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VIP PHARMACY INC
FQHCLA397E Health Service Alliance
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Covered Entity Details
Entity Name
Health Service Alliance
Subdivision Name
Palm Desert Community Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA397E
Entity Address
41990 Cook St STE F-2002
Palm Desert, CA 92211-6100
Grant Number
LALCS33333
Participating Start Date
10/1/2023
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
VIP PHARMACY INC
Pharmacy Address
DBA VIP PHARMACY
13193 CENTRAL AVE
STE 120
CHINO, CA 91710
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christen Grelling, Chief Operations Officer
(909) 464-9675 Ext: 104
Contract Pharmacy Representative
ABC Pharmacy
Edward Deng, VP
(909) 946-5512
Signed By Date
4/15/2025
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