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EXPRESS PHARMACY
FQ114E MISSION CITY COMMUNITY NETWORK INC
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Covered Entity Details
Entity Name
MISSION CITY COMMUNITY NETWORK INC
Subdivision Name
Mission City Community Network-Orange Grove
Type
Health Center Program Look-Alike
340B ID
FQ114E
Entity Address
1818 N Orange Grove Ave STE 205
Pomona, CA 91767-3028
Grant Number
LALCS00029
Participating Start Date
4/1/2013
Last Recertification Date
2/17/2017
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
EXPRESS PHARMACY
Pharmacy Address
EXPRESS PHARMACY
752 E ARROW HWY
POMONA, CA 91767
Pharmacy Comments
Contract Details
Approval Date
10/6/2014
Contract Begin Date
1/1/2015
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
JACK VASOYA, PHARMACIST
(909) 398-1289
Signed By Date
10/6/2014
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