Contract Pharmacy Details

AVITA PHARMACY 1002
CH092536H JWCH INSTITUTE, INC.

Covered Entity Details

Entity Name

JWCH INSTITUTE, INC.

Subdivision Name

JWCH Institute, Inc. Medical Clinic / Weingart Center

Type

HRSA-Funded Health Center

340B ID

CH092536H

Entity Address

522 S. San Pedro St.
Los Angeles, CA 90013-2102

Grant Number

H80CS06673

Participating Start Date

1/1/2011

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1002

Pharmacy Address

PHARMEDQUEST PHARMACY SERVICES DBA AVITA
954 N VERMONT AVE # 132
LOS ANGELES, CA 90029-3529

Pharmacy Comments

Contract Details

Approval Date

10/4/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009

Contract Pharmacy Representative

PharMedQuest
Jerry Chang, Pharmacist
(714) 364-4008 Ext: 104

Signed By Date

10/4/2019

340B Drug Pricing Program Database