Contract Pharmacy Details

ORANGE GROVE PHARMACY
FQ114E MISSION CITY COMMUNITY NETWORK INC

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

ORANGE GROVE PHARMACY

Pharmacy Address

1770 N ORANGE GROVE AVE STE 100
POMONA, CA 91767-3027

Pharmacy Comments

Contract Details

Approval Date

10/14/2014

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

Joyce Lin, Owner
(909) 623-6429

Signed By Date

10/14/2014

340B Drug Pricing Program Database