Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
CH092536AB JWCH INSTITUTE, INC.

Covered Entity Details

Entity Name

JWCH INSTITUTE, INC.

Subdivision Name

Wesley Health Centers -- Andrew Escajeda Clinic

Type

HRSA-Funded Health Center

340B ID

CH092536AB

Entity Address

1845 N. Fair Oaks Ave., Suite G151
Pasadena, CA 91103

Grant Number

H80CS06673

Participating Start Date

7/1/2016

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09694
900 N. LAKE AVE.
PASADENA, CA 91104

Pharmacy Comments

Contract Details

Approval Date

7/14/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/16/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/14/2020

340B Drug Pricing Program Database