Covered Entity Details

CHC08241-30 Mission City Community Network, Inc. (Active) - information as of 4/25/2025 6:31:35 PM

Main Details

Name

Mission City Community Network, Inc.

Subdivision Name

Mission City Community Network- Barstow II

Type

HRSA-Funded Health Center

Site ID

BPS-H80-034356

340B ID

CHC08241-30

Grant Number

H80CS08241

Additional Details

Current Program Status

Active

Registration Date

4/11/2023

Participating Start Date

7/1/2023

Participating Approval Date

4/12/2023

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Mission City Community Network
Nik Gupta, CEO
(818) 895-3100

Primary Contact

Mission City Community Network
Maureen Ndu, Director of Programs
(818) 895-3100 Ext: 627

Addresses

Street Address

401 E Buena Vista St
Barstow, CA 92311-2815

Billing Address

Mission City Community Network
8527 Sepulveda Blvd
North Hills, CA 91343

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC08241-00	Active	BPS-H80-001755	MISSION CITY COMMUNITY NETWORK		15206 PARTHENIA STREET	NORTH HILLS	CA
CHC08241-01	Terminated	BPS-H80-011794	MISSION CITY COMMUNITY NETWORK INC	MCCN- Inglewood	501 E Hardy St STE 110	Inglewood	CA
CHC08241-02	Active	BPS-H80-010990	MISSION CITY COMMUNITY NETWORK INC	Mission City Community Network - 15210 Parthenia	15210 Parthenia St	North Hills	CA
CHC08241-03	Terminated	BPS-H80-011128	MISSION CITY COMMUNITY NETWORK INC	Mission City Community Network - Pomona - Mobile Clinic	845 E Arrow Hwy	Pomona	CA
CHC08241-05	Active	BPS-H80-016820	MISSION CITY COMMUNITY NETWORK INC	Mission City Community Network- Mobile Clinic - SFV	8527 Sepulveda Blvd	North Hills	CA
CHC08241-06	Active	BPS-H80-017227	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network- Panorama City	8771 Van Nuys Blvd.	Panorama CIty	CA
CHC08241-07	Active	BPS-H80-002136	MISSION CITY COMMUNITY NETWORK, INC.	MISSION HILLS SITE	10200 Sepulveda Blvd STE 300	Mission Hills	CA
CHC08241-08	Active	BPS-H80-015060	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network- La Puente	1025 Willow Avenue	La Puente	CA
CHC08241-09	Active	BPS-H80-014436	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - Mobile-San Gabriel Valley	1818 N ORANGE GROVE AVE	POMONA	CA
CHC08241-10	Active	BPS-H80-015014	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network-Orange Grove	1818 N Orange Grove Ave Ste., # 205	Pomona	CA
CHC08241-11	Active	BPS-H80-016820	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - SFV- Mobile II	8527 Sepulveda Blvd	North Hills	CA
CHC08241-12	Active	BPS-H80-013073	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - Victorville	15201 11st Street Ste., # 300	Victorville	CA
CHC08241-13	Active	BPS-H80-017667	MISSION CITY COMMUNITY NETWORK, INC.	Mission CIty Community Network- Fairfax	359 N. Fairfax Avenue-2nd Floor	Los Angeles	CA
CHC08241-14	Active	BPS-H80-017376	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network- Sepulveda	8527 Sepulveda Blvd	North Hills	CA
CHC08241-15	Terminated	BPS-H80-017764	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - Anaheim	1661 W. Broadway Blvd.	Anaheim	CA
CHC08241-16	Terminated	BPS-H80-018249	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - Culver City	9808 Venice Blvd	Culver City	CA
