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PHARMEDQUEST PHARMACY SERVICES
FQHCLA048A County of Tulare
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Covered Entity Details
Entity Name
County of Tulare
Subdivision Name
VISALIA HEALTH CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA048A
Entity Address
2611 N Dinuba Blvd
Visalia, CA 93291
Grant Number
LALCS00070
Participating Start Date
7/1/1996
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
PHARMEDQUEST PHARMACY SERVICES
Pharmacy Address
DBA AVITA PHARMACY 1072
26800 CROWN VALLEY PKWY STE 185
MISSION VIEJO, CA 92691
Pharmacy Comments
Contract Details
Approval Date
11/21/2022
Contract Begin Date
11/22/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen M Elliott, Director of Public Health
(559) 624-8481
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
11/21/2022
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