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ADVANCECARE SAN FRANCISCO INC
FQHCLA477 AIDS SERVICES FOUNDATION ORANGE COUNTY
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Covered Entity Details
Entity Name
AIDS SERVICES FOUNDATION ORANGE COUNTY
Subdivision Name
Radiant Health Centers
Type
Health Center Program Look-Alike
340B ID
FQHCLA477
Entity Address
17982 Sky Park Cir STE J
Irvine, CA 92614-6482
Grant Number
LALCS53696
Participating Start Date
1/1/2025
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
ADVANCECARE SAN FRANCISCO INC
Pharmacy Address
MISTR SF
2301 MARKET ST
SAN FRANCISCO, CA 94114
Pharmacy Comments
Contract Details
Approval Date
11/13/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Danielle Nagao, CFO
(714) 264-2709
Contract Pharmacy Representative
AdvanceCare Pharmacy
Kyle Bernier, Director of Operations
(508) 971-8380
Signed By Date
10/14/2024
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