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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
CHC08241-01 MISSION CITY COMMUNITY NETWORK INC
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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
COUNTY OF LOS ANGELES - AUDITOR CONTROLL
Pharmacy Address
313 N FIGUEROA ST STE 1225
HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELES, CA 90012-2602
Pharmacy Comments
Contract Details
Approval Date
1/13/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/11/2018
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
1/13/2016
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