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MEDICAL CENTER PHARMACY
CH09489J Venice Family Clinic
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Covered Entity Details
Entity Name
Venice Family Clinic
Subdivision Name
Venice Family Clinic - Inglewood Health Center
Type
HRSA-Funded Health Center
340B ID
CH09489J
Entity Address
1091 S La Brea Ave
Inglewood, CA 90301-3817
Grant Number
H80CS04217
Participating Start Date
12/3/2021
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY
Pharmacy Address
501 E HARDY ST STE 130
INGLEWOOD, CA 90301-4055
Pharmacy Comments
Contract Details
Approval Date
11/30/2021
Contract Begin Date
12/7/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ELIZABETH BENSON FORER, EXECUTIVE DIRECTOR
(310) 664-7901
Contract Pharmacy Representative
Medical Center Pharamcy
JAMES PAI, PHARMACIST
(310) 671-7636
Signed By Date
11/29/2021
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