340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1003
CH092536X JWCH INSTITUTE, INC.
Print
Covered Entity Details
Entity Name
JWCH INSTITUTE, INC.
Subdivision Name
JWCH Medical Clinic - Lynwood
Type
HRSA-Funded Health Center
340B ID
CH092536X
Entity Address
3591 E Imperial Hwy
Lynwood, CA 90262-2684
Grant Number
H80CS06673
Participating Start Date
1/1/2015
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1003
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
3590 E IMPERIAL HWY RM 101
LYNWOOD, CA 90262-2655
Pharmacy Comments
Contract Details
Approval Date
1/21/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
PharMedQuest
Jerry Chang, Pharmacist
(714) 364-4008 Ext: 104
Signed By Date
1/21/2021
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