Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
CH092536AE JWCH Institute, Inc.

Covered Entity Details

Entity Name

JWCH Institute, Inc.

Subdivision Name

JWCH Institute, Inc., Mini House Residential Treatment

Type

HRSA-Funded Health Center

340B ID

CH092536AE

Entity Address

303 E 52nd St
Los Angeles, CA 90011-4513

Grant Number

H80CS06673

Participating Start Date

7/1/2018

Last Recertification Date

2/23/2025

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09732
861 NORTH VINE STREET
HOLLYWOOD, CA 90038

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2020

340B Drug Pricing Program Database