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RALPHS GROCERY CO
CHC11402-10 NORTHEAST COMMUNITY CLINIC, INC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic - Grand
Type
HRSA-Funded Health Center
340B ID
CHC11402-10
Entity Address
1400 SOUTH GRAND AVENUE STE 700
LOS ANGELES, CA 90015
Grant Number
H80CS12869
Participating Start Date
4/1/2014
Last Recertification Date
2/21/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO
Pharmacy Address
DBA RALPHS STORE #21
1745 GARFIELD AVENUE
SOUTH PASADENA, CA 91030
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
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/15/2019
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