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SIERRA VISTA PHARMACY, INC.
FQHCLA048A County of Tulare
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Covered Entity Details
Entity Name
County of Tulare
Subdivision Name
VISALIA HEALTH CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA048A
Entity Address
2611 N Dinuba Blvd
Visalia, CA 93291
Grant Number
LALCS00070
Participating Start Date
7/1/1996
Last Recertification Date
2/12/2025
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
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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