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THE MEDICINE SHOPPE
CHC08241-12 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 - 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
THE MEDICINE SHOPPE
Pharmacy Address
15555 MAIN STREET #D8
HESPERIA, CA 92345-3423
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
HUSAM IBRAHIM HASAN ABUKHIRAN, PHARMACIST
(760) 948-1000
Signed By Date
10/17/2016
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