Covered Entity Details

CH091025E MENDOCINO COAST CLINICS, INC. (Active) - information as of 6/27/2025 12:27:19 AM

Main Details

Name

MENDOCINO COAST CLINICS, INC.

Subdivision Name

Mendocino Coast Clinics Medication-Assisted Treatment & Support Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-034530

340B ID

CH091025E

Grant Number

H80CS00876

Additional Details

Current Program Status

Active

Registration Date

7/14/2023

Participating Start Date

10/1/2023

Participating Approval Date

7/25/2023

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Mendocino Coast Clinics
Lucresha Renteria, Executive Director
(707) 964-1251 Ext: 3433

Primary Contact

Mendocino Coast Clinics
Jeremie Foley, Operations Director
(707) 964-1251 Ext: 3430

Addresses

Street Address

690 S Main St
Fort Bragg, CA 95437-5108

Billing Address

Mendocino Coast Clinics Inc.
205 South Street
Fort Bragg, CA 95437

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
CH0910250	Active	BPS-H80-002154	MENDOCINO COAST CLINICS, INC.	MENDOCINO COAST CLINICS, INC.	205 South St	Fort Bragg	CA
CH091025A	Active	BPS-H80-000807	MENDOCINO COAST CLINICS, INC.	Mendocino Coast Clinics	855 Sequoia Cir	Fort Bragg	CA
CH091025B	Active	BPS-H80-010864	MENDOCINO COAST CLINICS, INC.	Mendocino Coast Clinics, Inc.	510 Cypress Street, Suite D	Fort Bragg	CA
CH091025C	Active	BPS-H80-021938	MENDOCINO COAST CLINICS, INC.	Mendocino Coast Clinics Family Wellness Center	510 Cypress St. Suite C 100	Fort Bragg	CA
CH091025D	Active	BPS-H80-032981	MENDOCINO COAST CLINICS, INC.	MCC Goes to School	208 Dana St	Fort Bragg	CA
CH091025E	Active	BPS-H80-034530	MENDOCINO COAST CLINICS, INC.	Mendocino Coast Clinics Medication-Assisted Treatment & Support Clinic	690 S Main St	Fort Bragg	CA
CH091025F	Active	BPS-H80-032782	MENDOCINO COAST CLINICS, INC.	MCC Street Medicine Clinic	101 N Franklin St	Fort Bragg	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0910250	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2023
CH0910250	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2023
CH0910250	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2023
CH0910250	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/01/2024
CH0910250	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/01/2024
CH0910250	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/01/2024
CH0910250	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2024
CH0910250	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/01/2024
CH0910250	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2021
CH0910250	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2021
CH0910250	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2021
CH0910250	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2021
CH0910250	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2021
CH0910250	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2021
CH0910250	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2021
CH0910250	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2021
CH0910250	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2021
CH0910250	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2021
CH0910250	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2022
CH0910250	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2022
CH0910250	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2021
CH0910250	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/01/2024
CH0910250	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2023
CH0910250	EVERGREEN PHARMACEUTICAL OF CALIFORNIA,	OMNICARE OF SANTA ROSA	EVERGREEN PHARMACEUTICAL CA 879 2ND STREET	SANTA ROSA	CA	95404-4621	01/01/2022
CH0910250	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2023
CH0910250	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2023
CH0910250	FORT BRAGG PHARMACY COMPANY		189 BOATYARD DRIVE	FORT BRAGG	CA	95437-5741	12/08/2010	12/30/2016
CH091025A	FORT BRAGG PHARMACY COMPANY		189 BOATYARD DRIVE	FORT BRAGG	CA	95437-5741	09/15/2010
CH0910250	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03932	150 S MAIN ST	FORT BRAGG	CA	95437	01/01/2020
CH0910250	MENDOCINO COAST PHARMACY	350 CYPRESS ST		FORT BRAGG	CA	95437-5408	10/01/2015
