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EVERGREEN RX INC
CHC28987-08 COMPLETE CARE COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Complete Care Community Health Center Inc--Porterville
Type
HRSA-Funded Health Center
340B ID
CHC28987-08
Entity Address
365 North Pearson Dr. STE 5
Porterville, CA 93257
Grant Number
H80CS28987
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
EVERGREEN RX INC
Pharmacy Address
DBA MEDICO PHARMACY
11779 SANTA MONICA BLVD
LOS ANGELES, CA 90025
Pharmacy Comments
Contract Details
Approval Date
8/29/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen Akopian, Vice President
(310) 730-6362
Contract Pharmacy Representative
Evergreen Rx, Inc DBA Medico Pharmacy
Afshin Azizisefat, PIC
(310) 444-9011
Signed By Date
7/22/2019
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