSINESS DR.
SUITE D
SACRAMENTOCA9582010/01/2021  
CHC24113-00FAMILY DISCOUNT PHARMACYPRESCRIPTION SERVICES INC 5830 JAMESON CT
SUITE B
CARMICHAELCA95608-089601/01/2020 01/23/2020
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582110/01/2019  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582010/01/2019  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10005 6401 MACK RD.
SACRAMENTOCA9582310/01/2019  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17342 2005 TOWN CENTER PLZ
WEST SACRAMENTOCA9569110/01/2019  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16857 8101 COSUMNES RIVER BLVD
SACRAMENTOCA9582304/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 8431 7200 BANCROFT AVE.
OAKLANDCA9460507/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10478 657 US HIGHWAY 101 N.
CRESCENT CITYCA9553107/01/2020 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567007/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10360 474 WINTON PKWY
LIVINGSTONCA9533407/01/2020 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5091 1771 PLEASANT GROVE BLVD.
SUITE 100
ROSEVILLECA9574707/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16413 7505 LAGUNA BLVD
ELK GROVECA9575810/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17516 10881 OLSON DR
RANCHO CORDOVACA9567010/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 00182 8400 BRADSHAW RD.
ELK GROVECA9562410/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16107 4707 PACIFIC AVE
STOCKTONCA9520710/01/2020 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17538 6507 4TH AVE
SACRAMENTOCA9581710/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16106 1919 FULTON AVE
SACRAMENTOCA9582510/01/2020  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16109 1153 BUTTE HOUSE RD
YUBA CITYCA9599101/01/2021  
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09696 10048 MILLS AVE.
WHITTIERCA9060401/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08897 3361 MARKET ST.
RIVERSIDECA9250107/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16234 3527 W FLORIDA AVE
HEMETCA9254507/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17508 4601 2ND ST
DAVISCA9561810/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16489 5837 SUNRISE BLVD
CITRUS HEIGHTSCA9561010/01/2021  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16755 5740 N BLACKSTONE AVE
FRESNOCA9371010/01/2021 05/08/2025
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17200 3601 N FREEWAY BLVD
SACRAMENTOCA9583410/01/2021  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16080 1925 DOUGLAS BLVD
ROSEVILLECA9566110/01/2021  
CHC24113-00GARFIELD BEACH CVS, L.L.C.CVS/PHARMACY # 11339 777 S. HARBOR BLVD., SUITE E-164
LA HABRACA9063110/01/2021 02/19/2024
CHC24113-00GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #17822 1707 J STREET
SACRAMENTOCA9581107/01/2023 02/27/2024
CHC24113-09GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #7136 3710 FRANKLIN BLVD
SACRAMENTOCA9582001/01/2024  
CHC24113-02GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582101/01/2024  
CHC24113-07GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17342 2005 TOWN CENTER PLZ
WEST SACRAMENTOCA9569101/01/2024  
CHC24113-17GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 5225 2636 MARCONI AVE.
SACRAMENTOCA9582107/01/2025  
CHC24113-00GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00040 1424 W BASELINE RD
TEMPEAZ8528307/01/2020 06/01/2023
CHC24113-00GERMAN DOBSON CVS, L.L.C.CVS/PHARMACY #10529 7111 EAST BELL RD.