CH0910250	MENDOCINO VILLAGE PHARMACY	10501 LANSING STREET	PO BOX 904	MENDOCINO	CA	95460	03/21/2011	04/30/2021
CH091025A	MENDOCINO VILLAGE PHARMACY	10501 LANSING STREET	PO BOX 904	MENDOCINO	CA	95460	03/21/2011
CH0910250	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2024
CH0910250	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	10/01/2024
CH0910250	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2021
CH0910250	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2021
CH0910250	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2021
CH0910250	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2021
CH0910250	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2024
CH0910250	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2024
CH0910250	SAFEWAY INC	SAFEWAY PHARMACY #0978	660 SOUTH MAIN STREET	FORT BRAGG	CA	95437	12/10/2010
CH091025A	SAFEWAY INC	SAFEWAY PHARMACY #0978	660 SOUTH MAIN STREET	FORT BRAGG	CA	95437	09/15/2010
CH0910250	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	07/01/2024
CH0910250	THRIFTY PAYLESS, INC.	RITE AID #6028	490 SOUTH MAIN STREET	FORT BRAGG	CA	95437	09/14/2012	06/26/2025
CH0910250	THRIFTY PAYLESS, INC.	RITE AID #6033	680 SOUTH STATE STREET	UKIAH	CA	95482	07/01/2024	06/26/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/9/2024 2:45:14 PM	2/11/2025 4:19:25 PM	2/11/2025 4:19 PM
Details	Last Recertification Date	Update	Recertification		2/9/2024 2:45:14 PM	2/9/2024 2:45 PM
Details	State	Update		Approved	Active	10/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Renteria, Lucresha Executive Director Mendocino Coast Clinics 7079641251-3433	7/25/2023 7:28 AM
Details	340B ID	Update	New Registration		CH091025E	7/25/2023 7:28 AM
Dates	Participating Approval Date	Update	New Registration		7/25/2023 7:28:29 AM	7/25/2023 7:28 AM
Details	State	Update	New Registration	Pending	Approved	7/25/2023 7:28 AM
Dates	Signed By Date	Update	New Registration		7/14/2023 6:38:20 PM	7/25/2023 7:28 AM
Dates	Start Date	Update	New Registration		10/1/2023 12:00:00 AM	7/25/2023 7:28 AM
Addresses	Main Address	Insert	New Registration		690 S Main St Fort Bragg, CA 95437-5108	7/14/2023 6:38 PM
Addresses	Billing Address	Insert	New Registration		Mendocino Coast Clinics Inc. 205 South Street Fort Bragg, CA 95437	7/14/2023 6:38 PM
Contacts	Authorizing Official	Insert	New Registration		Renteria, Lucresha Executive Director Mendocino Coast Clinics 7079641251-3433	7/14/2023 6:38 PM
Contacts	Primary Contact	Insert	New Registration		Foley, Jeremie Operations Director Mendocino Coast Clinics 7079641251-3430	7/14/2023 6:38 PM
Details	Assistance Received From Date	Insert	New Registration			7/14/2023 6:38 PM
Details	Assistance Received To Date	Insert	New Registration			7/14/2023 6:38 PM
Details	Last Recertification Date	Insert	New Registration			7/14/2023 6:38 PM
Details	Grant Number	Insert	New Registration		H80CS00876	7/14/2023 6:38 PM
Details	340B ID	Insert	New Registration			7/14/2023 6:38 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/14/2023 6:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/14/2023 6:38 PM
Details	Medicare Provider Number	Insert	New Registration			7/14/2023 6:38 PM
Details	Entity Name	Insert	New Registration		MENDOCINO COAST CLINICS, INC.	7/14/2023 6:38 PM
Details	NOFO Number	Insert	New Registration			7/14/2023 6:38 PM
Details	Program Code	Insert	New Registration		CH	7/14/2023 6:38 PM
Details	Entity Subname	Insert	New Registration		Mendocino Coast Clinics Medication-Assisted Treatment & Support Clinic	7/14/2023 6:38 PM
Dates	Participating Approval Date	Insert	New Registration			7/14/2023 6:38 PM
Details	State	Insert	New Registration		Pending	7/14/2023 6:38 PM
Dates	Registration Date	Insert	New Registration		7/14/2023 6:38:16 PM	7/14/2023 6:38 PM
Dates	Signed By Date	Insert	New Registration			7/14/2023 6:38 PM
Dates	Start Date	Insert	New Registration			7/14/2023 6:38 PM
Terminations	Termination Comments	Insert	New Registration			7/14/2023 6:38 PM
Terminations	Termination Date	Insert	New Registration			7/14/2023 6:38 PM
Terminations	Termination Effective Date	Insert	New Registration			7/14/2023 6:38 PM
Terminations	Termination Reason	Insert	New Registration			7/14/2023 6:38 PM

340B Drug Pricing Program Database