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OC PHARMACY INC
FQHCLA298 Centro Medico Community Clinic, Inc.
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Covered Entity Details
Entity Name
Centro Medico Community Clinic, Inc.
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA298
Entity Address
1303 W 6th St
105
Corona, CA 92882
Grant Number
LALCS00062
Participating Start Date
7/1/2012
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
OC PHARMACY INC
Pharmacy Address
OC PHARMACY
31654 RANCHO VIEJO RD STE N
SAN JUAN CAPISTRANO, CA 92675-2775
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andy Piskoulian, CEO
(951) 278-8910
Contract Pharmacy Representative
OC Pharmacy
Manijeh Askari, CEO
(949) 429-5326
Signed By Date
1/13/2020
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