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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
CH09311BB AltaMed Health Services Corporation
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Covered Entity Details
Entity Name
AltaMed Health Services Corporation
Subdivision Name
AltaMed Dental Group - Westlake, 3rd Street
Type
HRSA-Funded Health Center
340B ID
CH09311BB
Entity Address
2100 W. 3rd Street, Suite #220
Los Angeles, CA 90057-1993
Grant Number
H80CS00142
Participating Start Date
10/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
COUNTY OF LOS ANGELES - AUDITOR CONTROLL
Pharmacy Address
313 N FIGUEROA ST STE 1225
HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELES, CA 90012-2602
Pharmacy Comments
Contract Details
Approval Date
5/19/2020
Contract Begin Date
5/19/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose Esparza, Sr. VP, Finance & CFO
(323) 889-7320
Contract Pharmacy Representative
LA County DHS
Rabeah Elbanna, Pharmacy Supervisor I
(213) 288-7717
Signed By Date
5/19/2020
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