Contract Pharmacy Details

MARKET PHARMACY
CHC08241-12 MISSION CITY COMMUNITY NETWORK, INC.

Covered Entity Details

Entity Name

MISSION CITY COMMUNITY NETWORK, INC.

Subdivision Name

Mission City Community Network - Victorville

Type

HRSA-Funded Health Center

340B ID

CHC08241-12

Entity Address

15201 11st Street Ste., # 300
Victorville, CA 92395-0735

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

4/13/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Market Pharmacy
ARMEN TATEVOSSIAN, PHARMACIST
(818) 701-7777

Signed By Date

340B Drug Pricing Program Database