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AVITA PHARMACY 1025
CH09072X North County Health Project Incorporated
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Covered Entity Details
Entity Name
North County Health Project Incorporated
Subdivision Name
TrueCare - Casa de Amparo
Type
HRSA-Funded Health Center
340B ID
CH09072X
Entity Address
325 Buena Creek Rd BLDG A
San Marcos, CA 92069-9679
Grant Number
H80CS00228
Participating Start Date
10/1/2022
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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