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EL TEJON PHARMACY 3
CH09039B CLINICA SIERRA VISTA
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Covered Entity Details
Entity Name
CLINICA SIERRA VISTA
Subdivision Name
CLINICA SIERRA VISTA - Frazier Mountain Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH09039B
Entity Address
704 LEBEC ROAD
LEBEC, CA 93243
Grant Number
H80CS00540
Participating Start Date
1/1/2004
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
EL TEJON PHARMACY 3
Pharmacy Address
3544 MOUNT PINOS WAY
FRAZIER PARK, CA 93225
Pharmacy Comments
Contract Details
Approval Date
1/7/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dixit Bhakta, Director of Pharmacy
(661) 779-3118
Contract Pharmacy Representative
El Tejon Pharmacy Healthcare Inc
Rajesh Khosla, CEO
(661) 303-7948
Signed By Date
1/7/2025
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