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KROGER SPECIALTY PHARMACY INC
CH092143T LOS ANGELES CHRISTIAN HEALTH CENTERS
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Covered Entity Details
Entity Name
LOS ANGELES CHRISTIAN HEALTH CENTERS
Subdivision Name
Los Angeles Christian Health Centers at New Genesis
Type
HRSA-Funded Health Center
340B ID
CH092143T
Entity Address
456 S. Main Street
(Exam Rm 1 & 2, vitals room, waiting room)
Los Angeles, CA 90013
Grant Number
H80CS06674
Participating Start Date
1/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER SPECIALTY PHARMACY INC
Pharmacy Address
KROGER SPECIALTY PHARMACY CA 3
1821 KAISER AVE
IRVINE, CA 92614-5707
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bettina Lewis, Chief Operations Officer
(213) 893-1960
Contract Pharmacy Representative
Los Angeles Christian Health Centers
Elaine Rivera, Pharmacy Director
(323) 268-8391
Signed By Date
1/15/2020
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