SCOTTSDALEAZ8525401/01/2022 05/08/2025
CHC24113-00INNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089601/23/2020 10/01/2021
CHC24113-00INNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089607/01/2023 04/01/2024
CHC24113-01INNOVA PHARMACEUTICALS INCDBA INNOVA PHARMACY 5830 JAMESON CT
CARMICHAELCA95608-089601/01/2024 04/01/2024
CHC24113-00INNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554207/01/2020  
CHC24113-01INNOVA PHARMACY II3701 J ST STE 101
SACRAMENTOCA95816-554201/01/2021  
CHC24113-00INNOVA PHARMACY III2400 GLENDALE LN STE A
SACRAMENTOCA95825-243104/01/2020 10/01/2021
CHC24113-10INNOVA PHARMACY III2400 GLENDALE LN STE A
SACRAMENTOCA95825-243101/01/2021 10/01/2021
CHC24113-00INNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510801/01/2021  
CHC24113-20INNOVA PHARMACY IV4815 WATT AVE STE B101
NORTH HIGHLANDSCA95660-510804/01/2021  
CHC24113-00INNOVA PHARMACY OF ARDEN-ARCADERETAIL PHARMACY 2400 GLENDALE LN STE A
SACRAMENTOCA9582507/01/2023  
CHC24113-21INNOVA PHARMACY OF ARDEN-ARCADERETAIL PHARMACY 2400 GLENDALE LN STE A
SACRAMENTOCA9582501/01/2024  
CHC24113-00JEFFERSON PHARMACY1029 JEFFERSON BLVD STE A
WEST SACRAMENTOCA95691-334407/01/2014 07/19/2015
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09823 1350 FLORIN ROAD
SACRAMENTOCA9582210/01/2019  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09826 5333 ELKHORN BLVD
SACRAMENTOCA9584210/01/2019  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09992 3338 ARDEN WAY
SACRAMENTOCA9582504/01/2020 01/18/2024
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09199 5420 DEWEY DR
FAIR OAKSCA9562804/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09322 2085 FAIR OAKS BLVD
SACRAMENTOCA9582504/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03945 1701 K ST
SACRAMENTOCA9581104/01/2020 04/25/2023
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583304/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03943 5039 FOLSOM BLVD
SACRAMENTOCA9581904/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 01825 5040 LAGUNA BLVD
ELK GROVECA9575804/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09972 7465 RUSH RIVER DR STE 500
SACRAMENTOCA9583104/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 04151 2050 CLUB CENTER DR
SACRAMENTOCA9583504/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09208 13763 MONO WAY
SONORACA9537004/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09814 8101 GREENBACK LANE
FAIR OAKSCA9562807/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09809 4959 MARCONI AVE
CARMICHAELCA9560807/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09958 5090 FOOTHILLS BLVD
ROSEVILLECA9574707/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03066 8351 ELK GROVE FLORIN RD
SACRAMENTOCA9582907/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09186 110 E LAUREL DR
SALINASCA9390607/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06793 3020 GREEN VALLEY RD STE B
CAMERON PARKCA9568207/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09147 2605 WEST MARCH LANE
STOCKTONCA9520707/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09917 625 ELMIRA RD
VACAVILLECA9568707/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09261 100 W LODI AVE
LODICA9524007/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09155 1005 SUTTON WAY
GRASS VALLEYCA9594510/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07128 2780 ESPLANADE
CHICOCA9597310/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09597 1750 41ST AVE
CAPITOLACA9501010/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09691 906 E ST.
MARYSVILLECA9590110/01/2020  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09830 6632 PACIFIC AVENUE
STOCKTONCA9520710/01/2020 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07910 1794 ASHLAN AVE
CLOVISCA9361101/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09180 7 W MAIN ST
WOODLANDCA9569501/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09909 8320 EL CAMINO REAL
ATASCADEROCA9342201/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03009 3500 PALMER DR
CAMERON PARKCA9568201/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09993 9280 SIERRA COLLEGE BLVD
ROSEVILLECA9566107/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09916 5070 WEST LN
STOCKTONCA9521007/01/2021 05/11/2022
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09243 1000 W KETTLEMAN LN
LODICA9524007/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09815 738 BANCROFT RD
WALNUT CREEKCA9459810/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09980 9479 MADISON AVE
FOLSOMCA9563010/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09490 6450 PONY EXPRESS TRL
POLLOCK PINESCA9572610/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09927 1193 ADMIRAL CALLAGHAN LANE
VALLEJOCA9459110/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09142 1550 E COVELL BLVD
DAVISCA9561610/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02124 8585 ELK GROVE BLVD
ELK GROVECA9562410/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09219 330 BON AIR SHOPPING CTR
GREENBRAECA9490410/01/2021 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09132 9285 ELK GROVE BLVD
ELK GROVECA9562410/01/2021  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09536 490 MARKET PL
SAN RAMONCA9458301/01/2022 04/17/2024
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03909 4330 LATROBE RD
EL DORADO HILLSCA9576201/01/2022  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09923 1005 E BIDWELL ST
FOLSOMCA9563001/01/2022 05/08/2025
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09487 8861 GREENBACK LN
ORANGEVALECA9566201/01/2022 01/18/2023
CHC24113-14LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 02290 1587 W EL CAMINO AVE
SACRAMENTOCA9583301/01/2024  
CHC24113-00LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09868 2455 SAN RAMON VALLEY BLVD
SAN RAMONCA9458307/01/2024 05/08/2025
CHC24113-00NEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08792 680 N. MCCARRAN BLVD.
