Contract Pharmacy Details

CCRX INC
FQHCLA373A HEALTH ACCESS FOR ALL INC.

Covered Entity Details

Entity Name

HEALTH ACCESS FOR ALL INC.

Subdivision Name

Angeles Community Health Center - Huntington Park

Type

Health Center Program Look-Alike

340B ID

FQHCLA373A

Entity Address

6208 Seville Ave
Huntington Park, CA 90255-2913

Grant Number

LALCS31681

Participating Start Date

10/1/2018

Last Recertification Date

2/4/2019

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

CCRX INC

Pharmacy Address

DBA CCRX
1919 W 7TH ST UNIT M
LOS ANGELES, CA 90057-4103

Pharmacy Comments

Contract Details

Approval Date

1/15/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Peyman Banooni, CEO
(213) 228-3808

Contract Pharmacy Representative

CCRX INC
Soheil Zafarmehr, Owner
(213) 674-7577

Signed By Date

1/15/2019