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VISALIA PHARMACY
FQHCLA048 County of Tulare
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Covered Entity Details
Entity Name
County of Tulare
Subdivision Name
Tulare County Health Services
Type
Health Center Program Look-Alike
340B ID
FQHCLA048
Entity Address
5957 S. Mooney Blvd
Visalia, CA 93277
Grant Number
LALCS00070
Participating Start Date
7/1/1996
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
VISALIA PHARMACY
Pharmacy Address
VISALIA PHARMACY
444 NW 3RD AVE
VISALIA, CA 93291
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
12/13/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen M Elliott, Director of Public Health
(559) 624-8481
Contract Pharmacy Representative
Visalia Pharmacy
Suzette Mansour, Manager
(559) 667-9292
Signed By Date
10/13/2022
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