340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1025
CH092536AD JWCH Institute, Inc.
Print
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
AVITA PHARMACY 1025
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
3020 SATURN ST STE 100
BREA, CA 92821
Pharmacy Comments
Contract Details
Approval Date
8/6/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
PharMedQuest
Meera Hasolkar, Director of Pharmacy Operations
(714) 364-4008
Signed By Date
8/6/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session