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WHITE MEMORIAL MEDICAL PLAZA PHARMACY
FQHCLA82 White Memorial Community Health Center, A California Nonprofit Public Benef
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Covered Entity Details
Entity Name
White Memorial Community Health Center, A California Nonprofit Public Benef
Subdivision Name
WMCHC-Medical and Mental Health
Type
Health Center Program Look-Alike
340B ID
FQHCLA82
Entity Address
1828 E. Cesar E. Chavez Ave, Suite 5000
Los Angeles, CA 90033-2487
Grant Number
LALCS31625
Participating Start Date
1/1/2019
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WHITE MEMORIAL MEDICAL PLAZA PHARMACY
Pharmacy Address
1701 E CESAR E CHAVEZ AVE STE 109
LOS ANGELES, CA 90033-2496
Pharmacy Comments
Contract Details
Approval Date
9/16/2019
Contract Begin Date
9/16/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Grace Floutsis, Chief Medical Officer
(323) 987-1222
Contract Pharmacy Representative
White Memorial Community Health Center
Carl E. Coan, Chief Executive Officer
(323) 987-1200
Signed By Date
9/16/2019
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