Contract Pharmacy Details

FOX DRUG STORE INC.
CH090390 CLINICA SIERRA VISTA

Covered Entity Details

Entity Name

CLINICA SIERRA VISTA

Subdivision Name

CORPORATE HQ - CLINICA SIERRA VISTA

Type

HRSA-Funded Health Center

340B ID

CH090390

Entity Address

1430 Truxtun Ave STE 400
Bakersfield, CA 93301

Grant Number

H80CS00540

Participating Start Date

1/1/2004

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

FOX DRUG STORE INC.

Pharmacy Address

3020 SAN ANTONIO DR.
FOWLER, CA 93625

Pharmacy Comments

Contract Details

Approval Date

10/16/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/2/2019
Agreement registered in error

Contacts

Covered Entity Signing Official

Brian Harris, CEO
(661) 635-3050 Ext: 2152

Contract Pharmacy Representative

Sunnyside Pharmacy
Lunny Jung, CEO
(213) 590-2375

Signed By Date

10/16/2018