Contract Pharmacy Details

GKN RX INC
CH0919630 LIVINGSTON COMMUNITY HEALTH

Covered Entity Details

Entity Name

LIVINGSTON COMMUNITY HEALTH

Subdivision Name

LIVINGSTON HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH0919630

Entity Address

1140 MAIN STREET
LIVINGSTON, CA 95334

Grant Number

H80CS02588

Participating Start Date

1/1/2005

Last Recertification Date

2/5/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

GKN RX INC

Pharmacy Address

1471 B ST STE R
LIVINGSTON, CA 95334-1426

Pharmacy Comments

Contract Details

Approval Date

4/17/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/16/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Leslie Abasta-Cummings, CEO
(209) 850-3545

Contract Pharmacy Representative

Pratap K. Anne, Director
(209) 398-2035

Signed By Date

4/17/2017