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VERTEX PHARMACY
CHC28370-04 Tri-State Community Healthcare Center
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Covered Entity Details
Entity Name
Tri-State Community Healthcare Center
Subdivision Name
Tri-State Community Healthcare Center- Mobile Unit
Type
HRSA-Funded Health Center
340B ID
CHC28370-04
Entity Address
11888 Bartlett Ave
Adelanto, CA 92301-1709
Grant Number
H80CS28370
Participating Start Date
4/1/2020
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
VERTEX PHARMACY
Pharmacy Address
VERTEX CARE RX INC
11273 LAUREL CANYON BLVD STE 4
SAN FERNANDO, CA 91340
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aram Manoukian, CEO
(760) 326-0222 Ext: 8186584000
Contract Pharmacy Representative
Vertex Pharmacy
Anet Khachatourian, Administrator
(818) 638-9652
Signed By Date
10/12/2023
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