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KROGER SPECIALTY PHARMACY INC
CH092143Q LOS ANGELES CHRISTIAN HEALTH CENTERS
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Covered Entity Details
Entity Name
LOS ANGELES CHRISTIAN HEALTH CENTERS
Subdivision Name
PowerHouse Church of World Impact
Type
HRSA-Funded Health Center
340B ID
CH092143Q
Entity Address
2003 E Imperial Hwy
Los Angeles, CA 90059-2200
Grant Number
H80CS06674
Participating Start Date
7/1/2010
Last Recertification Date
2/9/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
KROGER SPECIALTY PHARMACY INC
Pharmacy Address
KROGER SPECIALTY PHARMACY CA 3
1821 KAISER AVE
IRVINE, CA 92614-5707
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bettina Lewis, Chief Operations Officer
(213) 893-1960
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/8/2018
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