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RALPHS GROCERY CO
RWI90003 Los Angeles County Department of Health Services
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Covered Entity Details
Entity Name
Los Angeles County Department of Health Services
Subdivision Name
Hubert Humphrey Comprehensive Health Center
Type
Ryan White Part A
340B ID
RWI90003
Entity Address
5850 South Main Street
Los Angeles, CA 90003
Grant Number
H89HA00016
Participating Start Date
1/1/2012
Last Recertification Date
2/22/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO
Pharmacy Address
DBA RALPHS #32
3410 W 3RD STREET
LOS ANGELES, CA 90020
Pharmacy Comments
Contract Details
Approval Date
9/6/2012
Contract Begin Date
9/6/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/25/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Amy Gutierrez, Chief Pharmacy Officer, Los Angeles County Department of Health Services
(213) 240-7717
Contract Pharmacy Representative
Kenny Kimball, VP Merchandising
(310) 884-4581
Signed By Date
9/5/2012
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