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LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
FQHCLA81L NORTHEAST COMMUNITY CLINIC, INC
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Covered Entity Details
Entity Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic - Elizabeth Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA81L
Entity Address
2822 EAST FLORENCE AVENUE
HUNTINGTON PARK, CA 90255-5749
Grant Number
LALCS00033
Participating Start Date
7/1/2013
Last Recertification Date
3/9/2016
Entity Termination Date
4/1/2017
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
4/8/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Contract Pharmacy Representative
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
4/8/2015
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