340B Drug Pricing Program Database


CH09538A MARIN COMMUNITY CLINIC (Active) - information as of 4/27/2025 11:34:38 PM

Main Details
MARIN COMMUNITY CLINIC
NOVATO
HRSA-Funded Health Center
BPS-H80-008138
CH09538A
H80CS00343


Additional Details
Active
4/1/2002
4/1/2002
12/31/2003
2/13/2025

Contacts

Marin Community Clinics
Kathryn E Powell, Interim Chief Executive Officer
(415) 448-1500

Marin Community Clinic
Sheri Dunham, Compliance Coordinator
(415) 376-3255

Addresses

6100 REDWOOD BLVD
NOVATO, CA 94945

MARIN COMMUNITY CLINIC
9 Commercial Blvd
Suite 100
NOVATO, CA 94949


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
10/28/11 - Changed AO title from interim executive director. 4/10/09-ADDR CHANGE(WAS 400 PROFESSIONAL CENTER DR SUITE 424) ID CORRECTION - REPLACES CH09538010/28/2011
4/10/09-ADDR CHANGE(WAS 400 PROFESSIONAL CENTER DR SUITE 424) ID CORRECTION - REPLACES CH09538004/10/2009
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA 1003900101,1912091018,1881057115
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailAVITA PHARMACY 1023PHARMEDQUEST PHARMACY SERVICES DBA AVITA 6100 REDWOOD BLVD STE A
NOVATOCA94945-450107/10/201909/30/2019 03/18/202203/18/2022
Contract DetailAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282104/03/201907/01/2019 08/08/202310/20/2023
Contract DetailCLINIC PHARMACIES, LLCDBA MCC PHARMACY NOVATO 6100 REDWOOD BLVD, SUITE A
NOVATOCA9494506/03/201507/01/2015 06/28/201907/10/2019
Contract DetailPHARMEDQUEST PHARMACY SERVICES451 W LAMBERT RD STE 208
BREACA92821-392004/03/201907/01/2019 08/08/202310/20/2023
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH095380ActiveBPS-H80-014015Marin Community ClinicMarin Community Clinic - Larkspur5 Bon Air Road, Suite 117 LarkspurCA
CH09538AActiveBPS-H80-008138MARIN COMMUNITY CLINICNOVATO6100 REDWOOD BLVD NOVATOCA
CH09538BActiveBPS-H80-007520MARIN COMMUNITY CLINICMarin Community Clinic - San Rafael3110 KERNER BLVD SAN RAFAELCA
CH09538CActiveBPS-H80-010418MARIN COMMUNITY CLINICSAN RAFAEL CAMPUS3260 KERNER BLVD. SAN RAFAELCA
CH09538DActiveBPS-H80-017900MARIN COMMUNITY CLINICMarin Community Clinic - Novato South6090 Redwood Blvd NovatoCA
CH09538EActiveBPS-H80-013619Marin Community ClinicHuckleberry Youth Programs361 3rd Street, Suite G San RafaelCA
CH09538FTerminatedBPS-H80-024858Marin Community ClinicMarin Community Clinic - 4th Street Dental Suite C411 4th St Ste C San RafaelCA
CH09538GTerminatedBPS-H80-009429Marin Community ClinicMarin Community Clinic - Novato Dental6090 Redwood Blvd. STE D NovatoCA
CH09538HActiveBPS-H80-011038Marin Community ClinicMarin Community Clinic - 4th Street Dental411 4th St STE A San RafaelCA
CH09538JActiveBPS-H80-030959Marin Community ClinicMarin Community Clinic - Greenbrae1260 S Eliseo Dr Ste 201 GreenbraeCA
CH09538KActiveBPS-H80-034364Marin Community ClinicMarin Community Clinic - West San Rafael1618 2nd St San RafaelCA
CH09538LActiveBPS-H80-038521MARIN COMMUNITY CLINICMarin Community Clinic - Downtown San Rafael999 Third Street STE A San RafaelCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH095380AVITA PHARMACY 1021PHARMEDQUEST PHARMACY SERVICES DBA AVITA 1260 S ELISEO DR STE 201
GREENBRAECA94904-200902/24/2021 02/25/2022
CH095380AVITA PHARMACY 1022PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3110 KERNER BLVD STE A
SAN RAFAELCA94901-541110/01/2019 08/08/2023
CH09538BAVITA PHARMACY 1022PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3110 KERNER BLVD STE A
