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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
CH09100A NORTHEAST VALLEY HEALTH CORPORATION
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Covered Entity Details
Entity Name
NORTHEAST VALLEY HEALTH CORPORATION
Subdivision Name
PACOIMA HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH09100A
Entity Address
12756 Van Nuys Blvd
Pacoima, CA 91331-1626
Grant Number
H80CS00139
Participating Start Date
10/1/1997
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
COUNTY OF LOS ANGELES - AUDITOR CONTROLL
Pharmacy Address
313 N FIGUEROA ST STE 1225
HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELES, CA 90012-2602
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kimberly Wyard, Chief Executive Officer
(818) 898-1388 Ext: 41620
Contract Pharmacy Representative
LA County DHS
Rabeah Elbanna, Pharmacy Supervisor I
(213) 288-7717
Signed By Date
1/15/2016
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