Contract Pharmacy Details

FRESNO PHARMACY
FQHCLA311 Greater Fresno Health Organization

Covered Entity Details

Entity Name

Greater Fresno Health Organization

Subdivision Name

Kings Winery Medical Clinic

Type

Health Center Program Look-Alike

340B ID

FQHCLA311

Entity Address

4929 E Cesar Chavez Blvd
Fresno, CA 93727-3812

Grant Number

LALCS00041

Participating Start Date

10/1/2018

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

FRESNO PHARMACY

Pharmacy Address

4917 E KINGS CANYON ROAD
NO 102
FRESNO, CA 93727

Pharmacy Comments

Contract Details

Approval Date

4/15/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

Bobby Bliatout, CEO
(559) 255-6476

Contract Pharmacy Representative

Fresno Pharmacy
QUI LY, Owner
(559) 255-8085

Signed By Date

4/15/2019