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RALPHS GROCERY CO
FQHCLA81C NORTHEAST COMMUNITY CLINIC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC
Subdivision Name
NECC - GAGE HEALTH CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA81C
Entity Address
2975 ZOE AVE
Huntington Park, CA 90255
Grant Number
LALCS00033
Participating Start Date
4/1/2011
Last Recertification Date
2/26/2024
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO
Pharmacy Address
DBA RALPHS STORE #21
1745 GARFIELD AVENUE
SOUTH PASADENA, CA 91030
Pharmacy Comments
Contract Details
Approval Date
6/5/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/19/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
6/5/2017
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