Contract Pharmacy Details

RALPHS GROCERY CO.
CHC11402-09 NORTHEAST COMMUNITY CLINIC, INC

Covered Entity Details

Entity Name

NORTHEAST COMMUNITY CLINIC, INC

Subdivision Name

Wilmington Family Health Center

Type

HRSA-Funded Health Center

340B ID

CHC11402-09

Entity Address

200 E Anaheim St
Wilmington, CA 90744-4516

Grant Number

H80CS12869

Participating Start Date

1/1/2010

Last Recertification Date

3/4/2025

Pharmacy Details

Pharmacy Name

RALPHS GROCERY CO.

Pharmacy Address

DBA: RALPHS #022
645 W. 9TH ST.
LOS ANGELES, CA 90015

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

1/5/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

6/5/2017

340B Drug Pricing Program Database