Primary Care Clinic - Consolidated  
Change of Location Application Packet

A State license is required to operate as a Primary Care Clinic (PCC) - Consolidated in California. A PCC – Consolidated means allowing eligible PCCs or affiliate clinics to add additional physical plants, maintained and operated on separate premises, to an existing PCC or affiliate clinic site. The PCC or affiliate clinic license shall be amended to include the additional physical plant as part of a single consolidated license. A PCC or affiliate clinic may add additional locations that are no more than one-half mile from the licensed clinic adding the additional physical plant under the consolidated license. Refer to Health and Safety Code (HSC) sections 1200 through 1245 for information regarding licensure requirements.

To report a Change of Location, you must complete the required application packet. Refer to Title 22 of the California Code of Regulations (CCR) section 75021 for information regarding Change of Location.

How to Apply

An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The application packet contains the required forms in one location. The provider checklist identifies the required forms and supporting documents needed to apply for licensing and certification. The provider instructions are a resource to guide you through the process. The Sample Application Packet is a visual aid that displays a sample of the completed forms contained in the application packet.

Please refer to the following links to get started:

• Provider Instructions (PDF)
  
• Provider Checklist (PDF)
  
• Sample Application (PDF)
  

Where to Submit Applications

Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.

          California Department of Public Health
          Licensing and Certification Program
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377