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MISSION CITY COMMUNITY NETWORK, INC.-
CHC08241-17 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 - Northridge
Type
HRSA-Funded Health Center
340B ID
CHC08241-17
Entity Address
8363 Reseda Blvd.
Northridge, CA 91324-4623
Grant Number
H80CS08241
Participating Start Date
4/1/2017
Last Recertification Date
2/1/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
MISSION CITY COMMUNITY NETWORK, INC.-
Pharmacy Address
COMMUNITY PHARMACY
15206 PARTHENIA STREET
NORTH HILLS, CA 91343-5305
Pharmacy Comments
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
IRIS BAO-NGOC NGUYEN, PHARMACIST
(818) 895-3100 Ext: 650
Signed By Date
4/4/2017
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