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VIA LIDO DRUGS
STD92914 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
Sexually Transmitted Diseases
340B ID
STD92914
Entity Address
17982 Sky Park Circle
J
Irvine, CA 92614-6482
Grant Number
NU65PS004745
Participating Start Date
4/1/2019
Last Recertification Date
5/27/2021
Entity Termination Date
10/1/2021
Pharmacy Details
Pharmacy Name
VIA LIDO DRUGS
Pharmacy Address
3445 VIA LIDO
NEWPORT BEACH, CA 92663
Pharmacy Comments
Contract Details
Approval Date
2/13/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Business decision by covered entity and/or pharmacy
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
1/15/2019
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