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HIGH DESERT HEALTHSYSTEM
FP93535 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
Lake Los Angeles Clinic
Type
Family Planning (Title X only)
340B ID
FP93535
Entity Address
16921 E. Avenue O, Space G
Lake Los Angeles, CA 93591
Grant Number
FPHPA096061
Participating Start Date
1/1/2013
Last Recertification Date
5/17/2016
Entity Termination Date
1/1/2017
Pharmacy Details
Pharmacy Name
HIGH DESERT HEALTHSYSTEM
Pharmacy Address
PHARMACY
44900 N. 60TH WEST
LANCASTER, CA 93536
Pharmacy Comments
01/16/2013 DEA register normalization removed address line 1 (was MAIN BUILDING ROOM D-26)
Contract Details
Approval Date
1/16/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Beryl Brooks, Administrator
(661) 471-4200
Contract Pharmacy Representative
High Desert Regional Health Center
Romina Panoussi, Chief of Pharmacy
(661) 471-4107
Signed By Date
1/3/2013
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