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PRIME PHARMACY SERVICES, INC.
CHC26619-00 KEDREN COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
KEDREN COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Kedren Community Care Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26619-00
Entity Address
4211 Avalon Blvd. Suite A
Los Angeles, CA 90011-5622
Grant Number
H80CS26619
Participating Start Date
7/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
PRIME PHARMACY SERVICES, INC.
Pharmacy Address
4211 SOUTH AVALON BLVD.,
LOS ANGELES, CA 90011
Pharmacy Comments
Contract Details
Approval Date
1/10/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARIA FE V MARFORI, CFO
(323) 802-0308
Contract Pharmacy Representative
Prime Pharmacy
Bashir Hamadani, Pharmacist
(323) 802-0306
Signed By Date
1/10/2025
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