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MARKET PHARMACY
CHC28368-00 SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Subdivision Name
Southern California Medical Center (EM)
Type
HRSA-Funded Health Center
340B ID
CHC28368-00
Entity Address
12100 VALLEY BLVD
EL MONTE, CA 91732-3100
Grant Number
H80CS28368
Participating Start Date
10/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MARKET PHARMACY
Pharmacy Address
9250 RESEDA BLVD STE 2C
NORTHRIDGE, CA 91324-5215
Pharmacy Comments
Contract Details
Approval Date
4/12/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sheila Busheri, CEO
(818) 324-3780
Contract Pharmacy Representative
Market Pharmacy
ARMEN TATEVOSSIAN, PHARMACIST
(818) 701-7777
Signed By Date
4/12/2017
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