Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
RWI92614A AIDS Services Foundation Orange County dba Radiant Health Centers

Covered Entity Details

Entity Name

AIDS Services Foundation Orange County dba Radiant Health Centers

Subdivision Name

Type

Ryan White Part A

340B ID

RWI92614A

Entity Address

2010 E. 1st Street
Suite 270
Santa Ana, CA 92705

Grant Number

H89HA00019

Participating Start Date

7/1/2019

Last Recertification Date

1/29/2020

Entity Termination Date

7/1/2020

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09486
5385 ALTON PARKWAY
IRVINE, CA 92604

Pharmacy Comments

Contract Details

Approval Date

6/3/2019

Contract Begin Date

7/1/2019

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

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/12/2019

340B Drug Pricing Program Database