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BELLA VIDA PHARMACY INC
RWI5 CITY OF LONG BEACH/DEPT HEALTH & HUMAN SERVICES
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Covered Entity Details
Entity Name
CITY OF LONG BEACH/DEPT HEALTH & HUMAN SERVICES
Subdivision Name
HIV Care Coordination
Type
Ryan White Part A
340B ID
RWI5
Entity Address
2525 GRAND AVENUE
LONG BEACH, CA 90815
Grant Number
H89HA00016
Participating Start Date
1/1/2012
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
BELLA VIDA PHARMACY INC
Pharmacy Address
DBA BELLA VIDA PHARMACY
1037 W CARSON ST
TORRANCE, CA 90502
Pharmacy Comments
Contract Details
Approval Date
10/9/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anissa Davis, Health Officer
(562) 570-4047
Contract Pharmacy Representative
Bella Vida Pharmacy, Inc.
Denise Pham, Owner, Pharmacist-in-charge
(310) 320-3333
Signed By Date
10/9/2018
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