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RALPHS GROCERY CO.
FQHCLA81 NORTHEAST COMMUNITY CLINIC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA81
Entity Address
2550 W MAIN STREET, SUITE 301
ALHAMBRA, CA 91801
Grant Number
LALCS00033
Participating Start Date
4/1/2011
Last Recertification Date
2/21/2017
Entity Termination Date
7/1/2017
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
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/15/2014
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