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WHITE CROSS PHARMACY
CH090250 CLINICAS DE SALUD DEL PUEBLO,Inc.
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Covered Entity Details
Entity Name
CLINICAS DE SALUD DEL PUEBLO,Inc.
Subdivision Name
Innercare K Street
Type
HRSA-Funded Health Center
340B ID
CH090250
Entity Address
1166 K St
Brawley, CA 92227-2737
Grant Number
H80CS00733
Participating Start Date
12/1/1992
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WHITE CROSS PHARMACY
Pharmacy Address
LS RX LLC
602 MAIN ST
BRAWLEY, CA 92227
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
10/13/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
YVONNE BELL, CEO
(760) 344-9951 Ext: 10102
Contract Pharmacy Representative
LS RX LLC
Sheshu Babu Valmiki, Owner
(760) 344-3131
Signed By Date
10/13/2023
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