340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1005
CH091026E SOUTH BAY FAMILY HEALTH CARE CENTER INC
Print
Covered Entity Details
Entity Name
SOUTH BAY FAMILY HEALTH CARE CENTER INC
Subdivision Name
SOUTH BAY HEALTHCARE CTR - OBGYN
Type
HRSA-Funded Health Center
340B ID
CH091026E
Entity Address
323 N. PRAIRIE AVE
INGLEWOOD, CA 90301-4502
Grant Number
H80CS00877
Participating Start Date
10/1/2013
Last Recertification Date
2/4/2021
Entity Termination Date
1/1/2022
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1005
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
2114 ARTESIA BLVD RM 111
REDONDO BEACH, CA 90278-3014
Pharmacy Comments
Contract Details
Approval Date
8/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JANN HAMILTON LEE, CHIEF EXECUTIVE OFFICER
(310) 802-6177 Ext: 1105
Contract Pharmacy Representative
PharMedQuest
Meera Hasolkar, Director of Pharmacy Operations
(714) 364-4008
Signed By Date
8/20/2020
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