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GARDEN GROVE COMMUNITY PHARMACY
FQHCLA382 LAGUNA BEACH COMMUNITY CLINIC INC
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Covered Entity Details
Entity Name
LAGUNA BEACH COMMUNITY CLINIC INC
Subdivision Name
Laguna Beach Community Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA382
Entity Address
362 Third Street
Laguna Beach, CA 92651
Grant Number
LALCS32582
Participating Start Date
4/1/2019
Last Recertification Date
2/10/2025
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
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jorge Rubal, C.E.O. / C.M.O.
(949) 494-0761 Ext: 132
Contract Pharmacy Representative
Advantage HealthCare Services
Vimal Bhanvadia, owner
(949) 364-0122
Signed By Date
10/14/2019
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