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MISSION PLAZA PHARMACY
RWI92653 Shanti Orange County
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Covered Entity Details
Entity Name
Shanti Orange County
Subdivision Name
Type
Ryan White Part A
340B ID
RWI92653
Entity Address
23461 South Pointe Drive
Suite 100
Laguna Hills, CA 92653
Grant Number
H89HA00019
Participating Start Date
4/1/2017
Last Recertification Date
2/22/2025
Pharmacy Details
Pharmacy Name
MISSION PLAZA PHARMACY
Pharmacy Address
26800 CROWN VALLEY PKWY STE 185
MISSION VIEJO, CA 92691-7304
Pharmacy Comments
Contract Details
Approval Date
4/2/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lindsay Ann Fitzpatrick, Executive Director
(949) 452-0888 Ext: 9494520888
Contract Pharmacy Representative
AHCS-Mental Health
Kinjal Patel, Director of Pharmacy
(626) 794-1124
Signed By Date
4/2/2021
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