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NATIONAL PHARMACY
CH09244C Clinic Inc, The
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Covered Entity Details
Entity Name
Clinic Inc, The
Subdivision Name
T.H.E. Clinic at Hawthorne
Type
HRSA-Funded Health Center
340B ID
CH09244C
Entity Address
10321 HAWTHORNE BLVD
INGLEWOOD, CA 90304-1500
Grant Number
H80CS00755
Participating Start Date
4/1/2018
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
NATIONAL PHARMACY
Pharmacy Address
NATIONAL PHARMACY, INC. DBA
7420 SANTA MONICA BLVD.
WEST HOLLYWOOD, CA 90046-5605
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
National Pharmacy
Michael Imanoel, Pharmacist
(800) 994-8990
Signed By Date
10/3/2018
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