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SIERRA VISTA PHARMACY, INC.
FP93223 County of Tulare
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Covered Entity Details
Entity Name
County of Tulare
Subdivision Name
Farmersville Health Center
Type
Family Planning (Title X only)
340B ID
FP93223
Entity Address
660 E, Visalia Road
Farmersville, CA 93223
Grant Number
FPHPA006470
Participating Start Date
1/1/2019
Last Recertification Date
5/18/2020
Entity Termination Date
7/1/2021
Pharmacy Details
Pharmacy Name
SIERRA VISTA PHARMACY, INC.
Pharmacy Address
650 E VISALIA RD
FARMERSVILLE, CA 93223
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Karen M Elliott, Director of Public Health
(559) 624-8481
Contract Pharmacy Representative
Sierra Vista Pharmacy
Fady Gaballa, Pharmacist
(559) 594-5656
Signed By Date
1/15/2020
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