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CRENSHAW PHARMACY INC
CH092440 CLINIC INC, THE
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Covered Entity Details
Entity Name
CLINIC INC, THE
Subdivision Name
T.H.E. CLINIC, INC.
Type
HRSA-Funded Health Center
340B ID
CH092440
Entity Address
3834 S. WESTERN AVE
LOS ANGELES, CA 90062-1104
Grant Number
H80CS00755
Participating Start Date
7/1/2003
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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