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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
CHC08241-26 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- 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
COUNTY OF LOS ANGELES - AUDITOR CONTROLL
Pharmacy Address
313 N FIGUEROA ST STE 1225
HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELES, CA 90012-2602
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
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
4/2/2019
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