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EVERGREEN RX INC
CHC28987-06 COMPLETE CARE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Complete Care Community Health Center - N. Vermont Avenue
Type
HRSA-Funded Health Center
340B ID
CHC28987-06
Entity Address
1300 North Vermont Avenue, Suite 606
Los Angeles, CA 90027
Grant Number
H80CS28987
Participating Start Date
10/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
EVERGREEN RX INC
Pharmacy Address
DBA MEDICO PHARMACY
11779 SANTA MONICA BLVD
LOS ANGELES, CA 90025
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Yury Akopyan, CEO
(310) 730-6362
Contract Pharmacy Representative
Evergreen Rx, Inc DBA Medico Pharmacy
Afshin Azizisefat, PIC
(310) 444-9011
Signed By Date
7/16/2018
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