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LOMA LINDA UNIVERSITY PHARMACY
CHC28992-03 Sac Health System
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Covered Entity Details
Entity Name
Sac Health System
Subdivision Name
SACHS-Frazee Clinic
Type
HRSA-Funded Health Center
340B ID
CHC28992-03
Entity Address
488 S K St
San Bernardino, CA 92410-2641
Grant Number
H80CS28992
Participating Start Date
7/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LOMA LINDA UNIVERSITY PHARMACY
Pharmacy Address
250 S G ST
SAN BERNARDINO, CA 92410
Pharmacy Comments
Contract Details
Approval Date
4/7/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
bonnie inquinn chi-lum, CMO
(951) 235-0642
Contract Pharmacy Representative
LLU
Danielle Davis-Khoromana, Pharmacy Supervisor
(909) 771-2990
Signed By Date
4/7/2020
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