Contract Pharmacy Details

COMMUNITY PHARMACY GROUP, INC.
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

COMMUNITY PHARMACY GROUP, INC.

Pharmacy Address

DBA GLESENER PHARMACY
321 N. CITRUS AVE.
COVINA, CA 91723

Pharmacy Comments

Contract Details

Approval Date

7/15/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2017

Contacts

Covered Entity Signing Official

Nik Gupta, CEO
(818) 895-3100

Contract Pharmacy Representative

Laura Scarbrough, COO
(626) 966-3691

Signed By Date

7/15/2016

340B Drug Pricing Program Database