CHC08241-17	Terminated	BPS-H80-018723	MISSION CITY COMMUNITY NETWORK, INC.	MIssion City Community Network - Northridge	8363 Reseda Blvd.	Northridge	CA
CHC08241-18	Active	BPS-H80-018722	MISSION CITY COMMUNITY NETWORK, INC.	Mission CIty Community Network - Prairie	301 N Prairie Ave STE 311	Inglewood	CA
CHC08241-19	Terminated	BPS-H80-018721	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - Hollywood	4842 Hollywood Blvd	Los Angeles	CA
CHC08241-20	Active	BPS-H80-018720	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - Monrovia	513 E. Lime Street STE 103	Monrovia	CA
CHC08241-21	Active	BPS-H80-018139	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - Victorville2	14357 7th Street	Victorville	CA
CHC08241-22	Active	BPS-H80-019015	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network-Barstow	405 E. Buena Vista Street	Barstow	CA
CHC08241-23	Terminated	BPS-H80-020906	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network - Maywood	5800 King Avenue	Maywood	CA
CHC08241-24	Terminated	BPS-H80-019198	MISSION CITY COMMUNITY NETWORK, INC.	Mission City Community Network- Olympic	2655 West Olympic Blvd.	Los Angeles	CA
CHC08241-25	Terminated	BPS-H80-021576	Mission City Community Network, Inc.	Mission City Community Network - Glendale	222 Eulalia Street Ste. 301	Glendale	CA
CHC08241-26	Terminated	BPS-H80-024524	Mission City Community Network, Inc.	Mission City Community Network- Hollywood-Santa Monica	5300 Santa Monica Blvd Suite 202	Los Angeles	CA
CHC08241-27	Active	BPS-H80-032696	Mission City Community Network, Inc.	Mission City Community Network - Corona	613 S Howard St	Corona	CA
CHC08241-28	Active	BPS-H80-034036	Mission City Community Network, Inc.	Mission City Community Network - Wilshire	3660 Wilshire Blvd Ste 102	Los Angeles	CA
CHC08241-29	Active	BPS-H80-036419	Mission City Community Network, Inc.	Mission City Community Network - Central	1204 S. Central Avenue	Glendale	CA
CHC08241-30	Active	BPS-H80-034356	Mission City Community Network, Inc.	Mission City Community Network- Barstow II	401 E Buena Vista St	Barstow	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC08241-00	986 PHARMACY #8007	MID-WILSHIRE HEALTH INC	1809 VERDUGO BLVD STE 110	GLENDALE	CA	91208	01/01/2020	06/02/2020
CHC08241-00	CAREMAX PHARMACY	4216 BEVERLY BLVD		LOS ANGELES	CA	90004-4430	07/01/2017
CHC08241-00	CAREMAX PHARMACY #2	4301 S FIGUEROA ST STE E		LOS ANGELES	CA	90037-2671	07/01/2017
CHC08241-00	CAREMAX PHARMACY #3	814 S. ALVARADO ST		LOS ANGELES	CA	90057	07/01/2017
CHC08241-00	COMMUNITY PHARMACY GROUP, INC.	DBA GLESENER PHARMACY	321 N. CITRUS AVE.	COVINA	CA	91723	07/01/2016	02/15/2021
CHC08241-00	COSMED PHARMACY INC.	986 PHARMACY #8006	6521 VAN NUYS BLVD.	VAN NUYS	CA	91401-1425	01/01/2020	06/02/2020
CHC08241-00	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016	01/11/2018
CHC08241-01	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016	01/11/2018
CHC08241-02	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016	01/11/2018
CHC08241-03	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016	01/11/2018
CHC08241-05	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	04/01/2016	01/11/2018
CHC08241-08	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	07/01/2016
CHC08241-06	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	07/01/2016
