Contract Pharmacy Details

IMANOEL PHARMACY
CHC08241-19 MISSION CITY COMMUNITY NETWORK, INC.

Covered Entity Details

Entity Name

MISSION CITY COMMUNITY NETWORK, INC.

Subdivision Name

Mission City Community Network - Hollywood

Type

HRSA-Funded Health Center

340B ID

CHC08241-19

Entity Address

4842 Hollywood Blvd
Los Angeles, CA 90027

Grant Number

H80CS08241

Participating Start Date

4/1/2017

Last Recertification Date

Entity Termination Date

4/1/2018

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

1/11/2017

Contract Begin Date

4/1/2017

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

340B Drug Pricing Program Database