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MANCHESTER PROFESSIONAL PHARMACY
CHC10608-05 CENTRAL CITY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
CENTRAL CITY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Central City Community Health Center - SLA
Type
HRSA-Funded Health Center
340B ID
CHC10608-05
Entity Address
5970 S.Central Ave
Los Angeles, CA 90001-1100
Grant Number
H80CS10608
Participating Start Date
1/1/2015
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
MANCHESTER PROFESSIONAL PHARMACY
Pharmacy Address
NO APARTMENT
600 W MANCHESTER AVE
LOS ANGELES, CA 90044-5770
Pharmacy Comments
Contract Details
Approval Date
1/12/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gilbert R. Varela, Chief Executive Officer
(323) 724-0019
Contract Pharmacy Representative
Irwin Sitkoff, Pharmacist
(323) 750-3523
Signed By Date
1/12/2016
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