Contract Pharmacy Details

OWL REXALL DRUG
CHC11402-11 NORTHEAST COMMUNITY CLINIC, INC

Covered Entity Details

Entity Name

NORTHEAST COMMUNITY CLINIC, INC

Subdivision Name

Northeast Community Clinic - Highland Park

Type

HRSA-Funded Health Center

340B ID

CHC11402-11

Entity Address

5420 N Figueroa St
Los Angeles, CA 90042-4118

Grant Number

H80CS12869

Participating Start Date

10/1/2014

Last Recertification Date

2/21/2019

Entity Termination Date

10/1/2019

Pharmacy Details

Pharmacy Name

OWL REXALL DRUG

Pharmacy Address

5634 N FIGUEROA ST
LOS ANGELES, CA 90042

Pharmacy Comments

Contract Details

Approval Date

1/13/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/24/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900

Contract Pharmacy Representative

Allen Cheung, Pic
(323) 254-2851

Signed By Date

1/13/2017

340B Drug Pricing Program Database