Contract Pharmacy Details

RALPHS GROCERY CO
CH092536AD JWCH Institute, Inc.

Covered Entity Details

Entity Name

JWCH Institute, Inc.

Subdivision Name

Wesley Health Centers -- Michael Antonovich Dental Clinic

Type

HRSA-Funded Health Center

340B ID

CH092536AD

Entity Address

1845 N. Fair Oaks Ave. Suite 1101
Pasadena, CA 91103-1620

Grant Number

H80CS06673

Participating Start Date

7/1/2018

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

RALPHS GROCERY CO

Pharmacy Address

DBA RALPHS STORE #21
1745 GARFIELD AVENUE
SOUTH PASADENA, CA 91030

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

9/10/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Ralphs
Hong Nguyen, Pharmacist
(626) 799-2926

Signed By Date

7/14/2020

340B Drug Pricing Program Database