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DEV PHARMA INC
CHC26624-03 POMONA COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
POMONA COMMUNITY HEALTH CENTER
Subdivision Name
Ontario
Type
HRSA-Funded Health Center
340B ID
CHC26624-03
Entity Address
1556 S. Sultana Avenue
Ontario, CA 91761
Grant Number
H80CS26624
Participating Start Date
10/1/2016
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
DEV PHARMA INC
Pharmacy Address
DBA EZRX PHARMACY
731 INDIAN HILL BLVD
POMONA, CA 91767
Pharmacy Comments
Contract Details
Approval Date
10/25/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Juliet Dominguez, HR & Compliance Manager
(909) 469-9013 Ext: 6037
Contract Pharmacy Representative
Gopal Sojitra, Pharmacist
(909) 764-3060
Signed By Date
10/25/2016
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