SPARKSNV8943110/01/2020  
CHC24113-00NEVADA CVS PHARMACY, L.L.C.CVS/PHARMACY # 10861 8491 FARM RD.
LAS VEGASNV8913101/01/2021 05/08/2025
CHC24113-00NEVADA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00157 2890 NORTHTOWNE LANE
RENONV8951207/01/2021  
CHC24113-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2020  
CHC24113-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2021  
CHC24113-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2021  
CHC24113-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681307/01/2021  
CHC24113-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255001/01/2025  
CHC24113-00RALEY'S PHARMACY #4163518 MARCONI AVENUE
SACRAMENTOCA9582101/01/2021 05/26/2025
CHC24113-00RALEY'S PHARMACY #4208391 FOLSOM BLVD.
SACRAMENTOCA9582601/01/2021  
CHC24113-00RALEY'S PHARMACY #4474650 NATOMAS BLVD.
SACRAMENTOCA9583501/01/2021  
CHC24113-00RALEY'S PHARMACY #4481601 WEST CAPITOL AVENUE
WEST SACRAMENTOCA9569101/01/2021 05/26/2025
CHC24113-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/01/2025  
CHC24113-00SAFEWAY INCSAFEWAY PHARMACY #2242 1025 ALHAMBRA BLVD
SACRAMENTOCA9581601/01/2021 10/18/2024
CHC24113-00SAFEWAY INCSAFEWAY PHARMACY #1530 3320 ARDEN WAY
SACRAMENTOCA9582501/01/2021 10/18/2024
CHC24113-00SAFEWAY INCSAFEWAY PHARMACY #2684 1814 19TH STREET
SACRAMENTOCA9581101/01/2021 10/18/2024
CHC24113-00SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301301/01/2025  
CHC24113-00THRIFTY PAYLESS INC.RITE AID #6070 2419 DEL PASO BOULEVARD
SACRAMENTOCA9581507/01/2014 07/19/2015
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582407/01/2014 07/19/2015
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583807/01/2014 07/19/2015
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6065 1260 WEST CAPITOL AVENUE
WEST SACRAMENTOCA9569107/01/2014 07/19/2015
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582410/01/2019 04/23/2024
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566010/01/2019  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6065 1260 WEST CAPITOL AVENUE
WEST SACRAMENTOCA9569110/01/2019  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6069 831 K STREET
SACRAMENTOCA9581410/01/2019 02/28/2022
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6071 1125 ALHAMBRA BOULEVARD
SACRAMENTOCA9581610/01/2019 05/03/2022
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583810/01/2019  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6080 1309 FULTON AVENUE
SACRAMENTOCA9582510/01/2019 10/18/2023
CHC24113-17THRIFTY PAYLESS, INC.RITE AID #6074 5610 STOCKTON BOULEVARD
SACRAMENTOCA9582401/01/2024 04/23/2024
CHC24113-06THRIFTY PAYLESS, INC.RITE AID #6228 4221 NORWOOD AVENUE
SACRAMENTOCA9583801/01/2024  
CHC24113-18THRIFTY PAYLESS, INC.RITE AID #6054 6639 WATT AVENUE
NORTH HIGHLANDSCA9566001/01/2024  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6083 7860 GERBER ROAD
SACRAMENTOCA9582804/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6043 2805 BELL ROAD
AUBURNCA9560304/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6044 4010 MANZANITA AVENUE
CARMICHAELCA9560804/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6403 4241 MARCONI AVENUE
SACRAMENTOCA9582104/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6081 9133 KIEFER BOULEVARD
SACRAMENTOCA9582604/01/2025  
CHC24113-00THRIFTY PAYLESS, INC.RITE AID #6086 4300 ELVERTA ROAD
ANTELOPECA9584304/01/2025  
CHC24113-00VIBRANT CARE PHARMACY, INC.7400 MACARTHUR BLVD STE B
OAKLANDCA94605-293901/01/2020 05/02/2025
CHC24113-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2019  
CHC24113-00WAL-MART PHARMACY 10-15543223 EAST HAMMER LANE
STOCKTONCA9521201/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-16978465 ELK GROVE BLVD
ELK GROVECA9575801/01/2023  
CHC24113-00WAL-MART PHARMACY 10-17601018 RILEY STREET
FOLSOMCA9563001/01/2023  
CHC24113-00WAL-MART PHARMACY 10-17891601 S. LOWER SACRAMENTO RD.
