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LAGUNA DRUGS
FP92614 AIDS Services Foundation Orange County dba Radiant Health Centers
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Covered Entity Details
Entity Name
AIDS Services Foundation Orange County dba Radiant Health Centers
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP92614
Entity Address
17982 Sky Park Circle
Suite J
Irvine, CA 92614-6482
Grant Number
FPHPA006537
Participating Start Date
1/1/2019
Last Recertification Date
5/15/2025
Pharmacy Details
Pharmacy Name
LAGUNA DRUGS
Pharmacy Address
239 BROADWAY ST
LAGUNA BEACH, CA 92651-1806
Pharmacy Comments
Contract Details
Approval Date
10/19/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Guita Sharifi, CFO
(949) 809-5753
Contract Pharmacy Representative
Laguna Drug
Dave Olsen, Owner
(949) 307-8335
Signed By Date
10/11/2018
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