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INNOVA PHARMACY IV
FQHCLA247B HEALTH AND LIFE ORGANIZATION INC.
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Covered Entity Details
Entity Name
HEALTH AND LIFE ORGANIZATION INC.
Subdivision Name
Sacramento Community Clinic-Assembly Court
Type
Health Center Program Look-Alike
340B ID
FQHCLA247B
Entity Address
5524 Assembly Ct.
Sacramento, CA 95823
Grant Number
LALCS00018
Participating Start Date
7/1/2012
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
1/4/2024
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
1/4/2024
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