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ABC PHARMACY
FQHCLA397 Health Service Alliance
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Covered Entity Details
Entity Name
Health Service Alliance
Subdivision Name
Chino Valley Community Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA397
Entity Address
13193 Central Ave STE 100
Chino, CA 91710
Grant Number
LALCS33333
Participating Start Date
10/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
ABC PHARMACY
Pharmacy Address
7974 HAVEN AVE STE 120
NDCBU #166
RANCHO CUCAMONGA, CA 91730
Pharmacy Comments
Contract Details
Approval Date
10/4/2021
Contract Begin Date
10/4/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeff Cox, Chief Executive Officer
(909) 784-6117
Contract Pharmacy Representative
ABC Pharmacy
Jonathan Chan, Pharmacy Director
(909) 285-1118
Signed By Date
10/4/2021
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