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INNOVA PHARMACY III
FQHCLA247 HEALTH AND LIFE ORGANIZATION INC.
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Covered Entity Details
Entity Name
HEALTH AND LIFE ORGANIZATION INC.
Subdivision Name
SACRAMENTO COMMUNITY CLINIC - SOUTHGATE
Type
Health Center Program Look-Alike
340B ID
FQHCLA247
Entity Address
7275 E. SOUTHGATE DRIVE
SUITE 204
SACRAMENTO, CA 95823
Grant Number
LALCS00018
Participating Start Date
4/1/2009
Last Recertification Date
1/31/2023
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
INNOVA PHARMACY III
Pharmacy Address
2400 GLENDALE LN STE A
SACRAMENTO, CA 95825-2431
Pharmacy Comments
Contract Details
Approval Date
7/13/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236
Contract Pharmacy Representative
Family Discount Pharmacy
Tim Le, Owner
(916) 481-6900
Signed By Date
7/13/2021
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