Contract Pharmacy Details

CIENEGA PHARMACY INC
CH092440 CLINIC INC, THE

Covered Entity Details

Entity Name

CLINIC INC, THE

Subdivision Name

T.H.E. CLINIC, INC.

Type

HRSA-Funded Health Center

340B ID

CH092440

Entity Address

3834 S. WESTERN AVE
LOS ANGELES, CA 90062-1104

Grant Number

H80CS00755

Participating Start Date

7/1/2003

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

CIENEGA PHARMACY INC

Pharmacy Address

CIENEGA PHARMACY
7360 SANTA MONICA BLVD.
SUITE 101
WEST HOLLYWOOD, CA 90046

Pharmacy Comments

Contract Details

Approval Date

9/5/2012

Contract Begin Date

9/5/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/10/2017
Agreement registered in error

Contacts

Covered Entity Signing Official

RISE PHILLIPS, CHIEF EXECUTIVE OFFICER
(323) 730-1920 Ext: 3007

Contract Pharmacy Representative

Khazaee Afreh, President
(310) 360-9969

Signed By Date

6/26/2012

340B Drug Pricing Program Database