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CAPITOL DRUGS - SHERMAN OAKS
CH092536AV JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Wesley Health Centers-- Vermont Annex
Type
HRSA-Funded Health Center
340B ID
CH092536AV
Entity Address
964 Vermont Ave.
Los Angeles, CA 90029-3529
Grant Number
H80CS06673
Participating Start Date
10/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
CAPITOL DRUGS - SHERMAN OAKS
Pharmacy Address
4454 VAN NUYS BLVD
STE J
SHERMAN OAKS, CA 91403
Pharmacy Comments
Contract Details
Approval Date
1/15/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
VLS Capitol Drugs, Inc.
Raja Sannidhi, President
(310) 289-1125
Signed By Date
1/15/2024
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