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COUNTY OF LOS ANGELES
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
COUNTY OF LOS ANGELES
Pharmacy Address
MARTIN LUTHER KING JR. MACC
OUTPATIENT PHARMACY
12021 S. WILMINGTON AV, RM 1086
LOS ANGELES, CA 90059
Pharmacy Comments
Contract Details
Approval Date
2/20/2013
Contract Begin Date
4/1/2013
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
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Contract Pharmacy Representative
Amy Gutierrez, Chief Pharmacy Officer, Los Angeles County Department of Health Services
(213) 240-7717
Signed By Date
1/9/2013
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