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LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
FQHCLA81F NORTHEAST COMMUNITY CLINIC, INC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic - California Family Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA81F
Entity Address
1414 Grand Avenue STE 200
Los Angeles, CA 90015-3072
Grant Number
LALCS00033
Participating Start Date
4/1/2011
Last Recertification Date
2/21/2019
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
Pharmacy Address
313 N FIGUEROA STREET
SUITE 1225
LOS ANGELES, CA 90012
Pharmacy Comments
Contract Details
Approval Date
4/8/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
4/8/2015
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