340B Drug Pricing Program Database
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CHC24115-04 Los Angeles Free Clinic., The (Active)
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Main Details
Name
Los Angeles Free Clinic., The
Subdivision Name
The Virgil
Type
HRSA-Funded Health Center
Site ID
BPS-H80-030157
340B ID
CHC24115-04
Grant Number
H80CS24115
Additional Details
Current Program Status
Active
Registration Date
4/14/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/15/2020
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Saban Community Clinic
Muriel Nouwezem, CEO
(323) 337-1707
Primary Contact
Saban Free CLinic
Raed Ahmed, Pharmacy Services Manager
(323) 337-1812
Addresses
Street Address
137 N Virgil Ave
Los Angeles, CA 90004-4811
Billing Address
Saban Community clinic
8405 Beverly Blvd.
Los Angeles, CA 90048
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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