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AVITA PHARMACY 1006
CH09162J EL PROYECTO DEL BARRIO, INC
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Covered Entity Details
Entity Name
EL PROYECTO DEL BARRIO, INC
Subdivision Name
EL PROYECTO DEL BARRIO--NORTHRIDGE COMMUNITY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH09162J
Entity Address
18250 Roscoe Blvd. Suite 200
Northridge, CA 91325
Grant Number
H80CS06647
Participating Start Date
4/1/2016
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1006
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
20800 SHERMAN WAY
WINNETKA, CA 91306-2707
Pharmacy Comments
Contract Details
Approval Date
7/17/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CORINNE SANCHEZ, PRESIDENT/CEO
(818) 810-3500
Contract Pharmacy Representative
PharMedQuest
Jerry Chang, Pharmacist
(714) 364-4008 Ext: 104
Signed By Date
7/17/2019
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