CHC08241-26	COUNTY OF LOS ANGELES - AUDITOR CONTROLL	313 N FIGUEROA ST STE 1225	HEALTH SERVICES CENTRAL PHARMACY	LOS ANGELES	CA	90012-2602	07/01/2019	04/01/2024
CHC08241-01	CRENSHAW PHARMACY		5010 CRENSHAW RD STE 160	PASADENA	TX	77505	04/01/2017	02/15/2021
CHC08241-01	CRENSHAW PHARMACY INC	DBA CRENSHAW PHARMACY	3631 CRENSHAW BLVD #111	LOS ANGELES	CA	90016	04/01/2017	02/15/2021
CHC08241-19	CRENSHAW PHARMACY INC	DBA CRENSHAW PHARMACY	3631 CRENSHAW BLVD #111	LOS ANGELES	CA	90016	04/01/2017	12/23/2017
CHC08241-18	CRENSHAW PHARMACY INC	DBA CRENSHAW PHARMACY	3631 CRENSHAW BLVD #111	LOS ANGELES	CA	90016	04/01/2017	02/15/2021
CHC08241-24	CRENSHAW PHARMACY INC	DBA CRENSHAW PHARMACY	3631 CRENSHAW BLVD #111	LOS ANGELES	CA	90016	04/01/2018	02/15/2021
CHC08241-00	DPD RX INC	DBA APPLE PHARMACY	12440 BROOKHURST ST	GARDEN GROVE	CA	92840	10/01/2023
CHC08241-00	EXPRESS PHARMACY	EXPRESS PHARMACY	752 E ARROW HWY	POMONA	CA	91767	04/01/2013
CHC08241-08	EXPRESS PHARMACY	EXPRESS PHARMACY	752 E ARROW HWY	POMONA	CA	91767	07/01/2016
CHC08241-10	EXPRESS PHARMACY	EXPRESS PHARMACY	752 E ARROW HWY	POMONA	CA	91767	07/01/2016	01/11/2022
CHC08241-09	EXPRESS PHARMACY	EXPRESS PHARMACY	752 E ARROW HWY	POMONA	CA	91767	07/01/2016
CHC08241-20	EXPRESS PHARMACY	EXPRESS PHARMACY	752 E ARROW HWY	POMONA	CA	91767	04/01/2017	02/15/2022
CHC08241-00	FISHBOR INC	PLAZA WEST PHARMACY	8704 SEPULVEDA BLVD.	NORTH HILLS	CA	91343	07/01/2022
CHC08241-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 04792	15232 SHERMAN WAY	VAN NUYS	CA	91405	07/01/2020
CHC08241-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 05022	7400 RESEDA BLVD.	RESEDA	CA	91335	07/01/2020
CHC08241-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08837	222 N. MARKET ST.	INGLEWOOD	CA	90301	07/01/2020
CHC08241-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09642	8530 RESEDA BLVD.	NORTHRIDGE	CA	91324	07/01/2020
CHC08241-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09689	950 WEST FOOTHILL BLVD	MONROVIA	CA	91016	07/01/2020
CHC08241-00	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09789	9900 SEPULVEDA BLVD	MISSION HILLS	CA	91345	07/01/2020
CHC08241-00	GARFIELD BEACH CVS, L.L.C.	CVS/PHARMACY # 16040	9725 LAUREL CANYON BLVD	ARLETA	CA	91331	07/01/2020
CHC08241-09	GLESENER PHARMACY		321 NORTH CITRUS STREET	COVINA	CA	91723	07/01/2016	02/15/2021
CHC08241-00	HEALTHY LIVING PHARMACY	YASHNAM CORPORATION	22343 LA PALMA AVENUE SUITE 114	YORBA LINDA	CA	92887	01/01/2017	04/10/2023
CHC08241-15	HEALTHY LIVING PHARMACY	YASHNAM CORPORATION	22343 LA PALMA AVENUE SUITE 114	YORBA LINDA	CA	92887	04/01/2018	04/01/2023
CHC08241-00	HI-DESERT COMPOUNDING PHARMACY INC	DBA PRESCRIPTION SHOPPE	15247 ELEVENTH ST STE 1000	VICTORVILLE	CA	92395-3727	07/01/2017
CHC08241-12	HI-DESERT COMPOUNDING PHARMACY INC	DBA PRESCRIPTION SHOPPE	15247 ELEVENTH ST STE 1000	VICTORVILLE	CA	92395-3727	07/01/2017
CHC08241-21	HI-DESERT COMPOUNDING PHARMACY INC	DBA PRESCRIPTION SHOPPE	15247 ELEVENTH ST STE 1000	VICTORVILLE	CA	92395-3727	07/01/2017
CHC08241-00	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	10/01/2016	12/03/2017
CHC08241-01	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2017	12/03/2017
CHC08241-13	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	07/01/2016	12/03/2017
CHC08241-16	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	01/01/2017	12/03/2017
