Contract Pharmacy Details

COUNTY OF LOS ANGELES - AUDITOR CONTROLL
FQHCLA308A Universal Community Health Center

Covered Entity Details

Entity Name

Universal Community Health Center

Subdivision Name

Universal Community Health Center - San Pedro St.

Type

Health Center Program Look-Alike

340B ID

FQHCLA308A

Entity Address

2801 S. San Pedro St.
Los Angeles, CA 90011

Grant Number

H80CS30722

Participating Start Date

10/1/2016

Last Recertification Date

1/30/2019

Entity Termination Date

7/1/2019

Pharmacy Details

Pharmacy Name

COUNTY OF LOS ANGELES - AUDITOR CONTROLL

Pharmacy Address

313 N FIGUEROA ST STE 1225
HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELES, CA 90012-2602

Pharmacy Comments

Contract Details

Approval Date

7/6/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Olive View UCLA Medical Center
Nadrine Balady-Bouziane, Pharm.D.
(747) 210-3059

Signed By Date

340B Drug Pricing Program Database