Contract Pharmacy Details

THE MEDICINE CABINET
CHC24202-00 WILMINGTON COMMUNITY CLINIC

Covered Entity Details

Entity Name

WILMINGTON COMMUNITY CLINIC

Subdivision Name

Mary B. Henry Community Clinic

Type

HRSA-Funded Health Center

340B ID

CHC24202-00

Entity Address

10901 S. Vermont Ave.
Los Angeles, CA 90044-3015

Grant Number

H80CS24202

Participating Start Date

1/1/2013

Last Recertification Date

2/25/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

THE MEDICINE CABINET

Pharmacy Address

228 E ANAHEIM ST
WILMINGTON, CA 90744

Pharmacy Comments

Contract Details

Approval Date

3/15/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Dolores Bonilla Clay, CEO
(310) 549-9717

Contract Pharmacy Representative

Sabrina Chau, Pharmacist
(310) 513-9214

Signed By Date

2/14/2013