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986 PHARMACY #8011
CHC28368-00 SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Subdivision Name
Southern California Medical Center (EM)
Type
HRSA-Funded Health Center
340B ID
CHC28368-00
Entity Address
12100 VALLEY BLVD
EL MONTE, CA 91732-3100
Grant Number
H80CS28368
Participating Start Date
10/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
986 PHARMACY #8011
Pharmacy Address
GALACTIC HEALTHCARE INC
1203 N AVALON BLVD STE A
WILMINGTON, CA 90744
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Abbas Hosseini, System Manager
(818) 421-1035
Contract Pharmacy Representative
ROYALTY PHARMACY
Brian Garner, Owner
(909) 624-1611
Signed By Date
10/10/2023
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