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CRENSHAW PHARMACY INC
CHC08241-18 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 - Prairie
Type
HRSA-Funded Health Center
340B ID
CHC08241-18
Entity Address
301 N Prairie Ave STE 311
Inglewood, CA 90301-4510
Grant Number
H80CS08241
Participating Start Date
4/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CRENSHAW PHARMACY INC
Pharmacy Address
DBA CRENSHAW PHARMACY
3631 CRENSHAW BLVD #111
LOS ANGELES, CA 90016
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
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
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
Crenshaw Pharmacy
KOHANCHI NASTARAN ESTHER, PHARMACIST
(323) 732-5555
Signed By Date
1/17/2017
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