Contract Pharmacy Details

LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
CHC08241-01 MISSION CITY COMMUNITY NETWORK INC

Covered Entity Details

Entity Name

MISSION CITY COMMUNITY NETWORK INC

Subdivision Name

MCCN- Inglewood

Type

HRSA-Funded Health Center

340B ID

CHC08241-01

Entity Address

501 E Hardy St STE 110
Inglewood, CA 90301-4015

Grant Number

H80CS08241

Participating Start Date

4/1/2013

Last Recertification Date

2/12/2021

Entity Termination Date

4/1/2022

Pharmacy Details

Pharmacy Name

LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY

Pharmacy Address

313 N FIGUEROA STREET
SUITE 1225
LOS ANGELES, CA 90012

Pharmacy Comments

Contract Details

Approval Date

10/25/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/15/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Nik Gupta, CEO
(818) 895-3100

Contract Pharmacy Representative

Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059

Signed By Date

10/25/2015

340B Drug Pricing Program Database