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AVITA PHARMACY 1009
CH09882U Children's Clinic 'serving Children And Their Families' The
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Covered Entity Details
Entity Name
Children's Clinic 'serving Children And Their Families' The
Subdivision Name
TCC Family Health
Type
HRSA-Funded Health Center
340B ID
CH09882U
Entity Address
1900 Atlantic Ave
Long Beach, CA 90806-5502
Grant Number
H80CS00264
Participating Start Date
10/1/2019
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1009
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
17660 LAKEWOOD BLVD
BELLFLOWER, CA 90706-6410
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elisa Nicholas, Chief Executive Officer
(562) 264-3551 Ext: 5622643985
Contract Pharmacy Representative
PharMedQuest
Duane Saikami, COO
(714) 364-4008
Signed By Date
7/9/2019
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