Contract Pharmacy Details

NATIONAL PHARMACY
CHC08241-26 Mission City Community Network, Inc.

Covered Entity Details

Entity Name

Mission City Community Network, Inc.

Subdivision Name

Mission City Community Network- Hollywood-Santa Monica

Type

HRSA-Funded Health Center

340B ID

CHC08241-26

Entity Address

5300 Santa Monica Blvd Suite 202
Los Angeles, CA 90029-1258

Grant Number

H80CS08241

Participating Start Date

4/1/2019

Last Recertification Date

1/30/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

NATIONAL PHARMACY

Pharmacy Address

NATIONAL PHARMACY, INC. DBA
7420 SANTA MONICA BLVD.
WEST HOLLYWOOD, CA 90046-5605

Pharmacy Comments

Contract Details

Approval Date

4/2/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/2/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Nik Gupta, CEO
(818) 895-3100

Contract Pharmacy Representative

National Pharmacy
MICHAEL M. IMANOEL, PRESIDENT
(323) 851-4444

Signed By Date

4/2/2019

340B Drug Pricing Program Database