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VIP PHARMACY INC
FQHCLA397A Health Service Alliance
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Covered Entity Details
Entity Name
Health Service Alliance
Subdivision Name
Montclair Community Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA397A
Entity Address
5050 San Bernardino St
Montclair, CA 91763-2326
Grant Number
LALCS33333
Participating Start Date
10/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
VIP PHARMACY INC
Pharmacy Address
DBA VIP PHARMACY
13193 CENTRAL AVE
STE 120
CHINO, CA 91710
Pharmacy Comments
Contract Details
Approval Date
9/17/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry Chase, Chief Executive Officer
(909) 465-7193
Contract Pharmacy Representative
VIP Pharmacy
Michele Louie, Pharmacy Tech
(909) 573-0123
Signed By Date
9/17/2019
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