SAN RAFAELCA94901-541109/30/2019 08/08/2023
CH09538AAVITA PHARMACY 1023PHARMEDQUEST PHARMACY SERVICES DBA AVITA 6100 REDWOOD BLVD STE A
NOVATOCA94945-450109/30/2019 03/18/2022
CH095380AVITA PHARMACY 1023PHARMEDQUEST PHARMACY SERVICES DBA AVITA 6100 REDWOOD BLVD STE A
NOVATOCA94945-450110/01/2019 03/18/2022
CH09538AAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282107/01/2019 08/08/2023
CH095380AVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282107/01/2019 08/08/2023
CH09538BAVITA PHARMACY 1025PHARMEDQUEST PHARMACY SERVICES DBA AVITA 3020 SATURN ST STE 100
BREACA9282107/01/2019 08/08/2023
CH095380AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080801/01/2021 08/08/2023
CH095380CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2020  
CH095380CLINIC PHARMACIES, LLCDBA MCC PHARMACY NOVATO 6100 REDWOOD BLVD, SUITE A
NOVATOCA9494501/01/2016 06/28/2019
CH09538ACLINIC PHARMACIES, LLCDBA MCC PHARMACY NOVATO 6100 REDWOOD BLVD, SUITE A
NOVATOCA9494507/01/2015 06/28/2019
CH095380CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2024  
CH095380CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2024  
CH095380EVERGREEN PHARMACEUTICAL OF CALIFORNIA,OMNICARE OF SANTA ROSA EVERGREEN PHARMACEUTICAL CA
879 2ND STREET 		SANTA ROSACA95404-462101/01/2023  
CH095380GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17629 125 SHORELINE PKWY
SAN RAFAELCA9490107/01/2019  
CH095380GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04952 909 GRAND ST.
SAN RAFAELCA9490107/01/2019 03/09/2022
CH095380GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16212 200 VINTAGE WAY
NOVATOCA9494507/01/2019  
CH095380GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16746 133 SERRAMONTE CTR
DALY CITYCA9401501/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 1483 1599 TIBURON BLVD
TIBURONCA9492001/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 04950 3301 ZINFANDEL DR.
RANCHO CORDOVACA9567007/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10368 400 SUTTER ST.
SAN FRANCISCOCA9410810/01/2020 02/07/2022
CH095380GARFIELD BEACH CVS, L.L.C.CVS/PHARMACY # 17694 180 DONAHUE STREET
SAUSALITOCA9496510/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 4675 377 32ND AVENUE
SAN FRANCISCOCA9412110/01/2020  
CH095380GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #5131 1900 19TH AVENUE
SAN FRANCISCOCA9411601/01/2022  
CH095380GARFIELD BEACH CVS, L.L.C.CVS/PHARMACY #10924 3010 BERNAL AVENUE
PLEASANTONCA9456601/01/2022  
CH095380GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17586 401 KENILWORTH DRIVE
PETALUMACA9495201/01/2022  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09529 442 LAS GALLINAS AVE
SAN RAFAELCA9490307/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09370 880 SIR FRANCIS DRAKE BLVD
SAN ANSELMOCA9496007/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09316 1707 GRANT AVE
NOVATOCA9494507/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09947 2035 NOVATO BLVD
NOVATOCA9494707/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09913 759 E BLITHEDALE AVE
MILL VALLEYCA9494107/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09219 330 BON AIR SHOPPING CTR
GREENBRAECA9490407/01/2019  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09962 150 DONAHUE ST
SAUSALITOCA9496507/01/2019 01/31/2022
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09480 365 E WASHINGTON ST
