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PREMIER PHARMACY SERVICES
CH092536AV JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Wesley Health Centers-- Vermont Annex
Type
HRSA-Funded Health Center
340B ID
CH092536AV
Entity Address
964 Vermont Ave.
Los Angeles, CA 90029-3529
Grant Number
H80CS06673
Participating Start Date
10/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PREMIER PHARMACY SERVICES
Pharmacy Address
410 CLOVERLEAF DR
BALDWIN PARK, CA 91706
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
Premier Pharmacy Services
Stephen Samuel, CEO
(714) 961-7930
Signed By Date
1/14/2022
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