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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
CH091037R ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
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Covered Entity Details
Entity Name
ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
Subdivision Name
Leavey Community Clinic
Type
HRSA-Funded Health Center
340B ID
CH091037R
Entity Address
3628 E. Imperial Hwy, Suite 301
Lynwood, CA 90262-2646
Grant Number
H80CS00873
Participating Start Date
10/1/2014
Last Recertification Date
2/10/2025
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
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/3/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James Mangia, CEO
(323) 541-1600 Ext: 4000
Contract Pharmacy Representative
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
10/17/2016
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