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DELIVERCARERX PHARMACY LLC
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
DELIVERCARERX PHARMACY LLC
Pharmacy Address
DELIVERCARERX PHARMACY LLC
1471 E BUSINESS CENTER DR
STE 200
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
1/12/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cindy Anne Snelgrove, Chief Clinical Services Officer
(530) 751-3755
Contract Pharmacy Representative
Agape
Dave Krishna, CEO
(847) 965-1600
Signed By Date
1/12/2017
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