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INNOVA PHARMACY III
CHC24113-00 Elica Health Centers
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Covered Entity Details
Entity Name
Elica Health Centers
Subdivision Name
Elica Health Centers
Type
HRSA-Funded Health Center
340B ID
CHC24113-00
Entity Address
155 15th St
West Sacramento, CA 95691
Grant Number
H80CS24113
Participating Start Date
1/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
INNOVA PHARMACY III
Pharmacy Address
2400 GLENDALE LN STE A
SACRAMENTO, CA 95825-2431
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
10/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
David E Hughes, COO/CFO
(916) 569-8484 Ext: 312
Contract Pharmacy Representative
Family Discount Pharmacy
Tim Le, Owner
(916) 481-6900
Signed By Date
1/15/2020
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