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GARDEN GROVE COMMUNITY PHARMACY
RWI92614 AIDS Services Foundation Orange County dba Radiant Health Centers
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Covered Entity Details
Entity Name
AIDS Services Foundation Orange County dba Radiant Health Centers
Subdivision Name
Type
Ryan White Part A
340B ID
RWI92614
Entity Address
17982 Sky Park Circle
Suite J
Irvine, CA 92614
Grant Number
H89HA00019
Participating Start Date
7/1/2018
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
GARDEN GROVE COMMUNITY PHARMACY
Pharmacy Address
12665 GARDEN GROVE BLVD STE 108
GARDEN GROVE, CA 92843-1915
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2022
Ownership change
Contacts
Covered Entity Signing Official
Guita Sharifi, CFO
(949) 809-5753
Contract Pharmacy Representative
Advantage Healthcare Services HIV and Compounding
Yatin Bera, CFO
(909) 800-2272
Signed By Date
10/11/2019
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