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SANTA ELENA PHARMACY
CH092536Y JWCH INSTITUTE, INC.
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Covered Entity Details
Entity Name
JWCH INSTITUTE, INC.
Subdivision Name
NORWALK REGIONAL HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH092536Y
Entity Address
12360 FIRESTONE BLVD
NORWALK, CA 90650-4324
Grant Number
H80CS06673
Participating Start Date
1/1/2015
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
SANTA ELENA PHARMACY
Pharmacy Address
9910 LONG BEACH BLVD
STE F
LYNWOOD, CA 90262
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
12/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
Santa Elena Pharmacy
Juana Valdez, Owner
(323) 249-8497
Signed By Date
7/14/2020
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