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AVITA PHARMACY 1025
CH09072T NORTH COUNTY HEALTH PROJECT INCORPORATED
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Covered Entity Details
Entity Name
NORTH COUNTY HEALTH PROJECT INCORPORATED
Subdivision Name
TrueCare
Type
HRSA-Funded Health Center
340B ID
CH09072T
Entity Address
1675 N. Perris Blvd. Suite G1
Perris, CA 92571
Grant Number
H80CS00228
Participating Start Date
7/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1025
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
3020 SATURN ST STE 100
BREA, CA 92821
Pharmacy Comments
Contract Details
Approval Date
11/22/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marie Russell, Chief Medical Officer
(760) 736-8689
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
11/22/2022
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