Contract Pharmacy Details

BRAVO PHARMACY
CHC10609-01 UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC.

Covered Entity Details

Entity Name

UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC.

Subdivision Name

Fremont Wellness Center

Type

HRSA-Funded Health Center

340B ID

CHC10609-01

Entity Address

7821 S. Avalon Blvd
Los Angeles, CA 90003-2348

Grant Number

H80CS10609

Participating Start Date

4/1/2015

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

BRAVO PHARMACY

Pharmacy Address

7316 S. COMPTON AVE
LOS ANGELES, CA 90001-2532

Pharmacy Comments

Contract Details

Approval Date

1/22/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

SANG KIM, CEO
(323) 586-9828

Signed By Date

340B Drug Pricing Program Database