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OLIVEHURST DRUG STORE, INC
CH090850 AMPLA HEALTH
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Covered Entity Details
Entity Name
AMPLA HEALTH
Subdivision Name
Ampla Health Lindhurst Medical, Dental, & Xpress Care
Type
HRSA-Funded Health Center
340B ID
CH090850
Entity Address
4941 Olivehurst Ave
Olivehurst, CA 95961-4225
Grant Number
H80CS00765
Participating Start Date
1/1/1998
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
OLIVEHURST DRUG STORE, INC
Pharmacy Address
4897 OLIVEHURST AVE
OLIVEHURST, CA 95961-4225
Pharmacy Comments
Contract Details
Approval Date
4/16/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/21/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Benjamin H. Flores, President & CEO
(530) 674-4261 Ext: 1155
Contract Pharmacy Representative
Hector Camacho, PIC
(530) 743-5451
Signed By Date
4/16/2015
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