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E.V.A HEALTH LLC
FQHCLA442 KWANG HE WON HEALTH CENTER
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Covered Entity Details
Entity Name
KWANG HE WON HEALTH CENTER
Subdivision Name
Kwang He Won Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA442
Entity Address
815 S Ardmore Ave FL 1
Los Angeles, CA 90005-2597
Grant Number
LALCS47458
Participating Start Date
4/1/2023
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
E.V.A HEALTH LLC
Pharmacy Address
DBA: CITRUS VALLEY PHARMACY
457 S CITRUS AVE
COVINA, CA 91723
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BONGJA BENA WON, CEO
(213) 385-0448
Contract Pharmacy Representative
Citrus Valley Pharmacy
Chad Nour, CEO
(626) 261-4400
Signed By Date
4/11/2023
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