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AVITA PHARMACY 1024
CH090390 CLINICA SIERRA VISTA
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Covered Entity Details
Entity Name
CLINICA SIERRA VISTA
Subdivision Name
CORPORATE HQ - CLINICA SIERRA VISTA
Type
HRSA-Funded Health Center
340B ID
CH090390
Entity Address
1430 Truxtun Ave STE 400
Bakersfield, CA 93301
Grant Number
H80CS00540
Participating Start Date
1/1/2004
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1024
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
330 E LAMBERT RD STE 120
BREA, CA 92821-4100
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Harris, CEO
(661) 635-3050 Ext: 2152
Contract Pharmacy Representative
PharMedQuest
Jerry Chang, Pharmacist
(714) 364-4008 Ext: 104
Signed By Date
1/14/2020
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