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PMD PHARMACY LLC
CH092536AP JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Wesley Health Centers- Palmdale East
Type
HRSA-Funded Health Center
340B ID
CH092536AP
Entity Address
37926 47th St E
Palmdale, CA 93552-3272
Grant Number
H80CS06673
Participating Start Date
5/2/2019
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PMD PHARMACY LLC
Pharmacy Address
PMD PHARMACY
44469 10TH STREET W
SUITE B
LANCASTER, CA 93534-9353
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/11/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
PMD Pharmacy #1
Minh Tran, Pharmacy POC
(571) 454-8174
Signed By Date
7/10/2019
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