Contract Pharmacy Details

MEMORIAL MEDICAL CTR 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

MEMORIAL MEDICAL CTR PHARMACY

Pharmacy Address

9806 VENICE BLVD
CULVER CITY, CA 90232

Pharmacy Comments

Contract Details

Approval Date

4/6/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/23/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Nik Gupta, CEO
(818) 895-3100

Contract Pharmacy Representative

SONNY KIM, PHARMACIST
(310) 837-6158

Signed By Date

4/6/2017

340B Drug Pricing Program Database