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KROGER SPECIALTY PHARMACY CA 2
CH092143Y Los Angeles Christian Health Centers
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Covered Entity Details
Entity Name
Los Angeles Christian Health Centers
Subdivision Name
Los Angeles Christian Health Centers at Grape Street Elementary
Type
HRSA-Funded Health Center
340B ID
CH092143Y
Entity Address
1940 E. 111th Street
Los Angeles, CA 90059
Grant Number
H80CS06674
Participating Start Date
7/1/2017
Last Recertification Date
2/15/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
KROGER SPECIALTY PHARMACY CA 2
Pharmacy Address
6240 WILSHIRE BLVD.
LOS ANGELES, CA 90048
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
4/1/2020
Covered Entity Terminated
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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