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MISSION PLAZA PHARMACY
FP92705 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
Family Planning (Title X only)
340B ID
FP92705
Entity Address
2010 E. 1st Street
Suite 270
Santa Ana, CA 92705
Grant Number
FPHPA006324
Participating Start Date
7/1/2019
Last Recertification Date
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
MISSION PLAZA PHARMACY
Pharmacy Address
26800 CROWN VALLEY PKWY STE 185
MISSION VIEJO, CA 92691-7304
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Guita Sharifi, CFO
(949) 809-5753
Contract Pharmacy Representative
AHCS-Mental Health
Kinjal Patel, Director of Pharmacy
(626) 794-1124
Signed By Date
1/14/2020
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