Contract Pharmacy Details

RALPHS GROCERY CO
FQHCLA81B NORTHEAST COMMUNITY CLINIC, INC

Covered Entity Details

Entity Name

NORTHEAST COMMUNITY CLINIC, INC

Subdivision Name

Northeast Community Clinic - Community Medical Alliance

Type

Health Center Program Look-Alike

340B ID

FQHCLA81B

Entity Address

4129 E Gage Ave
Bell, CA 90201

Grant Number

LALCS00033

Participating Start Date

4/1/2011

Last Recertification Date

3/4/2025

Pharmacy Details

Pharmacy Name

RALPHS GROCERY CO

Pharmacy Address

DBA RALPHS #295
8626 FIRESTONE BLVD
DOWNEY, CA 90241

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/19/2022
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

7/15/2020

340B Drug Pricing Program Database