CHC08241-19	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2017	12/03/2017
CHC08241-18	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2017	12/03/2017
CHC08241-17	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2017	12/03/2017
CHC08241-13	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2018
CHC08241-16	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2018	01/01/2019
CHC08241-12	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2018
CHC08241-07	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2018
CHC08241-17	IMANOEL PHARMACY	DBA SUNSHINE PHARMACY	357 N FAIRFAX AVE	LOS ANGELES	CA	90036	04/01/2018	04/01/2023
CHC08241-00	JC NEIGHBORHOOD PHARMACY	JC NEIGHBORHOOD PHARMACY	770 MAGNOLIA AVE STE 1-G	CORONA	CA	92879	07/01/2022	03/31/2025
CHC08241-00	KEY DRUG COMPANY		770 S VERMONT	LOS ANGELES	CA	90005	07/01/2015	02/15/2021
CHC08241-00	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	01/01/2016	02/15/2021
CHC08241-01	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	01/01/2016	02/15/2021
CHC08241-02	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	01/01/2016
CHC08241-03	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	01/01/2016	04/01/2019
CHC08241-05	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	01/01/2016
CHC08241-09	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	07/01/2016	02/15/2021
CHC08241-16	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	01/01/2019
CHC08241-13	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	02/15/2021
CHC08241-11	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018
CHC08241-13	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	02/15/2021
CHC08241-18	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	02/15/2021
CHC08241-24	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	02/15/2021
CHC08241-20	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	02/08/2022
CHC08241-23	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	01/01/2021
CHC08241-14	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018
CHC08241-10	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	01/11/2022
CHC08241-17	LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY	313 N FIGUEROA STREET	SUITE 1225	LOS ANGELES	CA	90012	04/01/2018	04/01/2023
CHC08241-00	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	01/24/2001	03/31/2025
CHC08241-02	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	01/01/2015
CHC08241-05	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	07/01/2016
CHC08241-08	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	07/01/2016
CHC08241-06	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	07/01/2016
CHC08241-12	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	07/01/2016
CHC08241-11	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	07/01/2016
CHC08241-14	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	10/01/2016
CHC08241-17	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	04/01/2017	04/01/2023
CHC08241-21	MARKET PHARMACY	9250 RESEDA BLVD STE 2C		NORTHRIDGE	CA	91324-5215	07/01/2017
CHC08241-07	MARKET PHARMACY INC	DBA MARKET PHARMACY LTC	9250 RESEDA BLVD UNIT 2D	NORTHRIDGE	CA	91324	07/01/2016
CHC08241-00	MCCARTHY PHARMACY INC	DBA FREEMAN MEDICAL PHARMACY	301 N PRAIRIE AVE STE 110	INGLEWOOD	CA	90301	07/01/2015	03/31/2025