PETALUMACA9495201/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09928 6378 COMMERCE BLVD
ROHNERT PARKCA9492801/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09163 291 N MCDOWELL BLVD
PETALUMACA9495401/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09904 3667 CASTRO VALLEY BLVD
CASTRO VALLEYCA9454604/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09656 2771 4TH ST
SANTA ROSACA9540507/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 07955 2025 VAN NESS AVE
SAN FRANCISCOCA9410907/01/2020 02/07/2022
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09818 572 FLETCHER PKWY
EL CAJONCA9202007/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09086 670 EL CERRITO PLZ
EL CERRITOCA9453010/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09255 931 MARINA VILLAGE PKWY
ALAMEDACA9450110/01/2020 03/20/2023
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09152 201 W NAPA ST STE 35
SONOMACA9547610/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09929 2000 MOUNTAIN BLVD
OAKLANDCA9461110/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09393 2075 MENDOCINO AVE
SANTA ROSACA9540110/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09226 3320 FRUITVALE AVE
OAKLANDCA9460210/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09872 6877 SEBASTOPOL AVENUE
SEBASTOPOLCA9547210/01/2020  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09832 3678 SONOMA BLVD
VALLEJOCA9459001/01/2022  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09099 4020 FREMONT HUB
FREMONTCA9453801/01/2022  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09946 463 STONY POINT RD
SANTA ROSACA9540101/01/2022  
CH095380LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09957 344 THOMAS L. BERKLEY WAY
OAKLANDCA9461201/01/2022 03/30/2022
CH095380LONGS DRUGS OF LEXINGTOND/B/A AVITA PHARMACY 1051 1216 W MAIN ST
STE D 		LEXINGTONSC29072-245301/01/2021 08/08/2023
CH095380MARIN APOTHECARIES, INC.MCC PHARMACY 3110 KERNER BLVD STE A
SAN RAFAELCA9490101/01/2016 06/28/2019
CH09538BMARIN APOTHECARIES, INC.MCC PHARMACY 3110 KERNER BLVD STE A
SAN RAFAELCA9490104/01/2015 06/28/2019
CH09538BMCC PHARMACY  3110 KERNER BLVD
SAN RAFAELCA9490102/14/2012 06/28/2019
CH095380MISSION WELLNESS PHARMACY  2424 MISSION STREET
SAN FRANCISCOCA9411007/01/2024  
CH095380OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2024  
CH095380OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140107/01/2024  
CH095380PHARMEDQUEST PHARMACYPHARMEDQUEST PHARMACY SERVICES 451 W. LAMBERT RD STE 209
BREACA92821-928201/01/2021 12/30/2022
CH09538BPHARMEDQUEST PHARMACY SERVICES451 W LAMBERT RD STE 208
BREACA92821-392007/01/2019 08/08/2023
CH095380PHARMEDQUEST PHARMACY SERVICES451 W LAMBERT RD STE 208
BREACA92821-392007/01/2019 12/30/2022
CH09538APHARMEDQUEST PHARMACY SERVICES451 W LAMBERT RD STE 208
BREACA92821-392007/01/2019 08/08/2023
CH095380ROSS VALLEY PHARMACY  1525 EAST FRANCISCO BLVD
SUITE #1 		SAN RAFAELCA9490108/01/2002 02/07/2019
CH09538BROSS VALLEY PHARMACY  1525 EAST FRANCISCO BLVD
SUITE #1 		SAN RAFAELCA9490109/26/2012 02/07/2019
CH095380RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135510/01/2018 06/28/2019
CH095380SAFEWAY INCSAFEWAY PHARMACY #2718 800 REDWOOD HWY FRONTAGE RD. STE 110
MILL VALLEYCA9494110/01/2018  
CH095380SAFEWAY INCSAFEWAY PHARMACY #2828 5720 NAVE DRIVE
NOVATOCA9494910/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5958 1500 NORTHGATE MALL
