340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OLIVE BRANCH PHARMACY
FQHCLA308 Universal Community Health Center
Print
Covered Entity Details
Entity Name
Universal Community Health Center
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA308
Entity Address
1005 E. Washington Blvd.
Suite A
Los Angeles, CA 90021
Grant Number
H80CS30722
Participating Start Date
4/1/2013
Last Recertification Date
1/30/2019
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
OLIVE BRANCH PHARMACY
Pharmacy Address
OLIVE BRANCH PHARMACY
2070 S CENTRAL AVE
LOS ANGELES, CA 90011
Pharmacy Comments
Contract Details
Approval Date
7/1/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Agustin Jaime Lara, Chief Executive Officer
(213) 745-3636
Contract Pharmacy Representative
Olive Branch Pharmacy
redda alhousayni, pharmacist
(213) 536-4888
Signed By Date
7/1/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session