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AVITA PHARMACY 1008
CH095320 VALLEY COMMUNITY HEALTHCARE
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Covered Entity Details
Entity Name
VALLEY COMMUNITY HEALTHCARE
Subdivision Name
VALLEY COMMUNITY HEALTHCARE
Type
HRSA-Funded Health Center
340B ID
CH095320
Entity Address
6801 Coldwater Canyon Ave
North Hollywood, CA 91605-5162
Grant Number
H80CS04222
Participating Start Date
11/17/2005
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1008
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
6801 COLDWATER CANYON AVE
NORTH HOLLYWOOD, CA 91605-5162
Pharmacy Comments
Contract Details
Approval Date
10/22/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAULA WILSON, PRESIDENT/CEO
(818) 763-1718 Ext: 204
Contract Pharmacy Representative
PharMedQuest Pharmacy Services
Sam Badianat, Director of Program Management
(714) 364-1422 Ext: 104
Signed By Date
10/22/2015
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