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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
FQHCLA81Q NORTHEAST COMMUNITY CLINIC, INC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA81Q
Entity Address
1414 SOUTH GRAND AVENUE; SUITE 380
LOS ANGELES, CA 90015
Grant Number
LALCS00033
Participating Start Date
10/1/2016
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
COUNTY OF LOS ANGELES - AUDITOR CONTROLL
Pharmacy Address
313 N FIGUEROA ST STE 1225
HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELES, CA 90012-2602
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
LA County DHS
Rabeah Elbanna, Pharmacy Supervisor I
(213) 288-7717
Signed By Date
4/6/2023
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