Contract Pharmacy Details

AVITA PHARMACY 1015
CH090390 CLINICA SIERRA VISTA

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 1015

Pharmacy Address

PHARMEDQUEST PHARMACY SERVICES DBA AVITA
2000 PHYSICIANS BLVD RM B
BAKERSFIELD, CA 93301-1277

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

Brian Harris, CEO
(661) 635-3050 Ext: 2152

Contract Pharmacy Representative

PharMedQuest
Jerry Chang, Pharmacist
(714) 364-4008 Ext: 104

Signed By Date

1/15/2020

340B Drug Pricing Program Database