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AVITA PHARMACY 1040
CH090390 CLINICA SIERRA VISTA
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Covered Entity Details
Entity Name
CLINICA SIERRA VISTA
Subdivision Name
CORPORATE HQ - CLINICA SIERRA VISTA
Type
HRSA-Funded Health Center
340B ID
CH090390
Entity Address
1430 Truxtun Ave STE 400
Bakersfield, CA 93301
Grant Number
H80CS00540
Participating Start Date
1/1/2004
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
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
Stacy Lynn Ferreira, CEO
(661) 635-3050
Contract Pharmacy Representative
Clinica Sierra Vista
Maria Nancy Banuelos, Deputy CEO
(661) 635-3050
Signed By Date
10/15/2020
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