Contract Pharmacy Details

MED-CARE RX PHARMACY
FQHCLA321 Southern California Medical Center

Covered Entity Details

Entity Name

Southern California Medical Center

Subdivision Name

Southern California Medical Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA321

Entity Address

8825 Whittier Blvd.
Pico Rivera, CA 90660-2600

Grant Number

LALCS00144

Participating Start Date

1/1/2014

Last Recertification Date

2/11/2019

Entity Termination Date

7/1/2019

Pharmacy Details

Pharmacy Name

MED-CARE RX PHARMACY

Pharmacy Address

14550 HAYNES ST SUITE #200A
VAN NUYS, CA 91411

Pharmacy Comments

Contract Details

Approval Date

4/13/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Sheila Busheri, CEO
(818) 324-3780

Contract Pharmacy Representative

Mohammad Hassani, PIC/President
(818) 650-6799

Signed By Date

4/13/2016