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CRENSHAW PHARMACY INC
CH09244A CLINIC INC, THE
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Covered Entity Details
Entity Name
CLINIC INC, THE
Subdivision Name
T.H.E. Community Health Center at La Brea
Type
HRSA-Funded Health Center
340B ID
CH09244A
Entity Address
3721 S. La Brea Avenue
Los Angeles, CA 90016-5310
Grant Number
H80CS00755
Participating Start Date
4/1/2015
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
CRENSHAW PHARMACY INC
Pharmacy Address
DBA CRENSHAW PHARMACY
3631 CRENSHAW BLVD #111
LOS ANGELES, CA 90016
Pharmacy Comments
Contract Details
Approval Date
10/3/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifford Shiepe, President and CEO
(323) 730-1920 Ext: 3053
Contract Pharmacy Representative
Crenshaw Pharmacy
KOHANCHI NASTARAN ESTHER, PHARMACIST
(323) 732-5555
Signed By Date
10/3/2018
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