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GILL PHARMACY WATERFORD
CH091963G LIVINGSTON COMMUNITY HEALTH
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Covered Entity Details
Entity Name
LIVINGSTON COMMUNITY HEALTH
Subdivision Name
Livingston Community Health Campus, B Street, Buildings A, B, C
Type
HRSA-Funded Health Center
340B ID
CH091963G
Entity Address
600 B Street BLDG A, B, C
Livingston, CA 95334-9593
Grant Number
H80CS02588
Participating Start Date
7/1/2019
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
GILL PHARMACY WATERFORD
Pharmacy Address
GILL PHARMACY INC
12648 BENTLEY ST
WATERFORD, CA 95386
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leslie Abasta-Cummings, CEO
(209) 850-3545
Contract Pharmacy Representative
Gill Pharmacy
Sandeep Gill, Owner
(209) 874-8185
Signed By Date
1/16/2024
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