Contract Pharmacy Details

SANTA MARIA PHARMACY
FQHCLA374 Community Medicine Inc.

Covered Entity Details

Entity Name

Community Medicine Inc.

Subdivision Name

COMMUNITY MEDICINE INC.

Type

Health Center Program Look-Alike

340B ID

FQHCLA374

Entity Address

8540 ALONDRA BLVD STE B2
PARAMOUNT, CA 90723-5200

Grant Number

LALCS31618

Participating Start Date

10/1/2018

Last Recertification Date

2/6/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

SANTA MARIA PHARMACY

Pharmacy Address

1224 S BROOKHURST ST
ANAHEIM, CA 92804

Pharmacy Comments

Contract Details

Approval Date

8/2/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

HABIB J HASHMANI, CEO
(562) 602-2508

Contract Pharmacy Representative

PHARMACY
MARCOS SOLIMAN, OWNER
(714) 556-7788

Signed By Date

7/10/2018