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LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
FQHCLA308 Universal Community Health Center
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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
LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
Pharmacy Address
313 N FIGUEROA STREET
SUITE 1225
LOS ANGELES, CA 90012
Pharmacy Comments
Contract Details
Approval Date
4/3/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Agustin Jaime Lara, Chief Executive Officer
(213) 745-3636
Contract Pharmacy Representative
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
4/3/2015
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