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RALPHS GROCERY CO.
FQHCLA81Q NORTHEAST COMMUNITY CLINIC, INC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA81Q
Entity Address
1414 SOUTH GRAND AVENUE; SUITE 380
LOS ANGELES, CA 90015
Grant Number
LALCS00033
Participating Start Date
10/1/2016
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO.
Pharmacy Address
DBA: RALPHS #022
645 W. 9TH ST.
LOS ANGELES, CA 90015
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/13/2020
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