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BIG 1 PHARMACY LA
CH09316E ARROYO VISTA FAMILY HEALTH FOUNDATION
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Covered Entity Details
Entity Name
ARROYO VISTA FAMILY HEALTH FOUNDATION
Subdivision Name
ARROYO VISTA FAMILY HEALTH CENTER ~ El Sereno Huntington Dr.
Type
HRSA-Funded Health Center
340B ID
CH09316E
Entity Address
4837 Huntington Dr N
Los Angeles, CA 90032-1981
Grant Number
H80CS00374
Participating Start Date
4/1/2013
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
BIG 1 PHARMACY LA
Pharmacy Address
656 N BROADWAY
LOS ANGELES, CA 90012
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lorraine J. Estradas, CEO
(323) 254-5291 Ext: 3201
Contract Pharmacy Representative
Steven Chin, Pharmacist-in-Charge
(626) 281-2186
Signed By Date
4/15/2014
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