Contract Pharmacy Details

COUNTY OF LOS ANGELES - AUDITOR CONTROLL
CHC08241-03 MISSION CITY COMMUNITY NETWORK INC

Covered Entity Details

Entity Name

MISSION CITY COMMUNITY NETWORK INC

Subdivision Name

Mission City Community Network - Pomona - Mobile Clinic

Type

HRSA-Funded Health Center

340B ID

CHC08241-03

Entity Address

845 E Arrow Hwy
Pomona, CA 91767-2535

Grant Number

H80CS08241

Participating Start Date

4/1/2013

Last Recertification Date

2/1/2019

Entity Termination Date

4/1/2019

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

340B Drug Pricing Program Database