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LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
CHC08241-09 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 - Mobile-San Gabriel Valley
Type
HRSA-Funded Health Center
340B ID
CHC08241-09
Entity Address
1818 N ORANGE GROVE AVE
POMONA, CA 91767-3028
Grant Number
H80CS08241
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
Pharmacy Address
313 N FIGUEROA STREET
SUITE 1225
LOS ANGELES, CA 90012
Pharmacy Comments
Contract Details
Approval Date
4/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059
Signed By Date
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