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CRYSTAL MEDICAL CENTER
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
CRYSTAL MEDICAL CENTER
Pharmacy Address
PHARMACY, INC.
2809 OLIVE HIGHWAY
SUITE 160
OROVILLE, CA 95966
Pharmacy Comments
Contract Details
Approval Date
7/2/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2019
Ownership change
Contacts
Covered Entity Signing Official
Benjamin H. Flores, President & CEO
(530) 674-4261 Ext: 1155
Contract Pharmacy Representative
Saeed Saleh, Owner
(530) 533-1545
Signed By Date
7/2/2015
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