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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
CH092536AV JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Wesley Health Centers-- Vermont Annex
Type
HRSA-Funded Health Center
340B ID
CH092536AV
Entity Address
964 Vermont Ave.
Los Angeles, CA 90029-3529
Grant Number
H80CS06673
Participating Start Date
10/1/2020
Last Recertification Date
2/19/2025
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
7/16/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/2/2021
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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