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PALMDALE MEDICAL PHARMACY
CH092536AN JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Wesley Health Centers- Palmdale Central
Type
HRSA-Funded Health Center
340B ID
CH092536AN
Entity Address
2151 E Palmdale Blvd
Palmdale, CA 93550-4037
Grant Number
H80CS06673
Participating Start Date
5/2/2019
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PALMDALE MEDICAL PHARMACY
Pharmacy Address
540 W PALMDALE BLVD #A
PALMDALE, CA 93551-4232
Pharmacy Comments
Contract Details
Approval Date
5/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
Palmdale Medical Pharmacy
Ivan Law, Pharmacy Manager
(661) 267-2638
Signed By Date
5/10/2019
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