LODICA9524201/01/2023  
CHC24113-00WAL-MART PHARMACY 10-18817901 WATT AVE
ANTELOPECA9584310/01/2019  
CHC24113-00WAL-MART PHARMACY 10-21901720 EAST MAIN STREET
WOODLANDCA9577601/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-24184300 MISSOURI FLAT RD
PLACERVILLECA9566701/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-245710655 FOLSOM BLVD.
RANCHO CORDOVACA9567001/01/2023  
CHC24113-00WAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583310/01/2019  
CHC24113-19WAL-MART PHARMACY 10-25983661 TRUXEL ROAD
SACRAMENTO (NW)CA9583301/01/2024  
CHC24113-00WAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582310/01/2019  
CHC24113-04WAL-MART PHARMACY 10-27356051 FLORIN ROAD
SACRAMENTOCA9582301/01/2024  
CHC24113-00WAL-MART PHARMACY 10-30905609 PACIFIC ST
ROCKLINCA9567701/01/2023  
CHC24113-00WAL-MART PHARMACY 10-35875454 CROSSING DR.
ROCKLINCA9567701/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-3652755 RIVER POINT CT
WEST SACRAMENTOCA9569110/01/2019  
CHC24113-10WAL-MART PHARMACY 10-3652755 RIVER POINT CT
WEST SACRAMENTOCA9569101/01/2024  
CHC24113-00WAL-MART PHARMACY 10-37127010 AUBURN BLVD
CITRUS HEIGHTSCA9562101/01/2023  
CHC24113-00WAL-MART PHARMACY 10-43098961 GREENBACK LANE
ORANGEVALECA9566201/01/2023  
CHC24113-00WAL-MART PHARMACY 10-51361131 N BEALE RD
MARYSVILLECA9590101/01/2022  
CHC24113-00WAL-MART PHARMACY 10-51925821 ANTELOPE ROAD
SACRAMENTOCA9584210/01/2019  
CHC24113-08WAL-MART PHARMACY 10-51925821 ANTELOPE ROAD
SACRAMENTOCA9584201/01/2024  
CHC24113-00WAL-MART PHARMACY 10-56061250 E GIBSON ROAD
WOODLANDCA9577601/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-56838455 ELK GROVE BLVD
ELK GROVECA9575801/01/2023  
CHC24113-00WAL-MART PHARMACY 10-584810075 BRUCEVILLE RD
ELK GROVECA9575701/01/2023  
CHC24113-00WAL-MART PHARMACY 10-5979255 LINCOLN BLVD.
LINCOLNCA9564801/01/2023 05/08/2025
CHC24113-00WAL-MART PHARMACY 10-59804080 DOUGLAS BLVD.
GRANITE BAYCA9574601/01/2023 04/12/2024
CHC24113-00WAL-MART PHARMACY 10-59816005 MADISON AVE
CARMICHAELCA9560801/01/2022  
CHC24113-00WAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582110/01/2019  
CHC24113-16WAL-MART PHARMACY 10-59822700 MARCONI AVE.
