Contract Pharmacy Details

OASIS PHARMACY
FQ114A MISSION CITY COMMUNITY NETWORK INC

Covered Entity Details

Entity Name

MISSION CITY COMMUNITY NETWORK INC

Subdivision Name

Mission City Community Network - Hollywood

Type

Health Center Program Look-Alike

340B ID

FQ114A

Entity Address

4842 Hollywood Blvd
Los Angeles, CA 90027

Grant Number

LALCS00029

Participating Start Date

7/1/2012

Last Recertification Date

2/17/2017

Entity Termination Date

4/1/2017

Pharmacy Details

Pharmacy Name

OASIS PHARMACY

Pharmacy Address

SUN OASIS MEDICAL, INC
15433 W SAND STREET
SUITE 102
VICTORVILLE, CA 92392-2903

Pharmacy Comments

Contract Details

Approval Date

4/14/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/15/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Nik Gupta, CEO
(818) 895-3100

Contract Pharmacy Representative

Pauline Tilton, Owner
(760) 241-4080

Signed By Date

4/14/2015

340B Drug Pricing Program Database