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SEASIDE PRESCRIPTION PHARM
CHC28366-02 Harbor Community Clinic
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Covered Entity Details
Entity Name
Harbor Community Clinic
Subdivision Name
Pacific Avenue Health Center
Type
HRSA-Funded Health Center
340B ID
CHC28366-02
Entity Address
425 S Pacific Ave
San Pedro, CA 90731-2625
Grant Number
H80CS28366
Participating Start Date
7/1/2020
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
SEASIDE PRESCRIPTION PHARM
Pharmacy Address
599 WEST 7TH STREET
SAN PEDRO, CA 90731
Pharmacy Comments
Contract Details
Approval Date
4/6/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Ownership change
Contacts
Covered Entity Signing Official
Nathalia Jimenez, COO
(310) 547-0202 Ext: 134
Contract Pharmacy Representative
THE MEDICINE CABINET
Ash Soliman, President
(323) 581-9106
Signed By Date
4/6/2020
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