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LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
CH092536AL JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Wesley Health Centers- Mobile Health Clinic I
Type
HRSA-Funded Health Center
340B ID
CH092536AL
Entity Address
45104 10th St W
Lancaster, CA 93534-2310
Grant Number
H80CS06673
Participating Start Date
5/2/2019
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
Pharmacy Address
313 N FIGUEROA STREET
SUITE 1225
LOS ANGELES, CA 90012
Pharmacy Comments
Contract Details
Approval Date
5/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
LA County DHS
Rabeah Elbanna, Pharmacy Supervisor I
(213) 288-7717
Signed By Date
5/1/2019
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