CHC08241-01	MCCARTHY PHARMACY INC	DBA FREEMAN MEDICAL PHARMACY	301 N PRAIRIE AVE STE 110	INGLEWOOD	CA	90301	01/01/2015	04/01/2022
CHC08241-18	MCCARTHY PHARMACY INC	DBA FREEMAN MEDICAL PHARMACY	301 N PRAIRIE AVE STE 110	INGLEWOOD	CA	90301	04/01/2017
CHC08241-00	MEDICAL CENTER PHARMACY	501 E HARDY ST STE 130		INGLEWOOD	CA	90301-4055	01/01/2015	03/31/2025
CHC08241-01	MEDICAL CENTER PHARMACY	501 E HARDY ST STE 130		INGLEWOOD	CA	90301-4055	01/01/2015	04/01/2022
CHC08241-00	MEMORIAL MEDICAL CTR PHARMACY	9806 VENICE BLVD		CULVER CITY	CA	90232	07/01/2017	06/02/2020
CHC08241-13	MEMORIAL MEDICAL CTR PHARMACY	9806 VENICE BLVD		CULVER CITY	CA	90232	07/01/2017	02/15/2021
CHC08241-16	MEMORIAL MEDICAL CTR PHARMACY	9806 VENICE BLVD		CULVER CITY	CA	90232	07/01/2017	01/01/2019
CHC08241-19	MEMORIAL MEDICAL CTR PHARMACY	9806 VENICE BLVD		CULVER CITY	CA	90232	07/01/2017	12/23/2017
CHC08241-00	MISSION CITY COMMUNITY NETWORK, INC.-	COMMUNITY PHARMACY	15206 PARTHENIA STREET	NORTH HILLS	CA	91343-5305	07/01/2017
CHC08241-02	MISSION CITY COMMUNITY NETWORK, INC.-	COMMUNITY PHARMACY	15206 PARTHENIA STREET	NORTH HILLS	CA	91343-5305	07/01/2017
CHC08241-05	MISSION CITY COMMUNITY NETWORK, INC.-	COMMUNITY PHARMACY	15206 PARTHENIA STREET	NORTH HILLS	CA	91343-5305	07/01/2017
CHC08241-07	MISSION CITY COMMUNITY NETWORK, INC.-	COMMUNITY PHARMACY	15206 PARTHENIA STREET	NORTH HILLS	CA	91343-5305	07/01/2017
CHC08241-06	MISSION CITY COMMUNITY NETWORK, INC.-	COMMUNITY PHARMACY	15206 PARTHENIA STREET	NORTH HILLS	CA	91343-5305	07/01/2017
CHC08241-11	MISSION CITY COMMUNITY NETWORK, INC.-	COMMUNITY PHARMACY	15206 PARTHENIA STREET	NORTH HILLS	CA	91343-5305	07/01/2017
CHC08241-14	MISSION CITY COMMUNITY NETWORK, INC.-	COMMUNITY PHARMACY	15206 PARTHENIA STREET	NORTH HILLS	CA	91343-5305	07/01/2017
CHC08241-17	MISSION CITY COMMUNITY NETWORK, INC.-	COMMUNITY PHARMACY	15206 PARTHENIA STREET	NORTH HILLS	CA	91343-5305	07/01/2017	04/01/2023
CHC08241-13	NATIONAL PHARMACY	NATIONAL PHARMACY, INC. DBA	7420 SANTA MONICA BLVD.	WEST HOLLYWOOD	CA	90046-5605	10/01/2017	04/02/2018
CHC08241-00	NATIONAL PHARMACY	NATIONAL PHARMACY, INC. DBA	7420 SANTA MONICA BLVD.	WEST HOLLYWOOD	CA	90046-5605	04/01/2018	04/02/2018
CHC08241-18	NATIONAL PHARMACY	NATIONAL PHARMACY, INC. DBA	7420 SANTA MONICA BLVD.	WEST HOLLYWOOD	CA	90046-5605	04/01/2018	04/02/2018
CHC08241-01	NATIONAL PHARMACY	NATIONAL PHARMACY, INC. DBA	7420 SANTA MONICA BLVD.	WEST HOLLYWOOD	CA	90046-5605	04/01/2018	04/02/2018
CHC08241-23	NATIONAL PHARMACY	NATIONAL PHARMACY, INC. DBA	7420 SANTA MONICA BLVD.	WEST HOLLYWOOD	CA	90046-5605	04/01/2018	04/02/2018
CHC08241-24	NATIONAL PHARMACY	NATIONAL PHARMACY, INC. DBA	7420 SANTA MONICA BLVD.	WEST HOLLYWOOD	CA	90046-5605	04/01/2018	04/02/2018
CHC08241-15	NATIONAL PHARMACY	NATIONAL PHARMACY, INC. DBA	7420 SANTA MONICA BLVD.	WEST HOLLYWOOD	CA	90046-5605	04/01/2019	04/01/2023
CHC08241-26	NATIONAL PHARMACY	NATIONAL PHARMACY, INC. DBA	7420 SANTA MONICA BLVD.	WEST HOLLYWOOD	CA	90046-5605	07/01/2019	07/02/2019
CHC08241-00	NEW VISTA PHARMACY	932 S. EUCLID ST		ANAHEIM	CA	92802	10/01/2018
CHC08241-00	NEW VISTA PHARMACY	932 S. EUCLID ST		ANAHEIM	CA	92802	10/01/2018	03/31/2025
CHC08241-00	NORMANDY PHARMACY	NORMANDY PHARMACY INC	5112 HOLLYWOOD BLVD #104 PO BOX 291900	LOS ANGELES	CA	90027	07/01/2017	01/11/2022