SACRAMENTOCA9582101/01/2024  
CHC24113-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2019  
CHC24113-00WALGREEN CODBA: WALGREENS #10693 6819 WATT AVE
NORTH HIGHLANDSCA95660-320301/01/2021 02/22/2024
CHC24113-00WALGREEN CODBA: WALGREENS #07191 6199 SUNRISE BOULEVARD
CITRUS HEIGHTSCA9561001/01/2022 02/20/2024
CHC24113-00WALGREEN CODBA: WALGREENS #10114 3521 DEL PASO ROAD
SACRAMENTOCA9583504/01/2023  
CHC24113-00WALGREEN CODBA: WALGREENS #10716 250 FLORIN RD
SACRAMENTOCA9583104/01/2023  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06706 7155 24TH STREET
SACRAMENTOCA9582201/01/2021 01/29/2025
CHC24113-00WALGREEN CO.DBA: WALGREENS #11262 840 EL CAMINO AVE
SACRAMENTOCA95815-251301/01/2021 11/08/2023
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05036 4495 MACK RD
SACRAMENTOCA9582301/01/2021  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05374 2900 STOCKTON BLVD
SACRAMENTOCA9581701/01/2021 06/26/2025
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06193 2201 ARDEN WAY
SACRAMENTOCA9582501/01/2021 04/09/2024
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06613 1401 BROADWAY
SACRAMENTOCA9581801/01/2021 01/23/2025
CHC24113-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15987 1020 29TH ST STE 140
SACRAMENTOCA9581601/01/2021 06/09/2021
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05500 4331 ANTELOPE ROAD
SACRAMENTOCA9584301/01/2021  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 04198 1351 W CAPITOL AVE
WEST SACRAMENTOCA9569101/01/2021  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06419 9180 FRANKLIN BLVD
ELK GROVECA9575801/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS #09532 4050 SUNRISE BLVD
RANCHO CORDOVACA9574201/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05501 3999 FOOTHILLS BLVD
ROSEVILLECA9574701/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05499 7299 LAGUNA BLVD
ELK GROVECA9575801/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 04107 10 WEST MAIN ST.
WOODLANDCA9569501/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06658 6325 FAIR OAKS BLVD
CARMICHAELCA9560801/01/2022 04/30/2025
CHC24113-00WALGREEN CO.DBA: WALGREENS #12525 700 TWELVE BRIDGES DR
LINCOLNCA9564801/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06142 9200 ELK GROVE FLORIN RD
ELK GROVECA9562401/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06915 2177 SUNSET BLVD
ROCKLINCA95765-474301/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06612 8400 ELK GROVE FLORIN ROAD
ELK GROVECA95624-945001/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05774 7787 SUNRISE BLVD
CITRUS HEIGHTSCA9561001/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS #16058 1492 BLUE OAKS BLVD
ROSEVILLECA9574701/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 06036 4051 DOUGLAS BLVD
GRANITE BAYCA95746-590101/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 05152 6144 DEWEY DRIVE
CITRUS HEIGHTSCA9562101/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 04170 4200 ARDEN WAY
SACRAMENTOCA9586404/01/2022  
CHC24113-00WALGREEN CO.DBA: WALGREENS # 04136 1919 FRUITRIDGE RD.
SACRAMENTOCA9582204/01/2022  
CHC24113-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15987 1020 29TH ST STE 140
SACRAMENTOCA9581610/01/2024  
CHC24113-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2024  
CHC24113-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2024  
CHC24113-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2024  
CHC24113-00WALMART PHARMACY #10-24648270 DELTA SHORES CIR
SACRAMENTOCA95832-910101/01/2023  
CHC24113-00WALMART PHARMACY 10-30818915 GERBER ROAD
SACRAMENTOCA9582901/01/2023  
CHC24113-00WALMART PHARMACY 10-4127215 CALIFORNIA ST.
