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CIENEGA PHARMACY INC
CH09244C Clinic Inc, The
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Covered Entity Details
Entity Name
Clinic Inc, The
Subdivision Name
T.H.E. Clinic at Hawthorne
Type
HRSA-Funded Health Center
340B ID
CH09244C
Entity Address
10321 HAWTHORNE BLVD
INGLEWOOD, CA 90304-1500
Grant Number
H80CS00755
Participating Start Date
4/1/2018
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
CIENEGA PHARMACY INC
Pharmacy Address
CIENEGA PHARMACY
7360 SANTA MONICA BLVD.
SUITE 101
WEST HOLLYWOOD, CA 90046
Pharmacy Comments
Contract Details
Approval Date
7/2/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifford Shiepe, President and CEO
(323) 730-1920 Ext: 3053
Contract Pharmacy Representative
CIENEGA PHARMACY
Afreh Khazaee, President
(310) 360-9969
Signed By Date
7/2/2019
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