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ST MARY PHARMACY & MEDICAL SUPPLIES INC
CHC28984-02 CENTER FOR FAMILY HEALTH & EDUCATION, INC.
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Covered Entity Details
Entity Name
CENTER FOR FAMILY HEALTH & EDUCATION, INC.
Subdivision Name
Priority Care Medical Group Long Beach
Type
HRSA-Funded Health Center
340B ID
CHC28984-02
Entity Address
500 West Willow Street
Long Beach, CA 90806-2831
Grant Number
H80CS28984
Participating Start Date
7/1/2019
Last Recertification Date
1/31/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
ST MARY PHARMACY & MEDICAL SUPPLIES INC
Pharmacy Address
ST MARY PHARMACY
505 W WILLOW ST
LONG BEACH, CA 90806
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Marisol Ramirez, Chief Administrative Officer
(818) 899-5555 Ext: 105
Contract Pharmacy Representative
ST MARY PHARMACY
Hany Georgy, Pharmacist
(562) 492-9484
Signed By Date
10/15/2019
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