WOODLANDCA9569501/01/2023 05/08/2025
CHC24113-00WALMART PHARMACY 10-42021400 LEAD HILL BLVD
ROSEVILLECA9566101/01/2023  
CHC24113-00WALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566010/01/2019  
CHC24113-15WALMART PHARMACY 10-43934675 WATT AVENUE
NORTH HIGHLANDSCA9566001/01/2024  
CHC24113-00WALMART PHARMACY 10-47596197 SUNRISE BLVD
CITRUS HEIGHTSCA9561001/01/2023  
CHC24113-00WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/01/2023  
CHC24113-00WALMART PHARMACY 10-523110470 TWIN CITIES ROAD
GALTCA9563201/01/2023  
CHC24113-00WALMART PHARMACY 10-65304420 FLORIN RD
SACRAMENTOCA9582310/01/2019 12/09/2019
CHC24113-00Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CHC24113-00WASHINGTON CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10285 10712 SE CARR ROAD
RENTONWA9805501/01/2022 05/08/2025
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesMain AddressUpdateChange Request 2400 Glendale Ln Sacramento, CA 95825-2431 2400 Glendale Ln Sacramento, CA 958254/1/2025 6:12 AM
AddressesBilling AddressInsertChange Request Elica Health Centers 1860 Howe Avenue Suite 440 Sacramento, CA 958254/1/2025 6:12 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/1/2025 6:12 AM
Medicaid BillingMedicaid: NumberInsertChange Request 13660511204/1/2025 6:12 AM
Medicaid BillingMedicaid: StateInsertChange Request CA4/1/2025 6:12 AM
Medicaid BillingNPI: NumberInsertChange Request 17904190594/1/2025 6:12 AM
Medicaid BillingNPI: StateInsertChange Request CA4/1/2025 6:12 AM
DetailsLast Recertification DateUpdateRecertification1/30/2024 11:28:02 AM2/10/2025 2:32:16 PM2/10/2025 2:32 PM
DetailsLast Recertification DateUpdateRecertification 1/30/2024 11:28:02 AM1/30/2024 11:28 AM
DetailsStateUpdate ApprovedActive7/1/2023 12:01 AM
ContactsSigned ByInsertNew Registration Hughes, David E COO/CFO Elica Health Centers 9165698484-3124/5/2023 7:20 AM
Details340B IDUpdateNew Registration CHC24113-214/5/2023 7:20 AM
DatesParticipating Approval DateUpdateNew Registration 4/5/2023 7:20:01 AM4/5/2023 7:20 AM
DetailsStateUpdateNew RegistrationPendingApproved4/5/2023 7:20 AM
DatesSigned By DateUpdateNew Registration 4/4/2023 6:26:17 PM4/5/2023 7:20 AM
DatesStart DateUpdateNew Registration 7/1/2023 12:00:00 AM4/5/2023 7:20 AM
AddressesMain AddressInsertNew Registration  2400 Glendale Ln Sacramento, CA 95825-24314/4/2023 5:15 PM
ContactsAuthorizing OfficialInsertNew Registration Hughes, David E COO/CFO Elica Health Centers 9165698484-3124/4/2023 5:15 PM
ContactsPrimary ContactInsertNew Registration Osman, Christina Project Director Elica Health Centers 9165698484-8024/4/2023 5:15 PM
DetailsAssistance Received From DateInsertNew Registration  4/4/2023 5:15 PM
DetailsAssistance Received To DateInsertNew Registration  4/4/2023 5:15 PM
DetailsLast Recertification DateInsertNew Registration  4/4/2023 5:15 PM
DetailsGrant NumberInsertNew Registration H80CS241134/4/2023 5:15 PM
Details340B IDInsertNew Registration  4/4/2023 5:15 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/4/2023 5:15 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/4/2023 5:15 PM
DetailsMedicare Provider NumberInsertNew Registration  4/4/2023 5:15 PM
DetailsEntity NameInsertNew Registration ELICA HEALTH CENTERS4/4/2023 5:15 PM
DetailsNOFO NumberInsertNew Registration  4/4/2023 5:15 PM
DetailsProgram CodeInsertNew Registration CH4/4/2023 5:15 PM
DetailsEntity SubnameInsertNew Registration Elica Health Centers - Glendale4/4/2023 5:15 PM
DatesParticipating Approval DateInsertNew Registration  4/4/2023 5:15 PM
DetailsStateInsertNew Registration Pending4/4/2023 5:15 PM
DatesRegistration DateInsertNew Registration 4/4/2023 5:15:52 PM4/4/2023 5:15 PM
DatesSigned By DateInsertNew Registration  4/4/2023 5:15 PM
DatesStart DateInsertNew Registration  4/4/2023 5:15 PM
TerminationsTermination CommentsInsertNew Registration  4/4/2023 5:15 PM
TerminationsTermination DateInsertNew Registration  4/4/2023 5:15 PM
TerminationsTermination Effective DateInsertNew Registration  4/4/2023 5:15 PM
TerminationsTermination ReasonInsertNew Registration  4/4/2023 5:15 PM