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FQ114D MISSION CITY COMMUNITY NETWORK INC (Terminated)
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Main Details
Name
MISSION CITY COMMUNITY NETWORK INC
Subdivision Name
Mission City Community Network - MOnrovia
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-012014
340B ID
FQ114D
Grant Number
LALCS00029
Additional Details
Current Program Status
Terminated
Registration Date
1/3/2013
Participating Start Date
4/1/2013
Participating Approval Date
2/27/2013
Last Recertification Date
2/17/2017
Termination Date
Termination Reason
4/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
Mission City Community Network
Nik Gupta, CEO
(818) 895-3100
Primary Contact
IRIS BAO-NGOC NGUYEN, PHARMACIST
(818) 895-3100 Ext: 650
Addresses
Street Address
513 E. Lime Street STE 103
Monrovia, CA 91016-2983
Billing Address
Mission City Community Network, Inc.
15206 Parthenia Street
North Hills, CA 91343-5305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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