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VERNON CENTRAL BOTICA
CHC28985-01 CENTRAL NEIGHBORHOOD HEALTH FOUNDATION
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Covered Entity Details
Entity Name
CENTRAL NEIGHBORHOOD HEALTH FOUNDATION
Subdivision Name
Central Neighborhood Health Foundation
Type
HRSA-Funded Health Center
340B ID
CHC28985-01
Entity Address
2707 South Central Avenue
Los Angeles, CA 90011-5527
Grant Number
H80CS28985
Participating Start Date
1/1/2016
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
VERNON CENTRAL BOTICA
Pharmacy Address
4375 S CENTRAL AVE
LOS ANGELES, CA 90011
Pharmacy Comments
Contract Details
Approval Date
10/21/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Fatima N. Jahangir, COO
(310) 962-8970
Contract Pharmacy Representative
Wang Lee, PIC
(323) 231-8892
Signed By Date
10/21/2016
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