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IC PHARMACY LLC
CH09056W United Health Centers of The San Joaquin Valley
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Covered Entity Details
Entity Name
United Health Centers of The San Joaquin Valley
Subdivision Name
United Health Centers - Parlier Manning
Type
HRSA-Funded Health Center
340B ID
CH09056W
Entity Address
429 E Manning Ave
Parlier, CA 93648-2600
Grant Number
H80CS00137
Participating Start Date
7/6/2020
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
IC PHARMACY LLC
Pharmacy Address
AMAZON PHARMACY #004
34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYN, NY 11232
Pharmacy Comments
Contract Details
Approval Date
7/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Navjot Singh, Contracting & Managed Care Officer
(559) 646-6618 Ext: 0039
Contract Pharmacy Representative
PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725
Signed By Date
7/9/2024
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