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GOOD LIFE PHARMACY INC
CHC28986-00 COMMUNITY MEDICAL WELLNESS CENTERS USA
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Covered Entity Details
Entity Name
COMMUNITY MEDICAL WELLNESS CENTERS USA
Subdivision Name
Community Medical Wellness Centers USA
Type
HRSA-Funded Health Center
340B ID
CHC28986-00
Entity Address
1360 E ANAHEIM ST, Suite 101
LONG BEACH, CA 90813-5514
Grant Number
H80CS28986
Participating Start Date
1/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GOOD LIFE PHARMACY INC
Pharmacy Address
DBA AVIVA PHARMACY
2633 ATLANTIC AVE
LONG BEACH, CA 90806
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sompia Paigne, CEO
(562) 270-0324
Contract Pharmacy Representative
Aviva Pharmacy
Amy Nguyen, Pharmacist
(562) 888-1277
Signed By Date
4/15/2020
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