Contract Pharmacy Details

MED-AID PHARMACY
CHC12872-01 WellSpace Health

Covered Entity Details

Entity Name

WellSpace Health

Subdivision Name

South Valley Community Health Center

Type

HRSA-Funded Health Center

340B ID

CHC12872-01

Entity Address

8233 East Stockton Blvd
Suite D
Sacramento, CA 95828-8203

Grant Number

H80CS12872

Participating Start Date

7/1/2018

Last Recertification Date

3/7/2025

Pharmacy Details

Pharmacy Name

MED-AID PHARMACY

Pharmacy Address

3100 STOCKTON BLVD.
SACRAMENTO, CA 95820-1417

Pharmacy Comments

Contract Details

Approval Date

3/19/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jonathan A. Porteus, CEO
(916) 313-8413

Contract Pharmacy Representative

Jas Banga, Owner
(916) 736-2028

Signed By Date

1/15/2013