CHC08241-00	OASIS PHARMACY	SUN OASIS MEDICAL, INC	15433 W SAND STREET SUITE 102	VICTORVILLE	CA	92392-2903	07/01/2015	01/11/2018
CHC08241-00	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/01/2023
CHC08241-00	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024	03/31/2025
CHC08241-00	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	01/01/2024	03/31/2025
CHC08241-00	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2023
CHC08241-02	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	01/01/2024
CHC08241-00	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	10/01/2023
CHC08241-00	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
CHC08241-00	ORANGE GROVE PHARMACY	1770 N ORANGE GROVE AVE STE 100		POMONA	CA	91767-3027	01/01/2015	01/22/2018
CHC08241-01	ORANGE GROVE PHARMACY	1770 N ORANGE GROVE AVE STE 100		POMONA	CA	91767-3027	01/01/2015	01/22/2018
CHC08241-00	PLAZA WEST PHARMACY	8540 SEPULVEDA BLVD	STE 102	LOS ANGELES	CA	90045	04/01/2021	08/31/2021
CHC08241-00	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	07/01/2017	06/02/2020
CHC08241-00	RALPHS GROCERY CO.	DBA RALPHS #016	670 S. WESTERN AVE.	LOS ANGELES	CA	90005	10/01/2022
CHC08241-00	ROYALTY PHARMACY	ROYALTY PHARMACY	1902 ROYALTY DR. STE 110	POMONA	CA	91767-3036	01/01/2020	06/02/2020
CHC08241-24	RX CENTRAL	IMANOEL PHARMACY, INC. DBA	800 S. CENTRAL AVENUE SUITE 101A	GLENDALE	CA	91204-4375	04/01/2018	04/01/2023
CHC08241-00	RX CENTRAL	IMANOEL PHARMACY, INC. DBA	800 S. CENTRAL AVENUE SUITE 101A	GLENDALE	CA	91204-4375	10/01/2018	06/02/2020
CHC08241-25	RX CENTRAL	IMANOEL PHARMACY, INC. DBA	800 S. CENTRAL AVENUE SUITE 101A	GLENDALE	CA	91204-4375	04/01/2019	04/01/2024
CHC08241-00	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	04/01/2016
CHC08241-01	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2016	02/15/2021
CHC08241-02	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2016
CHC08241-03	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2016	04/01/2019
CHC08241-05	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2016
CHC08241-08	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	07/01/2016
CHC08241-06	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	07/01/2016
CHC08241-16	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	01/01/2019
CHC08241-14	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018
CHC08241-13	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	02/15/2021
CHC08241-17	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	04/01/2023
CHC08241-11	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018
CHC08241-17	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	01/11/2018
CHC08241-14	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	01/11/2018
CHC08241-20	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	02/08/2022
CHC08241-18	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	02/15/2021
CHC08241-09	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	02/15/2021
CHC08241-24	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	02/15/2021
CHC08241-23	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	01/01/2021
CHC08241-10	RX E-FILL SOLUTIONS	28341 CONSTELLATION RD		SANTA CLARITA	CA	91355	04/01/2018	01/11/2022
CHC08241-26	RX E-FILL SOLUTIONS	CARDINAL HEALTH PHARMACY SERVICES, LLC	27680 AVENUE MENTRY STE 100	VALENCIA	CA	91355	07/01/2019	04/01/2024
