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VIA LIDO DRUGS
RWII92614 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
Ryan White Part B
340B ID
RWII92614
Entity Address
17982 Sky Park Circle
Suite J
Irvine, CA 92614-6482
Grant Number
X07HA12778
Participating Start Date
7/1/2018
Last Recertification Date
1/29/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
VIA LIDO DRUGS
Pharmacy Address
3445 VIA LIDO
NEWPORT BEACH, CA 92663
Pharmacy Comments
Contract Details
Approval Date
1/9/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
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
1/9/2019
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