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OLIVE BRANCH PHARMACY
CHC30722-01 UNIVERSAL COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
UNIVERSAL COMMUNITY HEALTH CENTER
Subdivision Name
Universal Community Health Center - San Pedro
Type
HRSA-Funded Health Center
340B ID
CHC30722-01
Entity Address
2801 S. San Pedro St.
Los Angeles, CA 90011-2023
Grant Number
H80CS30722
Participating Start Date
5/17/2019
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OLIVE BRANCH PHARMACY
Pharmacy Address
OLIVE BRANCH PHARMACY
2070 S CENTRAL AVE
LOS ANGELES, CA 90011
Pharmacy Comments
Contract Details
Approval Date
4/14/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Edgar Alexander Chavez, CEO
(323) 485-0467
Contract Pharmacy Representative
Olive Branch Pharmacy
Redda Alhoussayni, President
(323) 273-7400
Signed By Date
4/14/2022
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