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AP9 PHARMACY
CH09311AY AltaMed Health Services Corporation
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Covered Entity Details
Entity Name
AltaMed Health Services Corporation
Subdivision Name
AltaMed Medical & Dental Group: South Gate
Type
HRSA-Funded Health Center
340B ID
CH09311AY
Entity Address
8627 Atlantic Avenue
South Gate, CA 90280-3501
Grant Number
H80CS00142
Participating Start Date
10/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
AP9 PHARMACY
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES
1900 E. SLAUSON AVE.
HUNTINGTON PARK, CA 90255-2725
Pharmacy Comments
Contract Details
Approval Date
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
PharMedQuest
Jerry Chang, Pharmacist
(714) 364-4008 Ext: 104
Signed By Date
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