Contract Pharmacy Details

AVITA PHARMACY 1025
CH0921430 LOS ANGELES CHRISTIAN HEALTH CENTERS

Covered Entity Details

Entity Name

LOS ANGELES CHRISTIAN HEALTH CENTERS

Subdivision Name

JOSHUA HOUSE CLINIC

Type

HRSA-Funded Health Center

340B ID

CH0921430

Entity Address

311 Winston Street
Los Angeles, CA 90013

Grant Number

H80CS06674

Participating Start Date

1/1/2005

Last Recertification Date

2/10/2025

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

10/9/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Bettina Lewis, Chief Operations Officer
(213) 893-1960

Contract Pharmacy Representative

PharMedQuest
Meera Hasolkar, Director of Pharmacy Operations
(714) 364-4008

Signed By Date

10/9/2020

340B Drug Pricing Program Database