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MARKET PHARMACY
CHC08241-08 MISSION CITY COMMUNITY NETWORK, INC.
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Covered Entity Details
Entity Name
MISSION CITY COMMUNITY NETWORK, INC.
Subdivision Name
Mission City Community Network- La Puente
Type
HRSA-Funded Health Center
340B ID
CHC08241-08
Entity Address
1025 Willow Avenue
La Puente, CA 91746
Grant Number
H80CS08241
Participating Start Date
7/1/2016
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
4/10/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
Market Pharmacy
ARMEN TATEVOSSIAN, PHARMACIST
(818) 701-7777
Signed By Date
4/10/2016
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