340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
EVERGREEN RX INC
FQHCLA322 COMPLETE CARE COMMUNITY HEALTH CENTER, INC.
Print
Covered Entity Details
Entity Name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
COMPLETE CARE COMMUNITY HEALTH CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA322
Entity Address
2928 E Cesar E. Chavez Ave
Los Angeles, CA 90033-3110
Grant Number
LALCS00153
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2015
Entity Termination Date
1/1/2016
Pharmacy Details
Pharmacy Name
EVERGREEN RX INC
Pharmacy Address
DBA MEDICO PHARMACY
11779 SANTA MONICA BLVD
LOS ANGELES, CA 90025
Pharmacy Comments
Contract Details
Approval Date
7/1/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Yury Akopyan, CEO
(562) 806-7545
Contract Pharmacy Representative
Evergreen Rx, Inc DBA Medico Pharmacy
Afshin Azizisefat, PIC
(310) 444-9011
Signed By Date
7/1/2015
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session