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SHALOM COMPOUNDING PHARMACY
CHC08241-00 MISSION CITY COMMUNITY NETWORK
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Covered Entity Details
Entity Name
MISSION CITY COMMUNITY NETWORK
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC08241-00
Entity Address
15206 PARTHENIA STREET
NORTH HILLS, CA 91343
Grant Number
H80CS08241
Participating Start Date
7/1/2000
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SHALOM COMPOUNDING PHARMACY
Pharmacy Address
18000 VENTURA BLVD STE 2
ENCINO, CA 91316-9131
Pharmacy Comments
Contract Details
Approval Date
7/20/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
Imanoel Pharmacy, DBA Sunshine Pharmacy
Eli Seleh, Pharmacist
(310) 666-0514
Signed By Date
7/20/2016
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