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MED CENTER PHARMACY INC
CH091000 NORTHEAST VALLEY HEALTH CORPORATION
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Covered Entity Details
Entity Name
NORTHEAST VALLEY HEALTH CORPORATION
Subdivision Name
NORTHEAST VALLEY HEALTH CORPORATION
Type
HRSA-Funded Health Center
340B ID
CH091000
Entity Address
1172 N Maclay Ave
San Fernando, CA 91340-1328
Grant Number
H80CS00139
Participating Start Date
4/1/1995
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MED CENTER PHARMACY INC
Pharmacy Address
MED CENTER PHARMACY INC
14624 SHERMAN WAY STE 104
VAN NUYS, CA 91405-2287
Pharmacy Comments
Contract Details
Approval Date
4/9/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kimberly Wyard, Chief Executive Officer
(818) 898-1388 Ext: 41620
Contract Pharmacy Representative
Med Center Pharmacy Inc
Maria Spichkin, Pharmacy Owner/Pharmacist in Charge
(818) 785-4944
Signed By Date
4/9/2021
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