340B Drug Pricing Program Database
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CHC24115-05 Los Angeles Free Clinic., The (Active)
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Main Details
Name
Los Angeles Free Clinic., The
Subdivision Name
Saban Community Clinic - Mobile Clinic Site
Type
HRSA-Funded Health Center
Site ID
BPS-H80-034741
340B ID
CHC24115-05
Grant Number
H80CS24115
Additional Details
Current Program Status
Active
Registration Date
7/11/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/12/2022
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
6043 Hollywood Blvd.
Los Angeles, CA 90028
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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