CHC08241-00	SHALOM COMPOUNDING PHARMACY	18000 VENTURA BLVD STE 2		ENCINO	CA	91316-9131	10/01/2016	10/01/2020
CHC08241-00	THE MEDICINE SHOPPE	15555 MAIN STREET #D8		HESPERIA	CA	92345-3423	10/01/2017
CHC08241-12	THE MEDICINE SHOPPE	15555 MAIN STREET #D8		HESPERIA	CA	92345-3423	01/01/2017
CHC08241-21	THE MEDICINE SHOPPE	15555 MAIN STREET #D8		HESPERIA	CA	92345-3423	04/01/2017	04/10/2023
CHC08241-00	THRIFTY PAYLESS, INC.	RITE AID #5553	10823 ZELZAH AVENUE BLDG D	GRANADA HILLS	CA	91344	10/01/2021
CHC08241-00	THRIFTY PAYLESS, INC.	RITE AID #5563	8400 VAN NUYS BOULEVARD	PANORAMA CITY	CA	91402	10/01/2021
CHC08241-00	VAN NUYS MEDICAL PHARMACY INC.	8737 VAN NUYS BLVD UNIT B		PANORAMA CITY	CA	91402-2401	01/01/2017	03/31/2025
CHC08241-17	VAN NUYS MEDICAL PHARMACY INC.	8737 VAN NUYS BLVD UNIT B		PANORAMA CITY	CA	91402-2401	04/01/2017	04/01/2023
CHC08241-00	VERMONT V O PHARMACY	2655 W OLYMPIC BL #104		LOS ANGELES	CA	90006-2800	07/01/2018
CHC08241-24	VERMONT V O PHARMACY	2655 W OLYMPIC BL #104		LOS ANGELES	CA	90006-2800	04/01/2019	04/01/2023
CHC08241-00	WALGREEN CO	DBA: WALGREENS #11449	4616 DE LONGPRE AVE	LOS ANGELES	CA	90027	07/01/2013
CHC08241-00	WALGREEN CO	DBA: WALGREENS #09491	10955 MAGNOLIA BLVD	NORTH HOLLYWOOD	CA	91601	07/01/2013	04/01/2024
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 04227	903 E. HUNTINGTON DR.	MONROVIA	CA	91016	07/01/2013	04/30/2025
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 04382	795 E. FOOTHILL	POMONA	CA	91767	07/01/2013
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 05525	7155 VAN NUYS BLVD	VAN NUYS	CA	91405	07/01/2013
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 05527	25011 ALESSANDRO BLVD	MORENO VALLEY	CA	92553	07/01/2013
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 06124	9750 WOODMAN AVENUE	ARLETA	CA	91331	07/01/2013
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 06413	230 N LABREA AVE	INGLEWOOD	CA	90301	07/01/2013
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 06648	18430 SHERMAN WAY	RESEDA	CA	91335-4305	07/01/2013	04/03/2024
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 07950	15316 NORDHOFF ST	NORTH HILLS	CA	91343	07/01/2013
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 07230	495 E HOLT AVE	POMONA	CA	91767-5539	07/01/2013
CHC08241-00	WALGREEN CO.	DBA:WALGREENS #12576	15318 ROY ROGERS DR.	VICTORVILLE	CA	92394	10/01/2016
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 07015	20901 DEVONSHIRE	CHATSWORTH	CA	91311-2313	07/01/2017
CHC08241-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #12694	10990 WARNER AVE STE A	FOUNTAIN VALLEY	CA	92708	07/01/2017
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 05848	20505 SHERMAN WAY	CANOGA PARK	CA	91306-3427	04/01/2018
CHC08241-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15294	8490 SANTA MONICA BLVD STE 1	WEST HOLLYWOOD	CA	90069	04/01/2018
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 05744	128 S STATE COLLEGE BLVD.	ANAHEIM	CA	92806	10/01/2018
CHC08241-00	WALGREEN CO.	DBA: WALGREENS # 05744	128 S STATE COLLEGE BLVD.	ANAHEIM	CA	92806	10/01/2018
CHC08241-15	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #03815	111 S MAIN ST	ORANGE	CA	92868	01/01/2020	04/01/2023
