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INNOVA PHARMACY IV
FQHCLA247D HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)
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Covered Entity Details
Entity Name
HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)
Subdivision Name
Sacramento Community Clinic - Explorer Drive
Type
Health Center Program Look-Alike
340B ID
FQHCLA247D
Entity Address
3030 Explorer Drive
Sacramento, CA 95827-2728
Grant Number
LALCS00018
Participating Start Date
7/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
INNOVA PHARMACY IV
Pharmacy Address
4815 WATT AVE STE B101
NORTH HIGHLANDS, CA 95660-5108
Pharmacy Comments
Contract Details
Approval Date
1/3/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236
Contract Pharmacy Representative
Family Discount Pharmacy
Tim Le, Owner
(916) 481-6900
Signed By Date
1/3/2024
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