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LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
CH09311AG ALTAMED HEALTH SERVICES CORPORATION
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Covered Entity Details
Entity Name
ALTAMED HEALTH SERVICES CORPORATION
Subdivision Name
AltaMed Medical Group at Hollywood Presbyterian Medical Center
Type
HRSA-Funded Health Center
340B ID
CH09311AG
Entity Address
1300 North Vermont Avenue, Patient Tower, First Floor
Los Angeles, CA 90027
Grant Number
H80CS00142
Participating Start Date
1/1/2014
Last Recertification Date
2/10/2020
Entity Termination Date
4/1/2020
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
4/10/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jose Esparza, Sr. VP, Finance & CFO
(323) 889-7320
Contract Pharmacy Representative
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
4/10/2015
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