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VINCENT LY PHARMACY INCORPORATION
CH092887B Chinatown Service Center
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Covered Entity Details
Entity Name
Chinatown Service Center
Subdivision Name
CSC Community Health Center - San Gabriel
Type
HRSA-Funded Health Center
340B ID
CH092887B
Entity Address
559 W Las Tunas Dr
San Gabriel, CA 91776-1134
Grant Number
H80CS08735
Participating Start Date
4/1/2022
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
VINCENT LY PHARMACY INCORPORATION
Pharmacy Address
DBA 986 PHARMACY
701 S ATLANTIC BLVD STE 168
MONTEREY PARK, CA 91754-3866
Pharmacy Comments
Contract Details
Approval Date
4/3/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter Ng, CEO
(213) 808-1701
Contract Pharmacy Representative
986 Pharmacy
Vincent Ly, Pharmacist
(626) 672-9220
Signed By Date
4/3/2022
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