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FARMACIA BRISTOL
CH093110 ALTAMED Health Services Corporation
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Covered Entity Details
Entity Name
ALTAMED Health Services Corporation
Subdivision Name
AltaMed Health Services Corporation Headquarters
Type
HRSA-Funded Health Center
340B ID
CH093110
Entity Address
2040 CAMFIELD AVENUE
Commerce, CA 90040
Grant Number
H80CS00142
Participating Start Date
4/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
FARMACIA BRISTOL
Pharmacy Address
1155 W. CENTRAL AVE SUITE#112
SANTA ANA, CA 92707
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jose Esparza, Sr. VP, Finance & CFO
(323) 889-7320
Contract Pharmacy Representative
Equiscript
Vivian Suarez, Sr. Client Sales & Relationship Manager
(628) 249-3483
Signed By Date
4/15/2020
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