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MEDELLA PHARMACY 1
FQHCLA406 Tender Care Community Clinic, Inc.
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Covered Entity Details
Entity Name
Tender Care Community Clinic, Inc.
Subdivision Name
Tender Care Community Clinic, Inc.
Type
Health Center Program Look-Alike
340B ID
FQHCLA406
Entity Address
7862 Firestone Blvd
Downey, CA 90241-4221
Grant Number
LALCS33879
Participating Start Date
7/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MEDELLA PHARMACY 1
Pharmacy Address
8610 FIRESTONE BLVD
DOWNEY, CA 90241
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Lee Santos, CEO
(562) 869-7007
Contract Pharmacy Representative
Medella Pharmacy 1
Joseph Girgis, Owner
(310) 993-2363
Signed By Date
4/2/2020
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