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ILAB PHARMACY
CHC22686-00 BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Subdivision Name
Bartz-Altadonna Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC22686-00
Entity Address
43322 Gingham Ave.
43322
Gingham Ave
Lancaster, CA 93535
Grant Number
H80CS22686
Participating Start Date
7/1/2012
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
ILAB PHARMACY
Pharmacy Address
ILAB PHARMACY
44503 16TH ST W SUITE 101
LANCASTER, CA 93534-2886
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Emma Gutierrez, CEO
(661) 874-4355
Contract Pharmacy Representative
Jason Tambunting, Pharmacy Mgr.
(661) 945-8066
Signed By Date
10/13/2016
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