CHC08241-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #03815	111 S MAIN ST	ORANGE	CA	92868	01/01/2020
CHC08241-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15293	4940 VAN NUYS BLVD STE 104	SHERMAN OAKS	CA	91403	10/01/2021
CHC08241-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21231	1487 E CHEVY CHASE DR	GLENDALE	CA	91206	04/01/2023
CHC08241-00	WESTERN MEDICAL PHARMACY	1110 N WESTERN AVE STE 101		LOS ANGELES	CA	90029-1199	07/01/2017	10/01/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 12:19:49 PM	2/10/2025 11:34:14 AM	2/10/2025 11:34 AM
Details	Last Recertification Date	Update	Recertification		1/30/2024 12:19:49 PM	1/30/2024 12:19 PM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Gupta, Nik CEO Mission City Community Network 8188953100	4/12/2023 8:36 AM
Details	340B ID	Update	New Registration		CHC08241-30	4/12/2023 8:36 AM
Dates	Participating Approval Date	Update	New Registration		4/12/2023 8:36:04 AM	4/12/2023 8:36 AM
Details	State	Update	New Registration	Pending	Approved	4/12/2023 8:36 AM
Dates	Signed By Date	Update	New Registration		4/11/2023 6:35:37 PM	4/12/2023 8:36 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	4/12/2023 8:36 AM
Addresses	Main Address	Insert	New Registration		401 E Buena Vista St Barstow, CA 92311-2815	4/11/2023 6:35 PM
Addresses	Billing Address	Insert	New Registration		Mission City Community Network 8527 Sepulveda Blvd North Hills, CA 91343	4/11/2023 6:35 PM
Contacts	Authorizing Official	Insert	New Registration		Gupta, Nik CEO Mission City Community Network 8188953100	4/11/2023 6:35 PM
Contacts	Primary Contact	Insert	New Registration		Ndu, Maureen Director of Programs Mission City Community Network 8188953100-627	4/11/2023 6:35 PM
Details	Assistance Received From Date	Insert	New Registration			4/11/2023 6:35 PM
Details	Assistance Received To Date	Insert	New Registration			4/11/2023 6:35 PM
Details	Last Recertification Date	Insert	New Registration			4/11/2023 6:35 PM
Details	Grant Number	Insert	New Registration		H80CS08241	4/11/2023 6:35 PM
Details	340B ID	Insert	New Registration			4/11/2023 6:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2023 6:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2023 6:35 PM
Details	Medicare Provider Number	Insert	New Registration			4/11/2023 6:35 PM
Details	Entity Name	Insert	New Registration		Mission City Community Network, Inc.	4/11/2023 6:35 PM
Details	NOFO Number	Insert	New Registration			4/11/2023 6:35 PM
Details	Program Code	Insert	New Registration		CH	4/11/2023 6:35 PM
Details	Entity Subname	Insert	New Registration		Mission City Community Network- Barstow II	4/11/2023 6:35 PM
Dates	Participating Approval Date	Insert	New Registration			4/11/2023 6:35 PM
Details	State	Insert	New Registration		Pending	4/11/2023 6:35 PM
Dates	Registration Date	Insert	New Registration		4/11/2023 6:35:34 PM	4/11/2023 6:35 PM
Dates	Signed By Date	Insert	New Registration			4/11/2023 6:35 PM
Dates	Start Date	Insert	New Registration			4/11/2023 6:35 PM
Terminations	Termination Comments	Insert	New Registration			4/11/2023 6:35 PM
Terminations	Termination Date	Insert	New Registration			4/11/2023 6:35 PM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2023 6:35 PM
Terminations	Termination Reason	Insert	New Registration			4/11/2023 6:35 PM

340B Drug Pricing Program Database