SAN RAFAELCA9490310/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5957 471 3RD STREET
SAN RAFAELCA9490110/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5961 701 EAST BLITHEDALE AVE.
MILL VALLEYCA9494110/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5959 431 CORTE MADERA TOWN CENTER
CORTE MADERACA9492510/01/2018  
CH095380THRIFTY PAYLESS, INC.RITE AID #5963 910 DIABLO AVENUE
NOVATOCA9494710/01/2018 05/15/2024
CH095380WALGREEN CO.DBA: WALGREENS # 03084 7800 OLD REDWOOD HWY
COTATICA9493111/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 04491 15650 SAN PABLO AVE.
SAN PABLOCA9480611/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 04559 227 SHORELINE HWY
MILL VALLEYCA9494111/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 04625 830 3RD STREET
SAN RAFAELCA9490111/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 06625 2141 CHESTNUT STREET
SAN FRANCISCOCA94123-270811/09/2011  
CH095380WALGREEN CO.DBA: WALGREENS # 07445 820 SIR FRANCIS DRAKE BLVD
SAN ANSELMOCA9496011/09/2011 06/08/2023
CH095380WALGREEN CO.DBA: WALGREENS #13584 155 NORTHGATE ONE
SAN RAFAELCA94903-341711/09/2011  
CH095380WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15296 2262 MARKET ST
SAN FRANCISCOCA9411407/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/30/2024 12:40:23 PM2/13/2025 6:19:54 PM2/13/2025 6:19 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestFadoo, Farhan CEO Marin Community Clinic 4154481500Powell, Kathryn E Interim Chief Executive Officer Marin Community Clinics 415448150011/18/2024 8:18 AM
ContactsPrimary ContactUpdateGroup Change RequestMihai, Isabela Compliance Officer Marin Community Clinic 4157552509Dunham, Sheri Compliance Coordinator Marin Community Clinic 415376325511/18/2024 8:18 AM
DetailsLast Recertification DateUpdateRecertification2/1/2023 12:36:24 PM1/30/2024 12:40:23 PM1/30/2024 12:40 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestAndrews, Leigha Interim CEO Marin Community Clinic 4154481500Fadoo, Farhan CEO Marin Community Clinic 415448150012/7/2023 9:40 AM
DetailsLast Recertification DateUpdateRecertification2/2/2022 2:59:06 PM2/1/2023 12:36:24 PM2/1/2023 12:36 PM
Medicaid BillingNPI: NumberInsertChange Request 18810571151/6/2023 3:41 PM
Medicaid BillingNPI: StateInsertChange Request CA1/6/2023 3:41 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestPopat, Mitesh CEO Marin Community Clinics 4157552581Andrews, Leigha Interim CEO Marin Community Clinic 415448150012/29/2022 9:40 AM
DetailsLast Recertification DateUpdateRecertification2/3/2021 4:12:42 PM2/2/2022 2:59:06 PM2/2/2022 2:59 PM
Medicaid BillingNPI: NumberDeleteRecertification1912091018 ( ) 2/3/2021 4:12 PM
Medicaid BillingNPI: NumberInsertRecertification 10039001012/3/2021 4:12 PM
Medicaid BillingNPI: StateInsertRecertification CA2/3/2021 4:12 PM
Medicaid BillingNPI: NumberInsertRecertification 19120910182/3/2021 4:12 PM
Medicaid BillingNPI: StateInsertRecertification CA2/3/2021 4:12 PM
Medicaid BillingNPI: NumberDeleteRecertification1003900101 ( ) 2/3/2021 4:12 PM
DetailsLast Recertification DateUpdateRecertification1/31/2020 6:22:27 PM2/3/2021 4:12:42 PM2/3/2021 4:12 PM
Medicaid BillingNPI: NumberInsertChange Request 19120910183/30/2020 8:31 PM
DetailsLast Recertification DateUpdateRecertification2/8/2019 5:55:17 PM1/31/2020 6:22:27 PM1/31/2020 6:22 PM
DetailsLast Recertification DateUpdateRecertification3/5/2018 7:16:36 PM2/8/2019 5:55:17 PM2/8/2019 5:55 PM
