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CHERRY PHARMACY CUTLER INC
RWII93291 Source LGBT Center, INC
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Covered Entity Details
Entity Name
Source LGBT Center, INC
Subdivision Name
The Source LGBT+ Center
Type
Ryan White Part B
340B ID
RWII93291
Entity Address
109 NW 2nd Avenue
Visalia, CA 93291
Grant Number
X07HA12778
Participating Start Date
4/1/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CHERRY PHARMACY CUTLER INC
Pharmacy Address
40657 ROAD 128
CUTLER, CA 93615
Pharmacy Comments
Contract Details
Approval Date
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/14/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Poth, Executive Director
(559) 429-4277 Ext: 8
Contract Pharmacy Representative
Cherry Streey Pharmacies
Wenbo Liu, CEO
(559) 234-2112
Signed By Date
7/8/2021
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