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REGIONAL CARE PHARMACY , INC.
CHC26613-00 ANTELOPE VALLEY COMMUNITY CLINIC
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Covered Entity Details
Entity Name
ANTELOPE VALLEY COMMUNITY CLINIC
Subdivision Name
Antelope Valley Community Clinic - Health and Wellness Center
Type
HRSA-Funded Health Center
340B ID
CHC26613-00
Entity Address
45104 10th St W
Lancaster, CA 93534-2310
Grant Number
H80CS26613
Participating Start Date
4/1/2014
Last Recertification Date
2/1/2019
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
REGIONAL CARE PHARMACY , INC.
Pharmacy Address
326 E AVENUE I
LANCASTER, CA 93535
Pharmacy Comments
Contract Details
Approval Date
7/11/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
James A. Cook, CEO
(661) 942-2391
Contract Pharmacy Representative
Regional Care Pharmacy
Yemi Akao, Owner
(661) 945-4600
Signed By Date
7/11/2016
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