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IMANOEL PHARMACY
CHC08241-16 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 - Culver City
Type
HRSA-Funded Health Center
340B ID
CHC08241-16
Entity Address
9808 Venice Blvd
Culver City, CA 90232
Grant Number
H80CS08241
Participating Start Date
1/1/2017
Last Recertification Date
2/13/2018
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
IMANOEL PHARMACY
Pharmacy Address
DBA SUNSHINE PHARMACY
357 N FAIRFAX AVE
LOS ANGELES, CA 90036
Pharmacy Comments
Contract Details
Approval Date
10/24/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/3/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Imanoel Pharmacy, DBA Sunshine Pharmacy
Eli Seleh, Pharmacist
(310) 666-0514
Signed By Date
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