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RX CENTRAL
CHC08241-25 Mission City Community Network, Inc.
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Covered Entity Details
Entity Name
Mission City Community Network, Inc.
Subdivision Name
Mission City Community Network - Glendale
Type
HRSA-Funded Health Center
340B ID
CHC08241-25
Entity Address
222 Eulalia Street Ste. 301
Glendale, CA 91204
Grant Number
H80CS08241
Participating Start Date
10/1/2018
Last Recertification Date
1/30/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
RX CENTRAL
Pharmacy Address
IMANOEL PHARMACY, INC. DBA
800 S. CENTRAL AVENUE
SUITE 101A
GLENDALE, CA 91204-4375
Pharmacy Comments
Contract Details
Approval Date
1/10/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
Rx Central Pharmacy
Mosha seleh, Pharmacist
(818) 244-5062
Signed By Date
1/10/2019
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