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POLARIS SPECIALTY RX
RWI91711B Foothill AIDS Project
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Covered Entity Details
Entity Name
Foothill AIDS Project
Subdivision Name
Riverside
Type
Ryan White Part A
340B ID
RWI91711B
Entity Address
5750 Division Street Ste 102
Riverside, CA 92506
Grant Number
H89HA00032
Participating Start Date
4/1/2013
Last Recertification Date
3/7/2025
Pharmacy Details
Pharmacy Name
POLARIS SPECIALTY RX
Pharmacy Address
410 CLOVERLEAF DR
BALDWIN PARK, CA 91706
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
La Monica Stowers, Executive Director
(909) 482-2066 Ext: 302
Contract Pharmacy Representative
Polaris Specialty RX
Nef Villa, Specialty Sales Consultant
(909) 468-7084
Signed By Date
4/15/2024
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