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HI-DESERT COMPOUNDING PHARMACY INC
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
HI-DESERT COMPOUNDING PHARMACY INC
Pharmacy Address
DBA PRESCRIPTION SHOPPE
15247 ELEVENTH ST STE 1000
VICTORVILLE, CA 92395-3727
Pharmacy Comments
Contract Details
Approval Date
4/3/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
LOUIS EDWARD LONGORIA, PHARMACIST
(760) 245-7761
Signed By Date
4/3/2017
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