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AVITA PHARMACY 1019
CH090470 GOLDEN VALLEY HEALTH CENTERS
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Covered Entity Details
Entity Name
GOLDEN VALLEY HEALTH CENTERS
Subdivision Name
GVHC - MERCED SUITES
Type
HRSA-Funded Health Center
340B ID
CH090470
Entity Address
847 W. CHILDS AVE
MERCED, CA 95341-6862
Grant Number
H80CS00742
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1019
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
857 W CHILDS AVE.
SUITE 101
MERCED, CA 95341-6862
Pharmacy Comments
Contract Details
Approval Date
9/27/2016
Contract Begin Date
9/27/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2023
Ownership change
Contacts
Covered Entity Signing Official
Tony Weber, CEO
(209) 385-5551
Contract Pharmacy Representative
PharMedQuest Pharmacy Services
Sam Badianat, Director of Program Management
(714) 364-1422 Ext: 104
Signed By Date
9/27/2016
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