ContactsPrimary ContactUpdateChange RequestWalsh, Mary Ellen Director of Procurement & Contracts Marin Community Clinics 4157983108Mihai, Isabela Compliance Officer Marin Community Clinic 415755250912/10/2018 5:50 PM
DetailsLast Recertification DateUpdateRecertification1/27/2017 12:00:00 AM3/5/2018 7:16:36 PM3/5/2018 7:16 PM
ContactsAuthorizing OfficialUpdateChange RequestSHEN, JOHN EXECUTIVE DIRECTOR 4157983107Popat, Mitesh CEO Marin Community Clinics 415755258111/22/2017 7:46 AM
ContactsPrimary ContactUpdate Walsh, Mary Ellen Director of Procurement & Contracts 4157983108Walsh, Mary Ellen Director of Procurement & Contracts Marin Community Clinics 415798310811/20/2017 1:36 PM
ContactsPrimary ContactUpdate Maki, Jean Compliance Officer 4157552533Walsh, Mary Ellen Director of Procurement & Contracts 41579831085/25/2017 7:23 AM
AddressesMain AddressInsert   6100 REDWOOD BLVD NOVATO, CA 949455/25/2017 7:20 AM
AddressesBilling AddressInsert  MARIN COMMUNITY CLINIC 9 Commercial Blvd Suite 100 NOVATO, CA 949495/25/2017 7:20 AM
DetailsLast Recertification DateUpdate 2/29/2016 12:00:00 AM1/27/2017 12:00:00 AM1/27/2017 3:10 PM
Medicaid BillingNPI: NumberInsert  10039001017/18/2016 6:26 PM
DetailsLast Recertification DateUpdate 3/4/2015 12:00:00 AM2/29/2016 12:00:00 AM2/29/2016 3:38 PM
ContactsPrimary ContactUpdate WIEBERS, SUSAN DIRECTOR OF CLINIC SERVICES 4157983171Maki, Jean Compliance Officer 415755253311/2/2015 8:29 AM
DetailsLast Recertification DateUpdate 3/23/2014 12:00:00 AM3/4/2015 12:00:00 AM3/4/2015 1:29 PM
ContactsPrimary ContactUpdate WEIBERS, SUSAN DIRECTOR OF CLINIC SERVICES 4157983171WIEBERS, SUSAN DIRECTOR OF CLINIC SERVICES 41579831714/30/2014 10:39 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/23/2014 12:00:00 AM3/23/2014 12:31 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM2/7/2013 9:15 AM
ContactsPrimary ContactInsert  WEIBERS, SUSAN DIRECTOR OF CLINIC SERVICES 415798317110/28/2011 11:55 AM
DetailsComments PublicInsert  10/28/11 - Changed AO title from interim executive director. 4/10/09-ADDR CHANGE(WAS 400 PROFESSIONAL CENTER DR SUITE 424) ID CORRECTION - REPLACES CH09538010/28/2011 11:55 AM
ContactsAuthorizing OfficialInsert  SHEN, JOHN EXECUTIVE DIRECTOR 41579831075/26/2011 2:49 PM
DetailsLast Recertification DateInsert   4/10/2009 11:35 AM
DetailsGrant NumberInsert  H80CS003434/10/2009 11:35 AM
Details340B IDInsert  CH09538A4/10/2009 11:35 AM
DetailsIs Authorizing Official EHB DataInsert   4/10/2009 11:35 AM
DatesLast Date That 340B Drugs PurchasedInsert   4/10/2009 11:35 AM
DetailsMedicare Provider NumberInsert   4/10/2009 11:35 AM
DetailsEntity NameInsert  MARIN COMMUNITY CLINIC4/10/2009 11:35 AM
DetailsProgram CodeInsert  CH4/10/2009 11:35 AM
DetailsEntity SubnameInsert  NOVATO4/10/2009 11:35 AM
DatesParticipating Approval DateInsert  12/31/2003 12:00:00 AM4/10/2009 11:35 AM
DetailsStateInsert  Active4/10/2009 11:35 AM
DatesRegistration DateInsert  4/1/2002 12:00:00 AM4/10/2009 11:35 AM
DatesSigned By DateInsert   4/10/2009 11:35 AM
DatesStart DateInsert  4/1/2002 12:00:00 AM4/10/2009 11:35 AM
TerminationsTermination CommentsInsert   4/10/2009 11:35 AM
TerminationsTermination DateInsert   4/10/2009 11:35 AM
TerminationsTermination Effective DateInsert   4/10/2009 11:35 AM
TerminationsTermination ReasonInsert   4/10/2009 11:35 AM
DetailsComments PublicInsert  4/10/09-ADDR CHANGE(WAS 400 PROFESSIONAL CENTER DR SUITE 424) ID CORRECTION - REPLACES CH0953804/10/2009 11:35 AM