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RALPHS GROCERY CO.
CH0910370 ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
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Covered Entity Details
Entity Name
ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
Subdivision Name
St. Johns Well Child and Family Center Magnolia Place
Type
HRSA-Funded Health Center
340B ID
CH0910370
Entity Address
1910 Magnolia Ave
101
Los Angeles, CA 90007
Grant Number
H80CS00873
Participating Start Date
7/1/2003
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO.
Pharmacy Address
DBA RALPHS #016
670 S. WESTERN AVE.
LOS ANGELES, CA 90005
Pharmacy Comments
Contract Details
Approval Date
7/15/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/15/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Mangia, CEO
(323) 541-1600 Ext: 4000
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/15/2013
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