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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
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
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
1/13/2016
Contract Begin Date
4/1/2016
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
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
1/13/2016
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