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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
CH092536AR JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
JWCH PATH CLINIC
Type
HRSA-Funded Health Center
340B ID
CH092536AR
Entity Address
340 N. MADISON
LOS ANGELES, CA 90004-3504
Grant Number
H80CS06673
Participating Start Date
10/1/2020
Last Recertification Date
2/17/2022
Entity Termination Date
4/1/2023
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
7/21/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/27/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
LA County DHS
Rabeah Elbanna, Pharmacy Supervisor I
(213) 288-7717
Signed By Date
7/14/2020
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